目的：探讨C1q/肿瘤坏死因子相关蛋白9(CTRP9)在不同分期糖尿病视网膜病变(DR)及糖尿病性黄斑水肿(DME)患者血清中的表达水平。 方法：选取2021-04/2022-04甘肃省人民医院收治的2型糖尿病患者135例作为试验组，根据免散瞳眼底照相结果分为无DR(NDR)组(n=45)、非增殖型DR(NPDR)组(n=45)、增殖型DR(PDR)组(n=45)； 根据光学相干断层扫描结果将DR患者分为DME组(n=51)、非DME组(n=39)； 另选取与试验组年龄、性别相匹配的健康体检者45例作为正常对照组。记录并比较各组受试者的临床资料及生化指标检测结果，分析血清CTRP9水平与其他生化指标的相关性，探讨影响DR及DME发生的危险因素。结果：正常对照组、NDR组、NPDR组、PDR组受试者血清CTRP9水平有明显差异(P<0.001)，且正常对照组>NDR组>NPDR组>PDR组； DME组与非DME组患者血清CTRP9水平有明显差异(P<0.001)，且非DME组>DME组。Spearman秩相关性分析显示，DR患者血清CTRP9水平与糖尿病病程病程呈负相关(rs=-0.251，P<0.05)； DME患者血清CTRP9水平与空腹血糖(FBG)(rs=-0.370，P<0.05)、糖化血红蛋白(HbA1c)(rs=-0.421，P<0.05)呈负相关。Logistic多因素回归分析显示，糖尿病病程(OR=1.194，95%CI：1.068～1.335，P=0.002)、血清CTRP9水平(OR=0.936，95%CI：0.907～0.966，P<0.001)是影响DR发生的危险因素； 血清CTRP9水平是影响DME发生的危险因素(OR=0.838，95%CI：0.778～0.903，P<0.001)。结论：血清CTRP9水平降低是DR及DME发生的危险因素，可能对二者的风险评估有重要意义。

AIM: To investigate the expression and correlation of C1q/tumor necrosis factor related protein 9(CTRP9)levels in the serum of patients with different stages of diabetic retinopathy(DR)and diabetic macular edema(DME).METHODS: A total of 135 patients with type 2 diabetes who were admitted to Gansu Provincial Hospital from April 2021 to April 2022 were selected as the experimental group. According to the results of non-mydriatic fundus photography, they were divided into non-DR(NDR)group(n=45), non-proliferative DR(NPDR)group(n=45), proliferative DR(PDR)group(n=45); according to the results of optical coherence tomography, DR patients were divided into DME group(n=51), non-DME group(n=39). In addition, other 45 healthy subjects who matched the age and sex of the experimental group were selected as normal control group. The clinical data and biochemical index test results of subjects in each group were recorded and compared, the correlation between serum CTRP9 level and other biochemical indexes was analyzed, and the risk factors affecting the occurrence of DR and DME were explored.RESULTS: There were significant differences in serum CTRP9 levels among subjects in normal control group, NDR group, NPDR group and PDR group(P<0.001), and normal control group > NDR group > NPDR group > PDR group. There was significant difference in serum CTRP9 level between DME group and non-DME group(P<0.001), and non-DME group > DME group. Spearman rank correlation analysis showed that the level of serum CTRP9 in DR patients was negatively correlated with the course of diabetes(rs=-0.251, P<0.05), the level of serum CTRP9 in DME patients was negatively correlated with fasting blood glucose(FBG)(rs=-0.370, P<0.05)and glycosylated hemoglobin(HbA1c)(rs=-0.421, P<0.05). Logistic multivariate regression analysis showed that the course of diabetes(OR=1.194, 95%CI: 1.068～1.335,P=0.002)and the level of serum CTRP9(OR=0.936, 95%CI: 0.907～0.966,P<0.001)were risk factors for DR. The level of serum CTRP9 was a risk factor affecting the occurrence of DME(OR=0.838, 95%CI: 0.778～0.903, P<0.001).CONCLUSION: The reduction of CTRP9 level is a risk factor for the occurrence of DR and DME, which may be of great significance to the risk assessment of both DR and DME.

甘肃省卫生行业科研计划项目(No.GSWSKY-2019-40); 兰州市科技计划项目(No.2020-ZD-18); 甘肃省人民医院院内科研基金项目(No.20GSSY1-15)