Retinol-binding Protein 4(RBP4) And Other Clinical Indicators In The Vascular Complications Of Type 2 Diabetes Clinical Research

Objective To explore the association of retinol-binding protein 4(RBP4)with pancreatic islet function,blood lipid and renal function in type 2 diabetes and its vascular complications,and then to clarify the role and significance of RBP 4 in type2 diabetes(T2DM)and its vascular complications,so as to provide a theoretical basis for the prevention and treatment of T2 DM and its vascular complications.Methods Selected 652 T2 DM patients in the inpatient department of Endocrinology of affiliated Hospital of Inner Mongolia Medical University from May 2016 to January2020,The study subjects were divided into(1)group A: 122 cases of type 2 diabetes;(2)Group B: 53 patients with simple microvascular lesions of type 2 diabetes mellitus,Of these,24 patients with diabetic retinopathy(DR),29 patients with diabetic retinopathy and diabetic nephropathy(DR + DN);(3)Group C: 314 cases of simple large vessel disease in type 2 diabetes mellitus;(4)Group D: 163 cases of type 2diabetes mellitus complicated with the microvascular and macrovascular disease.Collect clinical data,RBP4,other laboratory indicators(islet function,blood routine,blood lipid,renal function,etc.),and analyze all these indicators in the four groups and microvascular subgroups,explore the predictive value of T2 DM vascular complications,and clarify the clinical significance of these indicators in the complications of vascular disease in type 2 diabetes.Results 1.Comparison of the study indicators between the four groups.(1)Compared with type 2 diabetes(Group A),In Group B,the disease duration,RBP4,LP(a),Urea,Ur,UA,Cys C,and UACR were higher than those in Group A,The e GFR was lower than that in group A(p<0.05);Age,disease duration,HOMA2 IR,and IMT were higher in group C than in group A,FCP,120 min CP,RBC,and e GFR were lower than those in group A(p<0.05);In group D,the age,disease duration,NEUT,NLR,LP(a),Cr,Cys C,UACR,and IMT were higher than those in group A,FCP,120 min CP,RBC,PA,and e GFR were lower than those in group A(p<0.05).(2)Compared with simple microangiopathy of type 2 diabetes(Group B),Age,e GFR,and IMT were higher in group C than in group B,RBP4,Urea,Cr,UA,Cys C,and UACR were lower than those in Group B(p <0.05);In Group D,the age,NLR,and IMT were higher than those in Group B,and RBP4,Cr,and Cys C were lower than those in Group B(p<0.05).(3)Compared with simple macrovascular disease in type 2 diabetes(group C),disease duration,Hb A1 c,NEUT,NLR,LP(a),Cr,Cys C,and UACR were higher in group D than that in group C,and IMT was lower than that in group C(p <0.05).2.Comparison of study indicators between microvascular subgroups and group A,DR group duration,RBP 4 were higher than Group A;DR + DN group duration,RBP4,NEUT,NLR,LP(a),Urea,Cr,UA,Cys C,UACR were higher than Group A,RBC,HDL,e GFR were lower than Group A;DR + DN group duration,RBP4,NEUT,NLR,LP(a),Urea,Cr,UA,Cys C,UACR were higher than DR group,and RBC and e GFR were lower than DR group(p <0.05).3.Association analysis: RBP4 showed a strong positive correlation with PA,moderate intensity with Cr and UA,disease duration,HOMA2 IR,TG,LP(a),NEUT,NLR,WBC,Urea,Cys C,and weak negative correlation with e GFR(P <0.05),and no correlation with WHR,BMI,Hb A1c(%),TC,AP0B100,LYM,and UACR(P> 0.05).After correcting for PA,RBP4 was still positively correlated with disease duration,HOMA2 IR,TG,LP(a),NEUT,NLR,WBC,Urea,Cr,UA,Cys C,and negatively correlated with e GFR(P <0.05).4.Multivariate binary Logistic regression analysis showed that RBP4(OR = 1.125,p<0.05)and LP(a)(OR = 2.23,p <0.01)were factors for microvascular complications of type 2 diabetes;multivariate binary Logistic regression analysis did not identify factors for macrovascular complications in type 2 diabetes.The ROC analysis revealed that RBP4(cut-off value=48.05mg/L,AUC=0.667,The sensitivity was0.471,The specificity was 0.844,p<0.01),LP(a)(cut-off value =0.077g/L,AUC=0.699,The sensitivity was 0.882,The specificity was 0.549,p <0.01),RBP4+LP(a)(cut-off value= 0.222,AUC=0.749,The sensitivity was 0.745,The specificity was 0.623,p <0.01)was better predictive for microvascular complications in T2 DM.Conclusion 1)Type 2 diabetes with simple microvascular disease has a longer disease duration,poor renal function,and higher LP(a)value than patients without vascular disease.Type 2 diabetes with simple macroangiopathy showed older age,with long disease duration,more pronounced insulin rr disease.2)RBP4 has a strong positive correlation with PA,and weak positive correlation with LP(a)and NLR.It may participate in the pathogenesis of type 2 desistance,large IMT value,and decreased RBC count compared with patients without vasculaiabetes and vascular complications through insulin resistance,pro-inflammatory and lipid metabolism pathways.3)RBP4 and LP(a)are the indicators to predict T2 DM microangiopathy and the joint detection of RBP4 and LP(a)in clinical work will improve the ability to determine the risk of T2 DM microangiopathy.