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

doi:10.11958/20253588

Abstract

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

CLC Number:

R587.26

Figures/Tables 6

References 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	-	-