本文選題：傳統(tǒng)脂質(zhì)比值 + 載脂蛋白比值��； 參考：《廣州醫(yī)科大學(xué)》2017年碩士論文

【摘要】：研究背景:近三十多年來,隨著我國經(jīng)濟(jì)高速發(fā)展,人口的老齡化及生活方式的改變,糖尿病(Diabetes mellitus,DM)患病率顯著增加,其患病人數(shù)遠(yuǎn)超其他國家而居于首位。DM已成為當(dāng)前威脅人類健康最重要的非傳染性疾病之一,其導(dǎo)致的長期的三大營養(yǎng)物質(zhì)代謝紊亂可進(jìn)一步造成心、腦、眼、腎、血管等多系統(tǒng)組織器官進(jìn)行性功能減退和結(jié)構(gòu)改變,甚至臟器衰竭。其中糖尿病視網(wǎng)膜病變(Diabetic retinopathy,DR)是DM患者眼部損害中最常見又最嚴(yán)重的疾病,也是成年人群中低視力和致盲的主要原因,嚴(yán)重影響著成千上萬人的生活質(zhì)量。DR因其起病隱匿、患病率高和致盲率高的特點而成為人們關(guān)注的熱點。大量流行病學(xué)資料顯示糖尿病病程、高血糖、高血壓和血脂紊亂是促進(jìn)DR的發(fā)生和發(fā)展重要危險因素。早期干預(yù)危險因素、早期篩查和及時治療可以有效減少90%由DR導(dǎo)致的視力殘疾。大量研究已經(jīng)證明脂質(zhì)代謝紊亂是心血管疾病最重要的危險因素,也是DM患者大血管發(fā)生動脈粥樣硬化病變主要危險因素,與其發(fā)生、發(fā)展和預(yù)后關(guān)系密切。臨床常用TC、TG、LDL-C和HDL-C等單項指標(biāo)預(yù)測大血管病變發(fā)生風(fēng)險。研究表明脂質(zhì)代謝紊亂導(dǎo)致的糖尿病大血管病變和微血管病變在發(fā)病機(jī)制方面存在一定關(guān)聯(lián),其中,DR是糖尿病患者最重要的微血管病變。大量臨床研究表明脂質(zhì)代謝紊亂也是DR的重要危險因素,但具體何項脂質(zhì)指標(biāo)可以預(yù)測DR的發(fā)生風(fēng)險目前研究尚未達(dá)成一致結(jié)論。研究證明傳統(tǒng)血脂比值和載脂蛋白比值為血脂綜合指標(biāo)在預(yù)測糖尿病大血管病變(心血管)方面比單項血脂檢測更有意義。而傳統(tǒng)血脂比值、載脂蛋白比值在預(yù)測DR方面的價值,鮮有研究,目前尚未有定論。國外有一項關(guān)于TG/HDL比值與2型糖尿病患者DR的研究;國內(nèi)關(guān)于TC/HDL比值和TG/HDL比值分別與2型糖尿病患者DR相關(guān)性的研究各有一項。此三項研究均表明TG/HDL、TC/HDL是DR發(fā)生的敏感指標(biāo)。同時,近些年來,國內(nèi)外有一些研究顯示載脂蛋白比值也是預(yù)測DR發(fā)生、發(fā)展的敏感指標(biāo)。而關(guān)于脂蛋白比值和載脂蛋白比值分別與2型糖尿病患者DR的關(guān)系對比研究尚未見報道。研究目的:探討傳統(tǒng)脂質(zhì)比值和載脂蛋白比值在預(yù)測2型糖尿病患者中糖尿病視網(wǎng)膜病變的臨床價值。研究方法:采用橫斷面回顧性研究方法,以2015年7月至2017年1月期間收治于廣州醫(yī)科大學(xué)附屬第三醫(yī)院內(nèi)分泌科及眼科病房的2型糖尿病患者為研究對象。根據(jù)2014年中華醫(yī)學(xué)會眼科學(xué)會眼底病學(xué)組糖尿病視網(wǎng)膜病變臨床診療指南中分期標(biāo)準(zhǔn)將研究對象分為無糖尿病視網(wǎng)膜病變(NDR)、非增殖期糖尿病視網(wǎng)膜病變(NPDR)組和增殖期糖尿病視網(wǎng)膜病變(PDR)組。采用單因素方差分析比較三組傳統(tǒng)脂質(zhì)比值和載脂蛋白比值在三組間的差異,對有統(tǒng)計學(xué)差異的各項指標(biāo)利用多分類Logistic回歸分析其與DR的關(guān)系。并運用ROC曲線定量分析可預(yù)測DR發(fā)生、發(fā)展的脂質(zhì)指標(biāo),從而進(jìn)一步探討脂質(zhì)異常與2型糖尿病視網(wǎng)膜病變的關(guān)系。研究結(jié)果:1.所收集261例患者中,NDR組有152例,NPDR組有85例,PDR組有24例。2.NDR組、NPDR組、PDR組三組間的TG、n HDL-C、TC/HDL-C、TG/HDL-C、LDL-C/HDL-C、n HDL-C/HDL-C、apo B、apo B/apo A1的差異均具有統(tǒng)計學(xué)意義(P0.05),且其值在NDR、NPDR、PDR依次升高。3.NDR組、NPDR組、PDR三組間HDL-C、apo A1的差異均有統(tǒng)計學(xué)意義(P0.05),且其值在NDR、NPDR、PDR三組間依次減小。4.NDR組、NPDR組、PDR三組間LDL-C、TC、脂蛋白a、apo E的差異均無統(tǒng)計學(xué)意義(P0.05)。5.NDR組、NPDR組、PDR三組間的糖尿病病程、糖化血紅蛋白、空腹血糖值、血肌酐、血尿素氮、高血壓病史、吸煙史的差異均有統(tǒng)計學(xué)意義(P0.05)。6.NDR組、NPDR組、PDR三組間性別、年齡、飲酒史、臀圍比、體重指數(shù)、血尿酸、CRP、中性粒細(xì)胞計數(shù)、淋巴細(xì)胞計數(shù)的差異均無統(tǒng)計學(xué)意義(P0.05)。7.多分類logistic回歸分析顯示糖尿病病程(B=1.083/1.162)、糖化血紅蛋白(OR=1.248/1.506)、apo B/apo A1(OR=3.171/6.098)、TG/HDL-C(OR=1.794/2.695)分別與非增值期視網(wǎng)膜病變和增殖期視網(wǎng)膜呈明顯正相關(guān)。8.TG/HDL-C與apo B/apo A1的受試者工作特征曲線,結(jié)果顯示TG/HDL-C的AUC=0.596(95%CI為0.522~0.671,P=0.038),apo B/apo A1的AUC=0.636(95%CI為0.566~0.706,P=0.000);apo B/apo A1比值曲線下面積大于TG/HDL-C。且TG/HDL-C比值預(yù)測2型糖尿病視網(wǎng)膜病變的適宜切點為2.195,敏感性為45.1%,特異性為73.4%;apo B/apo A1比值預(yù)測2型糖尿病視網(wǎng)膜病變的適宜切點為0.865,敏感性為52.4%,特異性為70.5%;但是對兩曲線下面積進(jìn)行Z檢驗發(fā)現(xiàn)兩比值的ROC曲線下面積比較差異無統(tǒng)計學(xué)意義(Z=0.774,P0.05),表明兩種脂質(zhì)比值在預(yù)測2型糖尿病視網(wǎng)膜病變發(fā)生、發(fā)展效能上差異無統(tǒng)計學(xué)意義。研究結(jié)論:1、血糖、脂質(zhì)、糖尿病病程是糖尿病視網(wǎng)膜病變發(fā)生、發(fā)展的重要危險因素。2、apo B/apo A1、TG/HDL-C比值較單項脂質(zhì)更能反映2型糖尿病視網(wǎng)膜病變的發(fā)生、進(jìn)展,是評估DR的一個有效指標(biāo)。3、apo B/apo A1和TG/HDL-C評估2型糖尿病視網(wǎng)膜病變的效能類似,但apo B/apo A1評估2型糖尿病視網(wǎng)膜病變的敏感性更好。
[Abstract]:Background: over the past thirty years, with the rapid development of China's economy, the aging of population and the change of life style, the prevalence rate of diabetes (Diabetes mellitus, DM) has increased significantly. The number of patients who suffer from the number of patients far beyond other countries and the first.DM has become one of the most important non communicable diseases that threaten human health, which has led to a long period of time. The metabolic disorders of the three major nutrients can further cause the heart, brain, eye, kidney, and blood vessels and other systemic tissues and organs to carry out sexual dysfunction and structural changes, and even organ failure. Among them, diabetic retinopathy (Diabetic retinopathy, DR) is the most common and most serious disease in the eye damage of DM patients, and is also the middle and low visual acuity of adult population. The main cause of blindness has seriously affected the quality of life of thousands of people.DR because of its insidious onset, high prevalence and high incidence of blindness. A large number of epidemiological data show that the course of diabetes, hyperglycemia, hypertension and dyslipidemia are important risk factors for the development and development of DR. Early intervention is dangerous. Risk factors, early screening and timely treatment can effectively reduce visual disability caused by 90% of DR. A large number of studies have shown that lipid metabolic disorders are the most important risk factors for cardiovascular disease, and are also the main risk factors for atherosclerotic lesions in large vessels in DM patients. They are closely related to their occurrence, development and prognosis. Clinical use of TC, T Single indicators such as G, LDL-C and HDL-C predict the risk of large vascular lesions. The study shows that the pathogenesis of diabetic macroangiopathy and microvascular disease caused by lipid metabolic disorders is associated with the pathogenesis of diabetes, among which DR is the most important microvascular lesion in diabetic patients. A large number of clinical studies show that lipid metabolic disorders are also important for DR. Risk factors, but what specific lipid indicators can predict the risk of DR is not a consensus conclusion. Studies have shown that the traditional blood lipid ratio and apolipoprotein ratio are more significant in predicting diabetic macrovascular lesions (cardiovascular) than in single blood lipids. Value in predicting the value of DR is rarely studied. There is no final conclusion. There is a study abroad on the TG/HDL ratio and DR in type 2 diabetic patients; there is a study on the correlation between the ratio of TC/HDL and the TG/HDL ratio with DR in type 2 diabetic patients respectively. These three studies all indicate that TG/HDL, TC/HDL is a sensitive indicator of DR. In recent years, some studies have shown that the ratio of apolipoprotein is also a sensitive index for predicting the occurrence and development of DR. The comparison of the relationship between the ratio of lipoprotein and apolipoprotein with DR in type 2 diabetic patients has not been reported. The clinical value of diabetic retinopathy. Study methods: a cross-sectional retrospective study was used to study type 2 diabetes patients in the Department of Endocrinology and ophthalmology ward of the Third Affiliated Hospital of Guangzhou Medical University from July 2015 to January 2017. According to the ophthalmology of the Ophthalmology Society of the Chinese Medical Association in 2014 The standard of clinical diagnosis and treatment of diabetic retinopathy was divided into non diabetic retinopathy (NDR), non proliferative diabetic retinopathy (NPDR) group and proliferative diabetic retinopathy (PDR) group. The three groups of traditional lipid ratio and apolipoprotein ratio were compared in the three groups by single factor analysis of variance. Differences were made by multiple classification Logistic regression analysis on the relationship with DR. The ROC curve quantitative analysis could be used to predict the incidence of DR and the development of lipid indicators, and the relationship between lipid abnormality and type 2 diabetic retinopathy was further explored. Fruit: among the 261 patients in the 1. group, there were 152 cases in NDR group, NPD There are 85 cases in group R, and in group PDR, there are 24 cases in group.2.NDR, NPDR group, and PDR group of TG, n HDL-C, TC/HDL-C, TG/HDL-C, LDL-C/HDL-C, and their values are all statistically significant. NDR, NPDR, PDR three groups reduced.4.NDR group, NPDR group, PDR three groups of LDL-C, TC, lipoprotein a, apo E were not statistically significant (P0.05) group, three groups of diabetes course, glycosylated hemoglobin, fasting blood glucose, blood creatinine, blood urea nitrogen, hypertension history, smoking history differences were statistically significant The differences in sex, age, drinking history, hip circumference, body mass index, blood uric acid, CRP, neutrophils count, and lymphocyte count were not statistically significant between groups.6.NDR, NPDR and PDR three (P0.05).7. multiple classification logistic regression analysis showed the course of diabetes (B= 1.083/1.162), glycosylated hemoglobin (OR=1.248/1.506), apo B/apo 8), TG/HDL-C (OR=1.794/2.695) showed significant positive correlation with.8.TG/HDL-C and apo B/apo A1 in non value-added retinopathy and proliferating retina, and the results showed that AUC=0.596 of TG/HDL-C (95%CI was 0.522~0.671, P=0.038). The appropriate cutting points were 2.195, the sensitivity was 45.1%, the specificity was 73.4%, and the appropriate point of apo B/apo A1 ratio was 0.865, the sensitivity was 52.4%, and the specificity was 70.5%, but the area under the two curve was two compared with the ratio of apo B/apo A1, but the Z test of the two curve found two ratio. There was no statistically significant difference in the area under the ROC curve of the value (Z=0.774, P0.05). It showed that the two kinds of lipid ratios had no significant difference in predicting the incidence of retinopathy of type 2 diabetic retinopathy. Conclusion: 1, blood sugar, lipid, and diabetes course are the occurrence of retinopathy of diabetic retinopathy, the important risk factor of development,.2, apo B/apo A1, The TG/HDL-C ratio is more likely to reflect the occurrence of type 2 diabetic retinopathy than single lipid. Progress is an effective indicator of DR,.3. Apo B/apo A1 and TG/HDL-C evaluate the efficacy of type 2 diabetic retinopathy, but apo B/apo A1 evaluation of type 2 diabetic retinopathy is more sensitive.
【學(xué)位授予單位】：廣州醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R587.2;R774.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 文子尹;張亮;;血脂水平監(jiān)測在糖尿病視網(wǎng)膜病變的臨床評價[J];數(shù)理醫(yī)藥學(xué)雜志;2017年01期

2 馬長紅;田永霞;李鴻雁;譚娜;符艷松;;糖尿病視網(wǎng)膜病變患者血脂和動態(tài)血壓變化特點[J];中國臨床醫(yī)生雜志;2016年12期

3 諸駿仁;高潤霖;趙水平;陸國平;趙冬;李建軍;;中國成人血脂異常防治指南(2016年修訂版)[J];中國循環(huán)雜志;2016年10期

4 王琛;李東豪;聞毅頤;;玻璃體內(nèi)注射康柏西普聯(lián)合周邊視網(wǎng)膜選擇性光凝治療視網(wǎng)膜靜脈阻塞繼發(fā)黃斑水腫的療效及安全性[J];眼科新進(jìn)展;2016年05期

5 宋光耀;任路平;;血脂紊亂對糖尿病心血管并發(fā)癥的影響及處理[J];中華糖尿病雜志;2016年03期

6 王超;張萍;;血脂比值預(yù)測心血管疾病的臨床研究進(jìn)展[J];山東醫(yī)藥;2015年36期

7 黃鑫;崔智威;武文;楊陽;曹志林;李虹;;血脂比值在心腦血管相關(guān)疾病危險性評價中的應(yīng)用[J];國際檢驗醫(yī)學(xué)雜志;2015年09期

8 邢薇;董志軍;張鐵民;;糖尿病視網(wǎng)膜病變發(fā)病機(jī)制的研究進(jìn)展[J];中國實用眼科雜志;2014年06期

9 吳京陽;劉磊;耿金;柳力敏;陳蕾;;社區(qū)糖尿病視網(wǎng)膜病變流行病學(xué)1.5a隨訪結(jié)果[J];國際眼科雜志;2014年04期

10 耿倩;高永峰;董玲芳;韓雅琪;;早期2型糖尿病視網(wǎng)膜病變與血清apoB/apoA1的關(guān)系[J];河南醫(yī)學(xué)研究;2014年01期

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