血清ApoB/ApoA-1、尿微量白蛋白与糖尿病黄斑水肿严重程度的关系

doi:10.11958/20253588

天津医药 ›› 2026, Vol. 54 ›› Issue (10): 1065-1070.doi: 10.11958/20253588

血清ApoB/ApoA-1、尿微量白蛋白与糖尿病黄斑水肿严重程度的关系

于桂军¹(), 魏素平²^,^△(), 李林松³, 张红卫⁴, 赵瑞玲⁵

¹ 沧州市中心血站质量管理科（邮编 061000）
² 沧州市眼科医院诊查中心
³ 沧州市和平医院检验科
⁴ 沧州市眼科医院检验科
⁵ 沧州市眼科医院功能科

收稿日期:2025-12-11 修回日期:2026-03-17 出版日期:2026-10-15 发布日期:2026-10-10
通讯作者: △E-mail：weisupingwsp@sina.com
作者简介:于桂军（1974），男，副主任技师，主要从事输血医学与血液安全方面研究。E-mail：yuguijunygj@163.com
基金资助:
河北省医学科学研究课题计划资助(20251506)

The relationship between serum ApoB/ApoA-1, urinary microalbumin and the severity of diabetic macular edema

YU Guijun¹(), WEI Suping²^,^△(), LI Linsong³, ZHANG Hongwei⁴, ZHAO Ruiling⁵

¹ Department of Quality Management, Cangzhou Central Blood Station, Cangzhou 061000, China
² Diagnostic Center, Cangzhou Eye Hospital
³ Department of Laboratory, Cangzhou Peace Hospital
⁴ Department of Laboratory, Cangzhou Eye Hospital
⁵ Department of Functional Diagnostics, Cangzhou Eye Hospital

Received:2025-12-11 Revised:2026-03-17 Published:2026-10-15 Online:2026-10-10
Contact: △E-mail：weisupingwsp@sina.com

于桂军, 魏素平, 李林松, 张红卫, 赵瑞玲. 血清ApoB/ApoA-1、尿微量白蛋白与糖尿病黄斑水肿严重程度的关系[J]. 天津医药, 2026, 54(10): 1065-1070.

YU Guijun, WEI Suping, LI Linsong, ZHANG Hongwei, ZHAO Ruiling. The relationship between serum ApoB/ApoA-1, urinary microalbumin and the severity of diabetic macular edema[J]. Tianjin Medical Journal, 2026, 54(10): 1065-1070.

摘要/Abstract

摘要：

目的探究血清载脂蛋白B/载脂蛋白A-1（ApoB/ApoA-1）、尿微量白蛋白（mAlb）对糖尿病黄斑水肿（DME）严重程度的影响。方法选取2022年6月—2023年5月沧州市眼科医院收治的228例DME患者为研究对象，根据DME严重程度将患者分为轻度组、中度组和重度组。比较3组患者的ApoB/ApoA-1、mAlb水平；Spearman法分析DME严重程度与ApoB/ApoA-1、mAlb水平的相关性；并使用单因素分析及多因素Logistic回归分析发展为重度DME的危险因素。采用受试者工作特征（ROC）曲线分析ApoB/ApoA-1、mAlb对重度DME的诊断价值。结果轻、中、重度组患者ApoB/ApoA-1与mAlb水平依次升高（P<0.05）。Spearman相关性分析显示，DME严重程度与ApoB/ApoA-1、mAlb水平均呈正相关（r_s分别为0.502、0.836，均P<0.01）。相比轻中度组，重度组的糖尿病病程、胰岛素治疗时间更长，ApoB/ApoA-1、mAlb及糖化血红蛋白（HbA1c）水平更高（P<0.05）。多因素Logistic回归分析显示，ApoB/ApoA-1、mAlb、HbA1c水平高，糖尿病病程长均为发展为重度DME的危险因素（P<0.05）。ROC曲线分析结果显示，ApoB/ApoA-1与mAlb水平单独及联合评估发展为重度DME风险的曲线下面积（AUC）分别为0.711、0.782、0.927，DeLong检验显示，联合模型的诊断效能显著优于单一指标（Z分别为5.063、4.099，均P<0.05）。结论 DME患者ApoB/ApoA-1、mAlb水平与严重程度关系密切，且是发展为重度DME的危险因素，两者联合检测对识别高危进展人群、预警重度DME发生风险具有重要的临床参考价值。

关键词: 载脂蛋白B类, 载脂蛋白A-Ⅰ, 白蛋白类, 糖尿病视网膜病变, 黄斑水肿, 尿微量白蛋白

Abstract:

Objective To explore the effects of serum apolipoprotein B/apolipoprotein A-1 (ApoB/ApoA-1) and urinary microalbumin (mAlb) on the severity of diabetic macular edema (DME). Methods From June 2022 to May 2023, 228 DME patients admitted to the Cangzhou Eye Hospital were selected as the research subjects. According to the severity of DME, patients were divided into the mild group, the moderate group and the severe group. The ApoB/ApoA-1 ratio and mAlb level of the three groups of patients were compared. The correlation between the degree of DME and the levels of ApoB/ApoA-1 ratio and mAlb was analyzed using the Spearman method. Univariate analysis and multivariate Logistic regression analysis were used to detect risk factors for developing severe DME. The diagnostic value of the ApoB/ApoA-1 ratio and mAlb for severe DME was analyzed using the receiver operating characteristic (ROC) curve. Results The levels of ApoB/ApoA-1 and mAlb in the mild, moderate and severe groups increased successively (P<0.05). The Spearman correlation analysis showed that the severity of DME was positively correlated with the levels of ApoB/ApoA-1 and mAlb (r_swere 0.502 and 0.836 respectively, both P<0.01). Compared with the mild-moderate group, the severe group had a longer duration of diabetes and insulin treatment time, and higher ApoB/ApoA-1 ratio, mAlb and HbA1c levels (P<0.05). The multivariate Logistic regression model showed that higher levels of ApoB/ApoA-1, mAlb, HbA1c and longer duration of diabetes were all risk factors for developing severe DME (P<0.05). The ROC curve analysis results showed that the area under the curve (AUC) for the ApoB/ApoA-1 ratio and the mAlb level alone and in combination in evaluating the risk of developing severe DME was 0.711, 0.782 and 0.927 respectively. The DeLong test indicated that the diagnostic efficacy of the combined model was significantly better than that of the single indicator (Z values were 5.063 and 4.099 respectively, both P<0.05). Conclusion The ApoB/ApoA-1 ratio and mAlb level in DME patients are closely related to the severity of the disease, and they are also risk factors for developing severe DME. The combined detection of these two indicators has important clinical reference value for identifying high-risk individuals with progressive disease and warning of the risk of severe DME occurrence.

Key words: apolipoproteins B, apolipoprotein A-I, albumins, diabetic retinopathy, macular edema, urinary microalbumin

中图分类号:

R587.26

图/表 6

参考文献 21

[1]	Gupta S, Sharma N, Arora S, et al. Diabetes:a review of its pathophysiology,and advanced methods of mitigation[J]. Curr Med Res Opin, 2024, 40(5):773-780. doi:10.1080/03007995.2024.2333440.
[2]	Lu Z, Fan B, Li Y, et al. RAGE plays key role in diabetic retinopathy:a review[J]. Biomed Eng Online, 2023, 22(1):128. doi:10.1186/s12938-023-01194-9.
[3]	曾国强, 钟键波, 张怡, 等. 眼内液细胞因子检测在糖尿病黄斑水肿中临床意义的研究进展[J]. 中华眼底病杂志, 2024, 40(8):651-655.
	Zeng G Q, Zhong J B, Zhang Y, et al. Research progress of clinical importance of detecting cytokines in the intraocular fluid in diabetic macular edema[J]. Chin J Ocul Fundus Dis, 2024, 40(8):651-655. doi:10.3760/cma.j.cn511434-20240305-00090.
[4]	Tatsumi T. Current treatments for diabetic macular edema[J]. Int J Mol Sci, 2023, 24(11):9591. doi:10.3390/ijms24119591.
[5]	魏丹, 安喜燕, 高军, 等. 不同OCT分型糖尿病黄斑水肿发病的影响因素分析[J]. 眼科新进展, 2023, 43(4):313-317.
	Wei D, An X Y, Gao J, et al. Influencing factors on the attack of different types of diabetic macular edema classified by optical coherence tomography[J]. Recent Advances in Ophthalmology, 2023, 43(4):313-317. doi:10.13389/j.cnki.rao.2023.0064.
[6]	李建良, 杜红彦, 骆煌, 等. 加味五苓肾气汤治疗糖尿病黄斑水肿的疗效及机制研究[J]. 山东中医杂志, 2024, 43(6):598-602.
	Li J L, Du H Y, Luo H, et al. Study on therapeutic effect and mechanism of Modified Wuling Shenqi Decoction(加味五苓肾气汤)in treatment of diabetic macular edema[J]. Shandong Journal of Traditional Chinese Medicine, 2024, 43(6):598-602. doi:10.16295/j.cnki.0257-358x.2024.06.008.
[7]	Zhu Y, Dou Z, Wang W, et al. Intravitreal injection of conbercept for diabetic macular edema complicated with diabetic nephropathy[J]. Int J Ophthalmol, 2024, 17(2):304-310. doi:10.18240/ijo.2024.02.12.
[8]	中国医师协会内分泌代谢科医师分会, 国家代谢性疾病临床医学研究中心. 糖尿病分型诊断中国专家共识[J]. 中华糖尿病杂志, 2022, 14(2):120-139.
	Chinese Medical Doctor Association-Endocrinology and Metabolism Specialty Branch,National Clinical Research Center for Metabolic Diseases. Classification of diabetes mellitus in China:an expert consensus statement[J]. Chin J Diabetes Mellitus, 2022, 14(2):120-139.doi:10.3760/cma.j.cn115791-20211219-00672.
[9]	邵毅, 王珊珊, 袁晴. 糖尿病黄斑水肿诊治规范—2018欧洲视网膜专家协会指南解读[J]. 国际眼科杂志, 2020, 20(1):1-3.
	Shao Y, Wang S S, Yuan Q. European Society of Retina Specialists guidelines for management of diabetic macular edema[J]. International Eye Science, 2020, 20(1):1-3. doi:10.3980/j.issn.1672-5123.2020.1.01.
[10]	阎文平, 弓剑戟. 血清PTX3和FABP4及PHD2水平与糖尿病性黄斑水肿严重程度的相关性[J]. 国际眼科杂志, 2026, 26(1):114-118.
	Yan W P, Gong J J. Correlation of serum pentraxin 3,fatty acid-binding protein 4 and prolyl hydroxylase 2 levels with the severity of diabetic macular edema[J]. International Eye Science, 2026, 26(1):114-118. doi:10.3980/j.issn.1672-5123.2026.1.20.
[11]	Apostolidi A, Stergiopoulos G, Bellou S, et al. Advances in modeling the inner blood-retinal barrier:from static tissue cell cultures to microphysiological systems[J]. Pharmaceuticals (Basel), 2025, 18(9):1374. doi:10.3390/ph18091374.
[12]	Noma H, Yasuda K, Shimura M. Involvement of cytokines in the pathogenesis of diabetic macular edema[J]. Int J Mol Sci, 2021, 22(7):3427. doi:10.3390/ijms22073427.
[13]	Paul S, Kim C, Soliman M K, et al. Can the future be bright with advances in diabetic eye care?[J]. Endocrinol Metab Clin North Am, 2023, 52(1):89-99. doi:10.1016/j.ecl.2022.06.004.
[14]	Soedarman S, Julia M, Gondhowiardjo T D, et al. Serum apolipoprotein A1 and B are associated with 6-month persistent and incident diabetic macular oedema in type 2 diabetes[J]. BMJ Open Ophthalmol, 2023, 8(1):e001207. doi:10.1136/bmjophth-2022-001207.
[15]	范瑞磊, 魏若愚, 金培新, 等. 尿微量白蛋白/肌酐比值、趋化因子样受体1、血清25-羟胆骨化醇与糖尿病视网膜病变的关系[J]. 安徽医药, 2022, 26(10):2081-2085.
	Fan R L, Wei R Y, Jin P X, et al. Relationship between urine microalbumin/creatinine ratio,chemokine-like receptor 1,25-hydroxycholecalciferol and diabetic retinopathy[J]. Anhui Medical and Pharmaceutical Journal, 2022, 26(10):2081-2085. doi:10.3969/j.issn.1009-6469.2022.10.040.
[16]	但玉娇, 张凌, 陈彬. ApoB/ApoA1与糖尿病视网膜病变继发玻璃体积血的相关性研究[J]. 新医学, 2023, 54(10):739-742.
	Dan Y J, Zhang L, Chen B. Study of the correlation between ApoB/ApoA1 and vitreous hemorrhage secondary to diabetic retinopathy[J]. Journal of New Medicine, 2023, 54(10):739-742. doi:10.3969/j.issn.0253-9802.2023.10.010.
[17]	朱春明, 鲍延丽. 血清COX-2和RAGE水平对糖尿病视网膜病变的诊断价值[J]. 国际眼科杂志, 2025, 25(6):1009-1013.
	Zhu C M, Bao Y L. Diagnostic value of serum COX-2 and RAGE for retinopathy of diabetes mellitus[J]. International Eye Science, 2025, 25(6):1009-1013. doi:10.3980/j.issn.1672-5123.2025.6.25.
[18]	Saucedo L, Pfister I B, Zandi S, et al. Ocular TGF-β,matrix metalloproteinases,and TIMP-1 increase with the development and progression of diabetic retinopathy in type 2 diabetes mellitus[J]. Mediators Inflamm, 2021, 2021:9811361. doi:10.1155/2021/9811361.
[19]	方石峰, 马翔, 王永平. HbA1c、mAlb、α1-MG与重度非增殖期糖尿病视网膜病变激光术后并发玻璃体积血的相关性分析[J]. 广西医科大学学报, 2020, 37(8):1537-1541.
	Fang S F, Ma X, Wang Y P. Correlation analysis between HbA1c,mAlb and α1-MG levels and vitreous hemorrhage complicating severe non-proliferative diabetic retinopathy after laser surgery[J]. Journal of Guangxi Medical University, 2020, 37(8):1537-1541. doi:10.16190/j.cnki.45-1211/r.2020.08.023.
[20]	Hector S, Thulesius H O, Landin-Olsson M, et al. Soluble CD163 and glycated haemoglobin were independently associated with the progression of diabetic retinopathy in adult patients with type 1 diabetes[J]. BMJ Open Ophthalmol, 2023, 8(1):e001314. doi:10.1136/bmjophth-2023-001314.
[21]	Trandafir M, Savu O I, Gheorghiu M. The complex immunological alterations in patients with type 2 diabetes mellitus on hemodialysis[J]. J Clin Med, 2024, 13(13):3687. doi:10.3390/jcm13133687.

组别	n	ApoB/ApoA-1	mAlb/（mg/L）
轻度组	74	1.07±0.11	56.51±10.11
中度组	83	1.18±0.15^a	83.29±20.30^a
重度组	71	1.29±0.22^ab	132.72±31.43^ab
F		33.277^＊＊	220.558^＊＊

组别	n	ApoB/ApoA-1	mAlb/（mg/L）
轻度组	74	1.07±0.11	56.51±10.11
中度组	83	1.18±0.15^a	83.29±20.30^a
重度组	71	1.29±0.22^ab	132.72±31.43^ab
F		33.277^＊＊	220.558^＊＊

组别			n	性别（男/女）		年龄/ 岁				糖尿病病程/年				胰岛素治疗时间/月
轻中度组			157	75/82		55.03±6.79				15.31±4.38				38.28±10.51
重度组			71	36/35		54.77±7.05				17.02±4.44				42.68±11.05
t或χ²				0.168		0.264				2.721^＊＊				2.886^＊＊
组别			收缩压/ mmHg					舒张压/ mmHg				BMI/ （kg/m²）			空腹血糖/ （mmol/L）
轻中度组			136.71±13.06					74.69±7.91				22.51±2.01			10.39±3.11
重度组			139.20±13.41					75.30±8.46				22.96±2.03			10.40±3.40
t			1.322					0.519				1.528			0.044
组别		餐后2 h血糖/（mmol/L）					ApoB/ ApoA-1				mAlb/ （mg/L）					HbA1c/ %
轻中度组		14.59±4.59					1.16±0.13				80.76±16.80					9.18±1.84
重度组		14.81±3.50					1.22±0.22				110.72±31.43					10.33±1.21
t		0.398					2.128^＊＊				7.557^＊＊					5.532^＊＊
组别	TC/ （mmol/L）				TG/ （mmol/L）				HDL-C/（mmol/L）				LDL-C/（mmol/L）
轻中度组	5.03±1.04				2.38±0.81				1.24±0.41				3.26±0.91
重度组	4.96±1.07				2.22±0.75				1.16±0.35				3.28±1.04
t	0.535				1.333				1.234				0.147

组别			n	性别（男/女）		年龄/ 岁				糖尿病病程/年				胰岛素治疗时间/月
轻中度组			157	75/82		55.03±6.79				15.31±4.38				38.28±10.51
重度组			71	36/35		54.77±7.05				17.02±4.44				42.68±11.05
t或χ²				0.168		0.264				2.721^＊＊				2.886^＊＊
组别			收缩压/ mmHg					舒张压/ mmHg				BMI/ （kg/m²）			空腹血糖/ （mmol/L）
轻中度组			136.71±13.06					74.69±7.91				22.51±2.01			10.39±3.11
重度组			139.20±13.41					75.30±8.46				22.96±2.03			10.40±3.40
t			1.322					0.519				1.528			0.044
组别		餐后2 h血糖/（mmol/L）					ApoB/ ApoA-1				mAlb/ （mg/L）					HbA1c/ %
轻中度组		14.59±4.59					1.16±0.13				80.76±16.80					9.18±1.84
重度组		14.81±3.50					1.22±0.22				110.72±31.43					10.33±1.21
t		0.398					2.128^＊＊				7.557^＊＊					5.532^＊＊
组别	TC/ （mmol/L）				TG/ （mmol/L）				HDL-C/（mmol/L）				LDL-C/（mmol/L）
轻中度组	5.03±1.04				2.38±0.81				1.24±0.41				3.26±0.91
重度组	4.96±1.07				2.22±0.75				1.16±0.35				3.28±1.04
t	0.535				1.333				1.234				0.147

变量	β	SE	Wald χ²	P	OR	OR 95%CI
ApoB/ApoA-1	0.061	0.012	27.437	<0.001	1.062	1.039~1.087
mAlb	0.064	0.011	32.823	<0.001	1.066	1.043~1.090
HbA1c	0.426	0.149	8.195	0.004	1.531	1.144~2.049
糖尿病病程	0.178	0.053	11.268	0.001	1.195	1.077~1.326
胰岛素治疗时间	0.013	0.018	0.512	0.474	1.013	0.978~1.049
常数项	-22.166	3.086	51.605	<0.001	-	-

血清ApoB/ApoA-1、尿微量白蛋白与糖尿病黄斑水肿严重程度的关系

The relationship between serum ApoB/ApoA-1, urinary microalbumin and the severity of diabetic macular edema

引用本文

RichHTML

PDF (PC)

可视化

摘要/Abstract

使用本文

图/表 6

参考文献 21

相关文章 15

编辑推荐

Metrics

本文评价

变量	最佳截断值	敏感度/ %	特异度/ %	AUC	95%CI	约登指数
ApoB/ApoA-1	1.23	78.87	73.89	0.711	0.648~0.769	0.528
mAlb	89.46 mg/L	67.61	79.62	0.782	0.723~0.834	0.472
联合	-	91.55	90.45	0.927	0.885~0.957	0.820

[1]	胡金宝, 柳文武, 胡志超. 视网膜静脉阻塞患者血清微小RNA表达水平与黄斑水肿程度的相关性[J]. 天津医药, 2026, 54(7): 741-746.
[2]	何紫叶, 祖洁, 郝倩, 贾志旸. 抗VEGF治疗应答异质性在糖尿病性黄斑水肿中的研究进展[J]. 天津医药, 2026, 54(7): 779-784.
[3]	许正杰, 李田, 畅立斌. DEX-I联合雷珠单抗治疗视网膜血管性疾病继发黄斑水肿的疗效观察[J]. 天津医药, 2026, 54(6): 647-652.
[4]	解鹏亮, 郑陆芳, 李琰, 郑艳瑾, 白领娣, 赵霞, 路迎龙. 血管内皮生长因子与糖尿病黄斑囊样水肿严重程度的相关性[J]. 天津医药, 2025, 53(9): 927-931.
[5]	隋源, 姜冰冰, 勾晓梅, 孙敬文, 张成森. TyG-BMI、HAR、GRI与糖尿病视网膜病变的关系[J]. 天津医药, 2025, 53(1): 93-97.
[6]	孙延文, 王聪, 陈世良, 张冉冉. 骨髓增生异常综合征相关的血脂异常分析[J]. 天津医药, 2024, 52(8): 872-876.
[7]	马良, 胡立影, 石羽, 龙刚. 光学相干断层扫描血管成像技术在慢性肾脏病临床评估中的应用进展[J]. 天津医药, 2024, 52(8): 882-887.
[8]	陈芋洁, 黄霞, 邓铂林, 贾文文. 金合欢素调节Hippo信号通路对糖尿病视网膜病变大鼠血管生成的影响[J]. 天津医药, 2024, 52(6): 578-583.
[9]	隋源, 张成森, 王爽, 李雪丽, 勾晓梅. circRNA-ZNF532、circRNA-HIPK3与糖尿病视网膜病变的相关性研究[J]. 天津医药, 2023, 51(9): 993-997.
[10]	罗影, 单伟, 张俏. 神经胶质成熟因子-β诱导糖尿病大鼠视网膜Müller细胞炎症反应的机制研究[J]. 天津医药, 2023, 51(4): 387-391.
[11]	陈灵芝, 钟开义, 陈立国. MTHFR基因启动子甲基化与糖尿病肾病发病的关系研究[J]. 天津医药, 2022, 50(6): 633-638.
[12]	陶琳, 赵晓莲 , 齐淑芳 . 血清TXNIP在2型糖尿病视网膜病变患者中的表达及其与氧化应激的关系[J]. 天津医药, 2022, 50(2): 186-190.
[13]	万芳 , 马利方. 叶黄素通过SIRT1/NLRP3信号通路提高人视网膜色素上皮细胞存活率的机制研究 #br#[J]. 天津医药, 2021, 49(2): 131-135.
[14]	张俏, 罗影, 刘学政. 番石榴叶总三萜改善糖尿病大鼠视网膜损伤的作用机制研究#br#[J]. 天津医药, 2020, 48(12): 1165-1168.
[15]	王莎莎, 姜波, Jorge A. Trujillo Perdomo, 廖荣丰△. 多光谱视网膜成像与光学相干断层扫描血管技术在非增殖性糖尿病视网膜病变检查中的应用[J]. 天津医药, 2020, 48(11): 1110-1114.