發(fā)布時間：2018-04-19 22:26

  本文選題：糖尿病微血管病變 + 糖尿病視網(wǎng)膜病變�。� 參考：《揚州大學》2017年碩士論文

【摘要】：背景/目的:糖尿病微血管病變涉及糖尿病周圍神經(jīng)病變(diabetic peripheral neuropathy,DPN)、糖尿病視網(wǎng)膜病變(diabetic retinopathy,DR)和糖尿病腎病(diabetic nephropathy,DN),其中DR與成人非創(chuàng)傷性致盲密切相關(guān),是糖尿病最常見的并發(fā)癥之一。DR為不可逆轉(zhuǎn)改變,對其進行早發(fā)現(xiàn)、早診斷、早治療極其重要。目前對于DR診斷主要有彩色眼底照相、眼底熒光素血管造影、光相干斷層掃描等,尚無有效的早期診斷DR的生物學指標。國內(nèi)外已有大量研究顯示神經(jīng)元特異性烯醇化酶(neuron-specific enolase,NSE)作為DPN的獨立危險因素,可能成為診斷早期DPN的生物學指標。國外也有研究報道NSE水平與糖尿病患者視網(wǎng)膜病變密切相關(guān),但國內(nèi)尚無此報道。為此,本研究探討血清NSE水平與DR的相關(guān)性,試圖為早期臨床診斷提供參考依據(jù)。方法:選取2015年9月～2016年6月在揚州大學臨床醫(yī)院內(nèi)分泌科和眼科住院的1型和2型糖尿病患者137例,其中男性87例,女性50例。所有患者均進行彩色眼底照相檢查,根據(jù)檢查結(jié)果分為兩組:1、糖尿病視網(wǎng)膜病變組(DR組),共110例,其中男性74例,女性36例,平均年齡(55.18± 13.73)歲;2、無糖尿病視網(wǎng)膜病變糖尿病組(NDR組),共27例,其中男性13例,女性14例,平均年齡(56.70± 10.07)歲。分別收集研究對象的基本信息:性別、年齡、病程、體重指數(shù)(BMI)、收縮壓(SBP)、舒張壓(DBP),采集靜脈血標本,測定NSE、糖化血紅蛋白(HBA1c)、尿微量白蛋白(UMA)、空腹血糖(FBG)、血尿素氮(BUN)、血肌酐(Scr)、甘油三脂(TG)、總膽固醇(TC)、高密度脂蛋白膽固醇(HDL-C)、低密度脂蛋白膽固醇(LDL-C)指標。所得數(shù)據(jù)應用SPSS21.0和Medcalc(v15.6)統(tǒng)計軟件處理。結(jié)果:DR組(n=110例)與NDR組(n=27例)在性別、年齡、病程、BMI、HBA1c、UMA、FBG、BUN、Scr、TG、TC、HDL-C、LDL-C 無顯著差異(P0.05)。NDR 組與DR組比較:血清NSE水平顯著升高,舒張壓水平下降,均有統(tǒng)計學差異(P0.05)。排除性別、年齡、病程、糖代謝指標等混雜因素影響后,二分類Logistic回歸分析顯示NSE水平仍與DR密切相關(guān)(OR=1.248,95%CI:1.070～1.457,P=0.005)。以血清NSE水平區(qū)分糖尿病患者是否有DR的Cutoff值是12.31 μmol/L,其診斷靈敏度為69.09%,特異性為59.26%。結(jié)論:DR患者NSE水平顯著升高,可能是DR的獨立預測因子,且可能是DR潛在生物學標志,血清NSE水平檢測可作為DR預測、早期診斷的方法之一。
[Abstract]:Background / objective: diabetic microangiopathy is involved in diabetic peripheral neuropathy (peripheral), diabetic retinopathy (peripheral) and diabetic nephropathy (DN), in which Dr is closely related to adult non-traumatic blindness. Dr is one of the most common complications of diabetes. At present, color fundus photography, fundus fluorescein angiography, optical coherence tomography and so on are the main diagnostic methods for Dr. There is no effective biological index for early diagnosis of Dr. A large number of studies have shown that neuron-specific enolase (NSE) as an independent risk factor for DPN may become a biological index for the diagnosis of early DPN. There are also reports that NSE level is closely related to diabetic retinopathy, but there is no such report in China. Therefore, this study was to investigate the correlation between serum NSE level and Dr in order to provide reference for early clinical diagnosis. Methods: 137 patients with type 1 and type 2 diabetes were selected from September 2015 to June 2016 in Department of Endocrinology and Ophthalmology, Yangzhou University Clinical Hospital, including 87 males and 50 females. All the patients were examined by color fundus photography. According to the results of the examination, they were divided into two groups: one group was divided into two groups: the diabetic retinopathy group (Dr group), the Dr group (n = 110), the male group (n = 74) and the female group (n = 36). The mean age was 55.18 鹵13.73 years old. There were 27 cases of NDR in diabetic patients without diabetic retinopathy, including 13 males and 14 females, with an average age of 56.70 鹵10.07 years. The basic information of the subjects were collected: sex, age, course of disease, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), and venous blood samples. NSE, HbA1cN, UMAG, FBGG, BUNA, creatinine, TGG, TCU, HDL-CU, LDL-C, LDL-C) were measured in patients with high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglyceride triglyceride (TGN), triglyceride triglyceride (TGG), serum urea nitrogen (bun), serum creatinine (Cr), triglyceride triglyceride (TGG). The data were processed by SPSS21.0 and Medcalcv15.6. Results compared with Dr group (n = 110) and NDR group (n = 27), there was no significant difference in serum NSE level and diastolic blood pressure (P 0.05). After discounting the influence of sex, age, course of disease, glucose metabolism and other mixed factors, the NSE level was still closely related to Dr by two classification Logistic regression analysis. The Cutoff value of NSE was 12.31 渭 mol / L, the diagnostic sensitivity was 69.09 and the specificity was 59.26. Conclusion the elevated NSE level in patients with 7% Dr may be an independent predictor of Dr and a potential biological marker of Dr. The detection of serum NSE level may be one of the methods for early diagnosis of Dr.
【學位授予單位】：揚州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R587.2;R774.1

【參考文獻】

相關(guān)期刊論文 前7條

1 魏劍芬;王穎;吳乃君;金秀平;盛佳曦;張肖;;糖尿病周圍神經(jīng)病變患者血清神經(jīng)元特異性烯醇化酶與神經(jīng)傳導速度的關(guān)系[J];中國糖尿病雜志;2016年06期

2 李文蓮;李文菊;王歡;姜杰;鄧萌;;白細胞介素6和神經(jīng)元特異性烯醇化酶在驚厥性腦損傷中的臨床價值[J];臨床薈萃;2015年10期

3 Montserrat B Duran-Salgado;Alberto F Rubio-Guerra;;Diabetic nephropathy and inflammation[J];World Journal of Diabetes;2014年03期

4 鄒立華;李惠;陳小丹;鄧忠慧;;甲鈷胺聯(lián)合α-硫辛酸、血府逐瘀膠囊治療糖尿病周圍神經(jīng)病變療效觀察[J];中西醫(yī)結(jié)合心腦血管病雜志;2014年03期

5 羅蓉;;丹參酮-ⅡA聯(lián)合鉀鈷胺治療糖尿病周圍神經(jīng)病變療效分析[J];中國醫(yī)院藥學雜志;2013年05期

6 王麗娟;;急性腦梗死血清中神經(jīng)元特異性烯醇化酶水平的變化及意義研究[J];實用心腦肺血管病雜志;2011年11期

7 何偉;王桂斌;;神經(jīng)元特異性烯醇化酶在神經(jīng)疾病中的應用價值[J];醫(yī)學綜述;2008年21期

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