Objective To detect the expression level of retinol binding protein 4 (RBP4) and neutrophil-lymphocyte ratio (NLR) in type 2 diabetic retinopathy (DR) patients, and to explore the relationship of RBP4 and NLR with DR. Methods A total of 163 subjects were investigated, including 41 cases of type 2 diabetes mellitus (T2DM group), 40 cases of non-proliferative type 2 diabetic retinopathy (NPDR group), 42 cases of proliferative diabetic retinopathy (PDR group) and 40 cases of normal control (NC group). Venous plasma glucose, circulating triglycerides, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, uric acid, homocysteine, neutrophil count and lymphocyte count were detected 10 hours after fasting test; and NLR was calculated. Fasting insulin was measured by electrochemical luminescence, and insulin resistance (HOMA-IR) was determined by homeo-stasis model assessment. Serum RBP4 was measured by enzyme linked immunosorbent assay. Data were statistically analyzed using analysis of variance, correlation analysis and logistic stepwise regression analysis. Results Compared with the NC group, RBP4 and NLR of the T2DM, NPDR and PDR groups significantly increased (P < 0.05), the increase of RBP4 in the PDR group was more significant than that in the NPDR group (P < 0.05). Pearson correlation analysis showed that RBP4 correlated with systolic blood pressure, diastolic blood pressure, fasting blood glucose, HOMA-IR, circulating triglycerides, total cholesterol, homocysteine and NLR; but negatively correlated with high- density lipoprotein cholesterol (P < 0.05). Logistic stepwise regression analysis showed that RBP4, NLR, systolic pressure, fasting blood glucose, HOMA-IR and cholesterol were the risk factors of DR. Conclusions  RBP4 expression level and NLR increase in patients with DR, and NLR can affect serum RBP4 expression in DR patients. RBP4 and NLR are the risk factors for DR, and associated with DR.