Relationship Between Serum Cystatin C,HbA1c And Retinopathy In Patients With Type 2 Diabetes

Objective: Over the past 30 years,the prevalence of diabetes in China has increased significantly,Diabetic retinopathy(DR)is one of the most common microvascular complications in patients with type 2 diabetes,and severe cases can lead to blindness.Serum Cystatin C(Cys C)is a low molecular weight,basic non-saccharified protein that is widely present in various tissues of body fluids and nucleated cells.Studies have found that rat vitreous and compartmental retinal cells all can express Cys C.Hb A1 c is a sensitive indicator of the average blood glucose level of patients,and it is the gold standard of monitoring the blood glucose,studies have showed that diabetic retinopathy is associated with Hb A1 c.This research mainly analysis the clinical characteristics of type 2 diabetic retinopathy,and explore the relationship between serum Cystatin C,Hb A1 c and retinopathy in patients With type 2 diabetes,Providing effective evaluation indicators for the prevention and treatment of type 2 diabetic retinopathy.Methods:1 Choose 650 hospitalized patients with type 2 diabetes mellitus from January 2015 to December 2016 in Endocrinology of Baoding First Central Hospital to carry on a retrospective case-control research.men with type 2diabetes in 312 cases,including DR patients with 120 cases,non-proliferative retinopathy(NPDR)patients in 75 cases and proliferative retinopathy(PDR)in45 cases;women with type 2 diabetes in 338 cases,including DR patients with143 cases,non-proliferative retinopathy(NPDR)patients in 80 cases and proliferative retinopathy(PDR)in 63 cases.2 From the hospital system to collect the patient’s personal basic information: including age,sex,diabetes course,diabetes family history,height,weight,smoking history(defined as at least one daily smoking formore than one year)、SBP、DBP;Blood samples Was drawn from the ulnar vein in the morning,and were used to measur FBG、Hb A1c、TC、TG、LDL-C、HDL-C、ALT、AST、GGT、BUN、SCr、SUA、Cys C;recording the eyes of patients whether it appears microvascular tumor,bleeding,hard exudation,neovascularization or other lesions and provide a reliable basis for Clinical stage of DR.Compare the prevalence of DR(NPDR、PDR)in type 2 diabetes mellitus patients among different gender.Compare the general clinical and laboratory examination in type 2 diabetes mellitus patients among NDR group and DR group,NPDR group and PDR group.Compare the prevalence of NDR and DR,NPDR and PDR in type 2 diabetes mellitus patients among different Cys C levels and different Hb A1 c levels.logistic regression analyze the related risk factors of type 2 diabetes mellitus patients witn DR.Results:1 The prevalence of DR in patients with type 2 diabetes mellitus was40.46%.In the Cys C Normal group and elevated group,there was significant difference in the prevalence of NDR and DR(X2 = 7.770,P = 0.0053)。In the different glycosylated hemoglobin levels(<7%,7%-8%,8%-9%,>9%),there was significant difference in the prevalence of NDR and DR(X2=66.68,P<0.001).2 Logistic regression analysis showed that: HDL[OR=0.134,(95%CI0.089-0.233,P=0.008]is protective factor of type 2 diabetes mellitus with DR;age[OR=1.214,(95%CI 1.152-1.320,P=0.021)],diabetes family history [OR=1.521,(95%CI 1.433-1.624,P=0.012)],smoking history[OR=1.210,(95%CI 1.104-1.264,P=0.044)],SBP [OR =1.301,(95%CI 1.275-1.421,P=0.034)],DBP [OR =1.284,(95%CI 1.204-1.328,P=0.036)],TG [OR =1.498,(95%CI 1.420-1.562,P=0.010)],diabetes course [OR =1.364,(95%CI 1.258-1.425,P=0.034)],Hb A1 c [OR =2.310,(95%CI 2.091-2.510,P=0.002)];Cys C[OR =3.211,(95%CI 3.047-3.451,P=0.021)] are risk factors of type 2 diabetes mellitus with DR.Conclusions:1 The risk factors of type 2 diabetes mellitus with DR are numerous,Hb A1 c can reflect the controling of patient’s blood glucose truly and the order of severity,it is risk factors of type 2 diabetes mellitus with DR.2 Cys C can be used as a good endogenous marker for type 2 diabetes patients with retinopathy,and it is all important risk factors for DR;Early monitoring cystatin C and Hb A1 c can be timely intervention、 delay、 reduce the incidence of diabetes complications,thus improve the patients’ quality of life of and reduce the economic burden of society.3 Also found HDL-C is protective factor of type 2 diabetes mellitus with DR;while Age,diabetes family history,smoking history,SBP,DBP,TG,course of diabetes mellitus,Hb A1 c,Cys C are risk factors of type 2 diabetes mellitus with DR.