探讨2型糖尿病(T2DM)患者载脂蛋白E(ApoE)基因多态性与糖尿病视网膜病变(DR)及血脂水平的关系。

采用病例对照研究，选取2022年1月至2024年5月徐州市第一人民医院收治的T2DM并发DR患者112例(DR组)和同期医院收治的单纯T2DM患者96例(T2DM组)。采用聚合酶链式反应-限制性片段长度多态性技术检测基因ApoE，两组基因型及等位基因频率比较，采用卡方检验或Fisher精确概率检验，并采用方差分析比较不同基因型患者的血脂水平。采用Logistic回归分析T2DM患者并发DR的风险因素。

DR组总胆固醇(TC)[(5.02±0.98)mmol/L]与甘油三酯(TG)[(2.92±1.07)mmol/L]水平均高于T2DM组[(4.51±1.33)mmol/L、(2.36±0.25)mmol/L]。两组ApoE基因型和等位基因总体分布比较，均差异有统计学意义(均P<0.01)。经Bonferroni校正，两组ε3/3、ε3/4、ε4/4基因型分布差异具有统计学意义(均P<0.0083)；DR组ApoE ε3和ε4等位基因分布低于T2DM组(均P<0.0167)。DR组ApoE不同等位基因患者的TC和TG水平比较差异有统计学意义(F＝3.429，4.947；均P<0.05)。Logistic回归分析显示TC(OR＝1.467，95%CI：1.080~1.993)、TG(OR＝2.761，95%CI：1.756~4.342)、ApoE ε4等位基因(OR＝0.056，95%CI：0.018~0.176)均是T2DM患者并发DR的影响因素(均P<0.05)。

血脂水平中TC、TG以及ApoE ε4等位基因与T2DM并发DR的关联密切，可能是其发病因素之一。

To investigate the relationship between apolipoprotein E (ApoE) gene polymorphism and diabetic retinopathy (DR) and plasma lipid levels in type 2 diabetes mellitus (T2DM).

A case-control study was conducted, including 112 patients with T2DM complicated by DR (DR group) and 96 patients with T2DM without DR (T2DM group), who were admitted to Xuzhou No.1 People′s Hospital between January 2022 and May 2024. The ApoE gene polymorphisms were detected using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. The genotypes and allele frequencies between the two groups were compared using the chi-square test or Fisher′s exact test, while analysis of ANOVA was performed to compare serum lipid levels among patients with different genotypes. Logistic regression analysis was applied to identify risk factors associated with the development of DR in patients with T2DM.

By comparison, the total cholesterol (TC) level [(5.02±0.98)mmol/L] and triglyceride (TG) level [(2.92±1.07)mmol/L] in the DR group were higher than those of the T2DM group [(4.51±1.33)mmol/L, (2.36±0.25)mmol/L]. The overall distributions of ApoE genotypes and alleles differed significantly between the two groups (all P<0.01). After Bonferroni correction, significant differences were observed in the distributions of the ε3/3, ε3/4, and ε4/4 genotypes between the DR and T2DM groups (all P<0.0083). The frequencies of the ApoE ε3 and ε4 alleles in the DR group were significantly lower than those in the T2DM group (all P<0.0167). There were differences in TC and TG levels among patients with different alleles of ApoE in the DR group (F=3.429, 4.947, all P<0.05). Logistic regression analysis indicated that TC (OR=1.467, 95%CI: 1.080-1.993), TG (OR=2.761, 95%CI: 1.756-4.342), and ApoE ε4 allele (OR=0.056, 95%CI: 0.018-0.176) were all independent risk factors for the development of DR in patients with T2DM (all P<0.05).

The TC, TG, and ApoE ε4 alleles in lipid levels are strongly associated with T2DM complicated with DR and may be one of the major factors in its pathogenesis.