摘要
目的探讨糖化血红蛋白(Hb A1c)、抗凝血酶Ⅲ(ATⅢ)和血栓弹力图(TEG)指标在糖尿病视网膜病变(DR)诊断中的作用。方法病例对照研究。选取2015年3月至2016年8月在郑州大学附属洛阳中心医院就诊的T2DM患者120例,其中有视网膜病变患者(DR组)57例,无视网膜病变患者(NDR组)63例。60名同期健康体检者为正常对照组(NC组)。检测各组Hb A1c水平、ATⅢ活性和TEG指标,DR组患者各指标之间做相关性分析,采用受试者工作特征曲线(ROC)评价Hb A1c和ATⅢ对DR的诊断性能。结果 Hb A1c水平在NDR组和DR组,明显高于NC组,且DR组更高,差异具有统计学意义(F=12.721,P<0.01);ATⅢ活性在NDR组和DR组,明显低于NC组,且DR组更低,差异具有统计学意义(F=4.152,P<0.05);TEG检测显示,在NC组、NDR组和DR组,R值和K值依次降低,组间比较差异具有统计学意义(F=10.478、9.931,P<0.01);在NC组、NDR组和DR组,Ma值和CI值依次升高,组间比较差异具有统计学意义(F=11.508、10.795,P<0.01);Spearman相关分析结果显示,DR组Hb Alc与K值呈负相关(r=-0.389,P=0.034),与CI值呈正相关(r=0.312,P=0.040),ATⅢ与R值呈正相关(r=0.299,P=0.043),与CI值呈负相关(r=-0.322,P=0.038),Hb Alc和ATⅢ之间无明显相关性。Hb Alc诊断DR界限值为7.55%,ROC曲线下面积为0.844(95%CI为0.795~0.894);ATⅢ诊断DR界限值为94.5%,ROC曲线下面积为0.768(95%CI为0.697-0.838)。结论糖化血红蛋白、抗凝血酶Ⅲ和血栓弹力图检测对糖尿病视网膜病变诊断具有一定的意义。
Objective To investigate the clinical significance of glycosylated hemoglobin（Hb A1c）,antithrombin（AT Ⅲ） and thrombelastogram（TEG） indexes in patients with diabetic retinopathy（DR）. Methods one hundred and twenty patients with type 2diabetes were enrolled from March 2015 to August 2016 in Luoyang central hospital of Zhengzhou university in this case control study. We divided the patients into two groups：diabetic retinopathy group（DR group,57 cases） and non-diabetic retinopathy group（NDR group,63 cases）. Sixty healthy subjects were included as normal control group（NC group）. HbA1 c,ATⅢ and TEG indexes were detected in all the groups. The correlations between the indexes in the DR group were analysed. Receiver operating characteristic curve（ROC） was used to analyze the diagnostic performance of Hb A1 c and ATⅢ for DR. Results Compared with NC group,the levels of HbA1 c in NDR group and DR group were significantly higher,and the level of Hb A1 c in DR group was significantly higher than that in NDR group（F=12.721,P 〈0.01）;Compared with NC group,the activity of ATⅢ in NDR group and DR group were significantly lower,and the activity of ATⅢ in DR group was significantly lower than that in NDR group（F=4.152,P 〈0.05）;R and K values in NDR group and DR group were significantly lower than those in NC group,and R and K values in DR group were lower than those in NDR group（F=10.478,P 〈0.001;F=9.931,P 〈0.01,respectively）;Ma and CI values in NDR group and DR group were significantly higher than those in NC group,and Ma and CI values in DR group were higher than those in NDR group（F=11.508,P 〈0.001;F=10.795,P 〈0.01,respectively）;Spearman correlation analysis showed that Hb Alc was negatively correlated with K value（P=0.034） and positively correlated with CI value（P=0.040） in DR group;ATⅢ was positively correlated with R value（P=0.043） and negatively correlated with CI value（P=0.038） in DR group. There was no significant correlation between Hb Alc and ATⅢ. When the optimum cutoff of Hb Alc level for DR diagnosis was 7.55%,the area under ROC curve was 0.844（95%CI：0.795-0.894）;When the optimum cutoff of AT-Ⅲ activity for DR diagnosis was 94.5%,the area under ROC curve was 0.768（95%CI： 0.697-0.838）. Conclusion The determinations of Hb Alc,ATⅢ and TEG indexes play a significant role in the diagnose of the DR patients.
作者
胡志清
邸平
赵星鹏
吕欢
刘俊晓
HU Zhiqing DI Ping ZHAO Xingpeng et al(Luoyang Central Hospital ,Zhengzhou University,Henan Luoyang 471009, China China PLA General Hospital ,Beijing 100853, China)
出处
《实验与检验医学》
CAS
2017年第1期43-46,共4页
Experimental and Laboratory Medicine
