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2型糖尿病患者视网膜病变与血浆氧化三甲胺水平的相关性分析

Correlation between retinopathy and plasma trimethylamine-N-oxide level in patients with type 2 diabetes mellitus

    摘要
  • 摘要:
      目的  探讨血浆氧化三甲胺（TMAO）水平与2型糖尿病（T2DM）患者糖尿病视网膜病变（DR）的关系。
      方法  选取102例T2DM患者，根据有无DR和DR分期标准将患者分为无DR（NDR）组38例、非增殖性DR（NPDR）组35例、增殖性DR（PDR）组29例，另选取40名同期健康体检者作为对照组。采用同位素稀释液相色谱-串联质谱（LC-MS/MS）法检测4组血浆TMAO浓度，比较4组一般资料和实验室指标，分析血浆TMAO浓度与各临床参数的相关性，采用多因素Logistic回归分析筛选DR的主要危险因素，并采用受试者工作特征（ROC）曲线分析血浆TMAO诊断DR的效能。
      结果  PDR组的糖尿病病程长于NDR组、NPDR组，差异有统计学意义（P < 0.05）。4组空腹血糖（FPG）、糖化血红蛋白（HbA1c）、C反应蛋白（CRP）和TMAO水平比较，差异有统计学意义（P < 0.05）。Spearman相关分析显示，TMAO与糖尿病病程、FPG、HbA1c、CRP呈显著正相关（P < 0.05）。Logistic回归分析显示，糖尿病病程长和FPG、HbA1c、CRP、TMAO水平高均是DR的危险因素（P < 0.05）。ROC曲线分析显示，TMAO诊断DR的曲线下面积（AUC）为0.833，糖尿病病程、FPG、HbA1c、CRP联合诊断DR的AUC为0.802，糖尿病病程、FPG、HbA1c、CRP、TMAO联合诊断DR的AUC为0.879。
      结论  血浆TMAO水平升高与T2DM患者DR的发生及其严重程度有关，是DR的主要危险因素之一，TMAO联合糖尿病病程、FPG、HbA1c、CRP对DR有较高的诊断效能。

     

    Abstract:
      Objective  To explore the correlation between plasma trimethylamine-N-oxide(TMAO) level and diabetic retinopathy (DR) in patients with type 2 diabetes mellitus(T2DM).
      Methods  A total of 102 patients with T2DM were selected and divided into non-diabetic retinopathy (NDR) group (n=38), non-proliferative DR(NPDR) group (n=35) and proliferative DR(PDR) group (n=29) according to presence of DR and its clinical diagnostic criteria for staging. Another 40 healthy persons with physical examinations were chosen as control group. Plasma TMAO concentration was determined by stable isotope dilution liquid chromatography tandem mass spectrometry(LC-MS/MS). The general data and laboratory indexes of the four groups were compared, and the correlation between plasma TMAO concentration and clinical parameters was analyzed. Multivariate Logistic regression analysis was used to screen the main risk factors of DR. Receiver operating curve (ROC) was used to analyze the efficacy of plasma TMAO concentration in the diagnosis of DR.
      Results  The duration of diabetes in the PDR group was significantly longer than that in the NDR group and NPDR group (P < 0.05). The levels of fasting blood glucose (FPG), glycosylated hemoglobin (HbA1c), C-reactive protein (CRP) and TMAO in four groups showed significant differences (P < 0.05). Spearman correlation analysis showed that TMAO was positively correlated with course of diabetes, higher levels of FPG, HbA1c and CRP (P < 0.05). Logistic regression analysis showed that long course of diabetes, and higher levels of FPG, HbA1c, CRP and TMAO were the main risk factors of DR (P < 0.05). ROC curve analysis showed that the area under curve (AUC) of DR diagnosed by TMAO alone was 0.833, was 0.802 by course of diabetes and detection of FPG, HbA1c and CRP in combination, and was 0.879 by course of diabetes and detection of FPG, HbA1c, TMAO and CRP.
      Conclusion  Elevated plasma TMAO level, one of the main risk factors of DR, is related to the occurrence and severity of DR in T2DM patients, and combination of course of diabetes, TMAO, FPG, HbA1c, CRP has a high accuracy in the diagnosis of DR.

     

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