CAJ | 학술논문

目的探讨糖尿病视网膜病变(DR)相关临床和生物化学指标在其监测和预警中的意义.方法研究对象为2型糖尿病(DM)人群.荧光素眼底血管造影(FFA)作为分组金标准:按预期灵敏度(Sen)为80％收集DR病例组100例,预期特异度(Spe)为60％收集无DR对照组150例.检测研究对象DR相关临床及外周血浆内皮素1(ET-1)、血管内皮生长因子、血镁、肾功能相关指标、胰岛功能相关指标、血液流变学指标、血脂等生物化学指标,运用受试者工作特征(ROC)方法进行准确度比较和分析,计算ROC曲线下面积(AUC)、Sen、Spe和约登指数,制定联合诊断试验方案.结果 ROC曲线分析显示,有DR临床预警价值的指标是年龄、DM病程、血浆ET-1、血镁和尿白蛋白(P＜0.05).预管指标诊断准确度分析显示,在轻度非增生型DR时期,血浆ET-1诊断效力最高,AUC=0.742,Spe=72.00％,Sen=72.20％；在中重度非增生型DR时期,尿白蛋白诊断效力最高,AUC=0.742,Spe=56.10％,Sen=87.88％；在增生型DR时期,血浆ET-1诊断效力最高,AUC=0.857,Spe=84.00％,Sen=85.71％.约登指数最高的联合方案是DM病程联合血浆ET-1的序列试验,预警值为DM病程＞3.5年和血浆ET-1＞160.00 pg/ml.结论 DM患者的年龄、病程、血浆ET-1、血镁和尿白蛋白是临床监测和预警DR的有意义指标.综合利用这些指标制定联合诊断试验可以帮助DM患者进行DR病情的监测和风险评估.
목적 탐토당뇨병시망막병변(DR)상관림상화생물화학지표재기감측화예경중적의의.방법 연구대상위2형당뇨병(DM)인군.형광소안저혈관조영(FFA)작위분조금표준:안예기령민도(Sen)위80％수집DR병례조100례,예기특이도(Spe)위60％수집무DR대조조150례.검측연구대상DR상관림상급외주혈장내피소1(ET-1)、혈관내피생장인자、혈미、신공능상관지표、이도공능상관지표、혈액류변학지표、혈지등생물화학지표,운용수시자공작특정(ROC)방법진행준학도비교화분석,계산ROC곡선하면적(AUC)、Sen、Spe화약등지수,제정연합진단시험방안.결과 ROC곡선분석현시,유DR림상예경개치적지표시년령、DM병정、혈장ET-1、혈미화뇨백단백(P＜0.05).예관지표진단준학도분석현시,재경도비증생형DR시기,혈장ET-1진단효력최고,AUC=0.742,Spe=72.00％,Sen=72.20％；재중중도비증생형DR시기,뇨백단백진단효력최고,AUC=0.742,Spe=56.10％,Sen=87.88％；재증생형DR시기,혈장ET-1진단효력최고,AUC=0.857,Spe=84.00％,Sen=85.71％.약등지수최고적연합방안시DM병정연합혈장ET-1적서렬시험,예경치위DM병정＞3.5년화혈장ET-1＞160.00 pg/ml.결론 DM환자적년령、병정、혈장ET-1、혈미화뇨백단백시림상감측화예경DR적유의의지표.종합이용저사지표제정연합진단시험가이방조DM환자진행DR병정적감측화풍험평고.
Objective To explore the values of different clinical parameters and biochemistry indicators to monitor and predict diabetic retinopathy (DR).Methods The study involved 250 patients with type 2 diabetes mellitua (DM).The patients were divided into DR group (100 patients) with expected sensitivity (Sen) 80％,without DR group (150 patients) with expected specificity (Spe) 60％.DR related clinical and biochemical indicators which including peripheral blood plasma endothelin-1 (ET-1),peripheral vascular endothelial growth factor,plasma magnesium,renal function related indicators,islet function related indicators,blood rheology and blood lipids were detected.Receiver operating characteristic (ROC)was used to analyze accuracy; count the area under a curve (AUC),Sen,Spe and Youden index; develop joint diagnostic testing program.Results The parameters or indicators with clinical value of DR early warning included age,DM duration,plasma ET 1,serum magnesium and urinary albumin (P＜0.05).In the period of mild non-progressive DR,plasma ET-1 had the highest diagnostic validity (AUC=0.742,Spe=72.00％,Sen=72.20％) ; in moderate and severe non-progressive DR period,urinary albumin had the highest diagnosis validity (AUC=0.742,Spe=56.10％,Sen=87.88％) ; in the progressive DR period,the diagnostic validity of plasma ET-1 was highest (AUC =0.857,Spe =84.00 ％,Sen =85.71％).The joint program with the highest Youden index was DM duration combined with plasma ET-1 serial test,and the early warning value was that DM duration exceeded 3.5 years and the tested plasma ET-1 was greater than 160.00 pg/ml.Conclusions Age,DM duration,plasma ET-1,serum magnesium and urinary albumin are the significant parameters or indicators for DR early warning.Joint diagnostic tests can help patients to monitor the progression of DR.