Expression And Correlation Of Ctrp9 And Cys C In Serum Of Patients With Diabetic Retinopathy

1 ObjectiveTo explore the changes and predictive value of CTRP9 and Cys C in the serum of patients with different stages of DR and DME,so as to provide guidance for the prevention and treatment of early clinical DR and DME.2 MethodsOne hundred and fifty patients diagnosed as T2DM and DR in the Department of Endocrinology and Ophthalmology of Gansu Provincial Hospital from April 2021 to June2022 were collected and divided into NDR group,NPDR group and PDR group with fifty cases each,and fifty healthy people were selected as normal control group.Subjects in NPDR and PDR groups were divided into DME group and non-DME group by OCT.The clinical indexes and serum CTRP9 and Cys C levels of the subjects in each group were recorded and compared,and the differences of the above indexes were analyzed.Spearman rank correlation analysis was used to analyze the correlation between variables.Logistic multivariate regression was used to analyze the risk factors of serum CTRP9 and Cys C of DR and DME subjects.ROC curve was used to evaluate the predictive value of CTRP9 and Cys C on DR and DME alone and in combination.3 Results(1)The difference analysis of the clinical indicators of subjects in the normal control group,NDR group,NPDR group and PDR group,the results showed that the gender(χ~2=2.340,P=0.505),age(Z=0.465,P=0.926)and LDL-C(Z=4.422,P=0.219)showed no significant difference;course of type 2 diabetes,BMI,FBG,Hb Alc,HDL-C,TG,TC(Z=38.768,16.673,92.677,117.110,35.264,16.783,33.902,all P<0.01)the difference was statistically significant.(2)The difference analysis of the serum CTRP9 and Cys C levels of subjects in the normal control group,NDR group,NPDR group and PDR group,the results showed that the differences in serum CTRP9 and Cys C levels among the four groups were statistically significant(Z=117.456,106.063,all P<0.001).And the serum CTRP9 level was normal control group>NDR group>NPDR group>PDR group(P<0.001),the serum Cys C level was normal control group<NDR group<NPDR group<PDR group(P<0.001).That is,with the progression of DR,the serum CTRP9 level gradually decreased and the serum Cys C level gradually increased.(3)The difference analysis of the clinical indicators between the DME group and the non-DME group,the results showed that there was no statistically significant difference between the two groups in terms of gender,age,course of type 2 diabetes,BMI,FBG,Hb Alc,HDL-C,LDL-C,TG and TC(all P>0.05).(4)The difference analysis of the serum CTRP9 and Cys C levels between the DME group and the non-DME group,the results showed that there were statistically significant differences in the serum CTRP9 and Cys C levels between the two groups(Z=-6.895,-2.573,all P<0.05).And compared with the non-DME group,the serum CTRP9 level was significantly lower and the serum Cys C level was significantly higher in the DME group(P<0.05).(5)Spearman rank correlation analysis results showed that the serum CTRP9 level of DR subjects was positively correlated with BMI(r_s=0.207,P<0.05),and negatively correlated with course of type 2 diabetes,Hb Alc,HDL-C and LDL-C(r_s=-0.377,-0.210,-0.174,-0.066,all P<0.05).The serum Cys C level was positively correlated with course of type 2 diabetes,FBG and Hb Alc(r_s=0.611,0.182,0.336,all P<0.05),and negatively correlated with BMI(r_s=-0.262,P<0.05).And there was a significant correlation between serum CTRP9 level and Cys C in DR patients(r_s=-0.369,P<0.001).(6)Spearman rank correlation analysis results showed that the serum CTRP9 level of DME subjects was positively correlated with BMI(r_s=0.208,P<0.05),and negatively correlated with course of type 2 diabetes,FBG and Hb Alc(r_s=-0.277,-0.220,-0.211,all P<0.05).The serum Cys C levels were positively correlated with course of type 2 diabetes,FBG,and Hb Alc(r_s=0.563,0.228,0.265,all P<0.05).And serum CTRP9 levels in DME patients were negatively correlated with Cys C(r_s=-0.277,P=0.005).(7)The results of Logistic multivariate regression analysis showed that serum CTRP9 and Cys C were independent predictors of DR(P<0.05).And the risk of DR increased with the decrease of serum CTRP9 level and the increase of Cys C level.(8)The results of Logistic multivariate regression analysis showed that CTRP9 was an independent predictor of DME(P<0.001).And the risk of DME increased with the decrease of serum CTRP9 level.Cys C level was not a risk factor affecting DME(P>0.05).(9)ROC curve was used to analyze the diagnostic efficacy of serum CTRP9 and Cys C on DR.The results showed that the areas under curve(AUC)of CTRP9 and Cys C in predicting T2DM patients with DR were 0.828 and 0.804,respectively.Taking 110.53 pg/ml and 1.33mg/L as cut-off values,the sensitivities of predicting DR were 80.0%,94.0%,and the specificities were 76.0%,63.0%,respectively.When CTRP9 and Cys C jointly predicted DR,the best predictive value could be obtained,the AUC for predicting DR was 0.890,and the sensitivity was 92.0%,the specificity was 77.0%.(10)ROC curve was used to analyze the diagnostic efficacy of serum CTRP9 and Cys C on DME.The results showed that the AUC of CTRP9 and Cys C in predicting DR patients with DME were 0.903 and 0.650,respectively.Taking 104.68pg/ml and 1.64mg/L as cut-off values,the sensitivities of predicting DME were 94.6%,90.9%,and the specificities were77.3%,39.3%,respectively.When CTRP9 and Cys C jointly predicted DME,the AUC for predicting DME was 0.903,and the sensitivity was 77.3%,the specificity was 94.6%.4 Conclusions(1)The occurrence and development of DR and DME are closely related to the serum levels of CTRP9 and Cys C.CTRP9 is the protective factor for DR and DME.Cys C is the risk factor for DR and DME.(2)The serum levels of CTRP9 and Cys C in DR patients are related to the severity of their disease.The combined prediction of CTRP9 and Cys C levels in the risk of DR is more valuable than the independent prediction.(3)Cys C has a low predictive value for DME,while CTRP9 has a good predictive value for the occurrence risk of DME,and can be used as a potential indicator for patients’disease judgment.