Study on the Relationship between Serum Cys-C,TNF-α,HbA1c Levels and Microangiopathy in Type 2 Diabetes Patients

WANG Guangli; PENG Li; SUN Jing

doi:10.12102/j.issn.1672-1349.2025.08.019

Abstract：Objective: To explore the relationship between serum cystatin C (Cys-C), tumor necrosis factor alpha (TNF-α), and glycated hemoglobin (HbA1c) levels with microvascular complications (DMAP) in patients with type 2 diabetes. Methods: A total of 209 patients with type 2 diabetes admitted to our hospital from January 2022 to January 2023 were collected. Patients were divided into DMAP group (137 cases) and non-DMAP group (72 cases) based on whether they had DMAP. Patients with DMAP were further classified into diabetic nephropathy (DN) group (50 cases), diabetic retinopathy (DR) group (45 cases), and DR+DN group (42 cases). Patients in the DR group were divided into proliferative diabetic retinopathy (PDR) group (18 cases) and non-proliferative diabetic retinopathy (NPDR) group (27 cases). Patients in the DN group were divided into stage III or IV DN group (13 cases) and stage I or II DN group (37 cases). Clinical data and serum levels of Cys-C, TNF-α, and HbA1c were compared among groups. Logistic regression analysis was used to identify risk factors for DMAP in patients with type 2 diabetes. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic value of serum Cys-C, TNF-α, and HbA1c levels for DMAP. Results: Serum levels of disease duration, total cholesterol (TC), blood urea nitrogen (BUN), serum creatinine (Scr), fasting plasma glucose (FPG), Cys-C, TNF-α, and HbA1c were significantly higher in the DMAP group than in the non-DMAP group (P < 0.05). Serum Cys-C and TNF-α levels were significantly higher in the DR+DN group compared to the DN group, DR group, and non-DMAP group. Serum Cys-C level was higher in the DN group than in the non-DMAP group. Serum TNF-α and HbA1c levels were significantly higher in the DN group than in the DR group and non-DMAP group. Serum HbA1c level was significantly higher in the DR+DN group than in the DR group and non-DMAP group (P < 0.05). Serum Cys-C, TNF-α, and HbA1c levels were significantly higher in the PDR group than in the NPDR group (P < 0.05). Serum Cys-C, TNF-α, and HbA1c levels were significantly higher in the stage III or IV DN group than in the stage I or II DN group (P < 0.05). Cys-C, TNF-α, and HbA1c were all risk factors for DMAP in patients with type 2 diabetes (P < 0.05). The area under the curve (AUC) for serum Cys-C, TNF-α, HbA1c, and their combination in diagnosing DMAP were 0.739, 0.777, 0.712, and 0.887, respectively. The sensitivity and specificity of combined diagnosis were 81.02% and 88.89%, respectively. Combined diagnosis was superior to individual diagnosis of Cys-C, TNF-α, or HbA1c (Z combined-Cys-C = 4.649, Z combined-TNF-α = 4.024, Z combined-HbA1c = 4.885, P < 0.001). Conclusion: Serum Cys-C, TNF-α, and HbA1c levels are elevated in patients with type 2 diabetes complicated by DMAP. Combined diagnosis of these three markers has high diagnostic efficiency.