中文摘要：

目的探讨糖尿病视网膜病变（DR）合并亚临床甲状腺功能减退（SCH）患者血清视黄醇结合蛋白4（RBP4）的水平变化及其对DR的影响。方法选取2013年1月—2015年6月在临沂市河东区人民医院门诊就诊或住院的糖尿病患者（DM组）60例、DR患者（DR组）60例、SCH患者（SCH组）60例、DR合并SCH患者（DR＋SCH组）60例及同期体检血糖和甲状腺功能均正常的健康者（对照组）60例。记录各组受检者的性别、年龄、血压、体质指数（BMI）,测定糖化血红蛋白（Hb A1c）、三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、血清半胱氨酸（Hcy）、胱抑素C（Cys-C）、血清促甲状腺激素（TSH）、RBP4水平。结果 5组受检者TG、TC、LDL-C、Hb A1c、TSH、RBP4、Hcy、Cys-C比较,差异均有统计学意义（P〈0.05）;其中DR＋SCH组患者RBP4水平均高于DM组、DR组、SCH组及对照组,差异有统计学意义（P〈0.05）;DR组RBP4水平均高于DM组及对照组（P〈0.05）。增殖期（PDR）患者RBP4、Hcy及Cys-C水平均高于非增殖期（NPDR）患者,差异均有统计学意义（P〈0.01）。重度SCH患者RBP4、Hcy及Cys-C水平均高于轻度SCH患者,差异均有统计学意义（P〈0.01）。Pearson相关分析结果显示,血清TG、LDL-C、TSH、收缩压及DM病程与RBP4均呈正相关（r=0.482、0.573、0.826、0.417、0.746,P〈0.001）。Logistic回归分析结果显示,RBP4、TG、Hb A1c、收缩压和DM病程是影响2型糖尿病患者发生DR的因素（P〈0.05）。结论 DR合并SCH患者RBP4水平明显升高,并与DR分期及SCH严重程度有关;RBP4、TG、Hb A1c、收缩压和DM病程是DR的独立危险因素。

英文摘要：

Objective To investigate the change of serum retinol binding protein 4（ RBP4） level in patients with diabetic retinopathy（ DR） and subclinical hypothyroidism（ SCH） and its effects on DR. Methods We selected 60 DM patients（ DM group）,60 DR patients（ DR group）,60 SCH patients（ SCH group） and 60 patients with both DR and SCH（ DR ＋ SCH group） who received treatment in the outpatient department or hospitalized in Hedong District People＇s Hospital of Linyi from January 2013 to June 2015. And we also enrolled 60 healthy people with normal blood glucose and thyroid function as control group in the same period. We recorded gender,age,blood pressure,BMI,Hb A1 c,TG,TC,LDL-C,Hcy,Cys-C,TSH and RBP4 level of each group. Results The five groups were significantly different in TG,TC,LDL-C,Hb A1 c,TSH,RBP4,Hcy and Cys-C（ P〈0. 05）; DR ＋ SCH group was higher than DM group,DR group,SCH group and control group in RBP4 level（ P〈0. 05）; DR group was higher than DM group and control group in RBP4 level（ P〈0. 05）. Patients with proliferative diabetic retinopathy（ PDR） were higher than patients with nonproliferative diabetic retinopathy（ NPDR） in the levels of RBP4,Hcy and Cys-C（ P〈0. 01）. Patients with severe SCH were higher than patients with mild SCH in the levels of RBP4,Hcy and Cys-C（ P〈0. 01）. Pearson correlation analysis showed that TG, LDL-C, TSH, systolic pressure and duration of DM were positively correlated with RBP4（ r = 0. 482,0. 573,0. 826,0. 417,0. 746; P〈0. 001）. Logistic regression analysis showed that RBP4, TG, Hb A1 c,systolic pressure and duration of DM were influencing factors for DR in T2 DM patients（ P〈0. 05）. Conclusion DR combined with SCH causes notable increase in the RBP4 level and is related with DR staging and SCH severity; RBP4,TG,Hb A1 c,systolic pressure and the duration of diabetes are independent risk factors for DR.