HbA1c、LCN2、FGF-21对2型糖尿病患者发生视网膜病变的诊断价值-东南大学学报医学版

HbA1c、LCN2、FGF-21对2型糖尿病患者发生视网膜病变的诊断价值

单位：1. 首都医科大学附属北京友谊医院眼科, 北京 100050;
2. 首都医科大学附属北京友谊医院急诊科, 北京 100050

分类号：R587.2;R774.1

出版年·卷·期（页码）：2026·45·第一期（105-111）

摘要：

目的:探讨糖化血红蛋白(HbA1c)、脂质运载蛋白2(LCN2)、成纤维细胞生长因子21(FGF-21)对2型糖尿病(T2DM)患者并发视网膜病变(DR)的诊断价值。方法:纳入2023年1月至2024年12月收治的165例T2DM患者为观察对象,根据眼底荧光血管造影诊断结果将确诊DR的71例患者纳入DR组,其余94例无网膜病病变者纳入无DR组。采集两组患者入院后24 h内的临床数据,并采用高效液相色谱仪检测HbA1c水平,酶联免疫吸附法(ELISA)检测血清LCN2、FGF-21水平。运用Logistic回归模型分析影响T2DM患者发生DR的因素。构建受试者工作特征(ROC)曲线评估HbA1c、LCN2、FGF-21水平及三者联合对T2DM患者发生DR的诊断价值。采用Hosmer-Lemeshow检验评价模型校准度,并基于100次Bootstrap重抽样对模型进行内部验证。结果:DR组患者HbA1c、LCN2、FGF-21水平以及T2DM病程、空腹血糖(FPG)、餐后2 h血糖(2hPG)水平均显著高于无DR组(P＜0.05)。Logistic回归模型分析显示,T2DM病程、FPG、2hPG、HbA1c、LCN2、FGF-21水平升高是影响DR发生的危险因素(P＜0.05)。ROC曲线分析显示,HbA1c、LCN2、FGF-21单一诊断T2DM患者发生DR的AUC分别为0.708、0.613、0.787,而联合诊断的AUC为0.863。联合诊断效能显著优于单一诊断(Z_联合-HbA1c=4.021,Z_联合-LCN2=5.171,Z_{联合-FGF-21}=3.143,P＜0.05)。Hosmer-Lemeshow拟合优度检验结果(χ²=2.697,自由度=8,P=0.952)及Bootstrap内部验证(100次重复)的校准曲线均表明,模型预测值与实际观测值具有良好的一致性。结论:T2DM合并DR患者HbA1c、LCN2、FGF-21水平均升高,均为发生DR的影响因素,三者联合检测对T2DM患者DR的发生具有更高诊断价值。

Objective: To investigate the diagnostic value of glycated hemoglobin(HbA1c), lipocalin-2(LCN2) and fibroblast growth factor 21(FGF-21) for diabetic retinopathy(DR) in patients with type 2 diabetes mellitus(T2DM). Methods: This study included 165 T2DM patients admitted from January 2023 to December 2024 as the observation subjects. Based on the diagnosis results of fundus fluorescein angiography, 71 patients diagnosed with DR were included in the DR group, and the remaining 94 patients without retinal lesions were included in the non-DR group. Clinical data were collected from both groups within 24 h after admission. High performance liquid chromatography was used to detect HbA1c. Enzyme-linked immunosorbent assay(ELISA) was used to detect the serum levels of LCN2 and FGF-21. A Logistic regression model was used to explore the factors affecting the occurrence of DR in T2DM patients. Receiver operating characteristic(ROC) curves were constructed to evaluate the diagnostic value of HbA1c, LCN2, FGF-21 and their combination for DR in T2DM patients. The Hosmer-Lemeshow test was used to assess model calibration, and internal validation was performed using 100 bootstrap resamples. Results: The DR group had significantly higher HbA1c, LCN2, FGF-21, T2DM duration, fasting blood glucose(FPG), and 2-hour postprandial blood glucose(2hPG) than the non-DR group(P<0.05). Logistic regression model analysis showed that longer T2DM duration, elevated FPG, 2hPG, HbA1c, LCN2, and FGF-21 were risk factors affecting the occurrence of DR(P<0.05). ROC curve revealed that the AUC of HbA1c, LCN2, and FGF-21 alone in predicting DR in T2DM patients was 0.708, 0.613, and 0.787, respectively, while the AUC of joint prediction was 0.863. The joint prediction performance was clearly better than those of single prediction(Z_joint-HbA1c=4.021, Z_joint-LCN2=5.171, Z_joint-FGF-21=3.143, P<0.05). The Hosmer-Lemeshow goodness-of-fit test(χ²=2.697, df=8, P=0.952) and the calibration curve from the bootstrap internal validation(100 repetitions) both indicate good agreement between the model's predicted values and the actual observations. Conclusion: The levels of HbA1c, LCN2 and FGF-21 in patients with T2DM and DR were all significantly elevated. All of these three factors were independently associated with the occurrence of DR. The combined detection of these three indicators had a higher diagnostic value for the occurrence of DR in T2DM patients.

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