振动感觉阈值与2型糖尿病视网膜病变的关系

Relationship between vibrating perception threshold and retinopathy in type 2 diabetes mellitus

目的探讨振动感觉阈值(VPT)与2型糖尿病(T2DM)患者糖尿病视网膜病变(DR)的关系及其对DR的预测价值。方法纳入225例行眼底检查的T2DM患者,根据检查结果将其分为正常组(126例)、非增殖期DR组(66例)和增殖期DR组(33例)。比较3组患者的一般资料、生化指标和VPT。DR的危险因素分析采用logistic回归分析。采用受试者工作特征(ROC)曲线分析VPT对DR的最佳预测值,VPT的相关危险因素采用相关性分析和多元逐步回归分析。结果与正常组比较,非增殖期DR组和增殖期DR组患者的年龄、糖尿病病程、尿微量白蛋白与尿肌酐比值(UACR)、VPT均明显增加(P<0.05)。Logistic回归分析结果显示,糖尿病病程(OR=1.309,P<0.001)和VPT(OR=1.054,P=0.049)是DR的独立危险因素。相关分析结果显示,VPT与糖尿病病程、年龄、UACR、同型半胱氨酸(Hcy)、胱抑素C(Cys C)呈正相关,与舒张压、总胆固醇(TC)呈负相关(P<0.05)。多元逐步回归分析结果显示,年龄(β=0.372,P<0.001)和UACR(β=0.005,P=0.005)是VPT的独立危险因素。ROC曲线分析结果显示,当VPT=17.76 V时,预测DR的敏感度为72%,特异度为59%,ROC曲线下面积为0.66。结论T2DM DR与VPT关系密切,VPT高于17.76 V对预测DR的发生具有一定价值。

Objective To explore the relationship between vibrating perception threshold(VPT)and diabetic retinopathy(DR)in type 2 diabetic mellitus(T2 DM),and verify the screening value of VPT for DR.Methods A total of 225 patients with T2 DM were examined by fundoscopy,and divided into normal group(n=126),non-proliferative DR group(n=66)and proliferative DR group(n=33)according to their fundus oculiphotography.The general data,biochemical indexes and VPT of the three groups were compared.The risk factors of DR were analyzed by logistic regression analysis.ROC curve was used to analyze the best predictive value of VPT for DR,and correlation analysis and multiple stepwise regression were used to analyze the related risk factors of VPT.Results Compared with the normal group,the age,duration of diabetes,urine albumin/creatinine ratio(UACR)and VPT of the non-proliferative DR group and the proliferative DR group were significantly increased(P<0.05).Logistic regression analysis showed that the duration of diabetes(OR=1.309,P<0.001)and VPT(OR=1.054,P=0.049)were independent risk factors for DR.The results of correlation analysis showed that VPT was positively correlated with diabetes duration,age,UACR,homocysteine(Hcy),cystatin C(Cys C),and negatively correlated with diastolic blood pressure and total cholesterol(TC,P<0.05).Multiple stepwise regression analysis showed that age(β=0.372,P<0.001)and UACR(β=0.005,P=0.005)were independent risk factors for VPT.The results of ROC curve analysis showed that when VPT=17.76 V,the sensitivity of predicting DR was 72%,the specificity was 59%,and the area under ROC curve was 0.66.Conclusion T2 DM DR is closely related to VPT.That VPT is higher than 17.76 V has certain value in predicting the occurrence of DR.