eGFR作为糖尿病视网膜病变预警因子的研究

Study on estimated GFR as predictor of DR

目的评价糖尿病患者中糖尿病视网膜病变(diabetic retinopathy,DR)的患病率及其与肾小球滤过率(glomerular filtration rate,GFR)的相互关系,探讨eGFR(estimated GFR)作为DR预警因子的可行性。方法 1613例2型糖尿病(type 2 diabetes mellitus,T2DM)患者参与本研究。所有研究对象均自愿接受生物化学和眼部检查。DR由眼科医师通过眼底镜检查和眼底照相确诊。通过易尔统计分析软件评估DR与eGFR之间的关系。结果 1613例糖尿病患者中,DR患病率为34.10%(550例)。将有无DR的患者分组比较,DR组与NDR组差异有统计学意义的变量有:年龄、DM病程、DM家族史、空腹及餐后2 h血糖、糖化血红蛋白、总胆固醇、收缩压、eGFR、血清肌酐及高、低密度脂蛋白胆固醇。Logistic回归分析结果显示,年龄、DM病程、血浆糖化血红蛋白、收缩压、舒张压、eGFR以及高密度脂蛋白胆固醇为DR的独立危险因素,其中eGFR与DR呈负相关。经调整后的饱和效应分析结果表明当eGFR<99.4 mL·min-1时,糖尿病患者患DR的风险明显增加。结论 eGFR与DR负相关,eGFR为99.4 mL·min-1是预测DR发生的关键点。检测和评价这一因素对于DR的早期发现具有极其重要的临床意义。

Objective To examine the relationship between the glomerular filtration rate（ GFR） and prevalence of diabetic retinopathy（ DR） in patients with type 2 diabetes mellitus, and determine whether estimated GFR（ eGFR） could be used as a predictor of DR. Methods A total of 1613 T2 DM patients were included in this study. All subjects voluntarily accepted biochemical and eye examinations. A trained ophthalmologist examined the patients using ophthalmoscopy and fundus photography to diagnose DR. EmpowerStats software program was used to assess the potential relationship between DR and GFR. Results Among the 1613 participants, 550（ 34. 1%） patients suffered from DR. The patients with or without DR were grouped, statistically significant differences were detected for age,history of DM, duration of DM, fasting blood-glucose（ FBG） and2 hPG,hemoglobin A1c（ HbA1c）,total cholesterol（ TC）, systolic blood pressure（ SBP）,eGFR,Scr,high-density lipoprotein cholesterol（ HDL-C） and low-density lipoprotein cholesterol（ LDL-C）between the DR and non-DR groups. The multivariate analysis revealed that the factors associated with DR include age, duration of DM,HbA1 c, SBP,DBP,HDL-C, and eGFR. Interestingly, eGFR was negatively correlated with DR. The results of the saturation effect analysis suggested that the risk of DR in diabetic patients significantly increased when the eGFR was lower than 99. 4mL·min- 1. Conclusion eGFR is negatively correlated with DR. Our data suggests that a eGFR of 99. 4 mL·min- 1 or lower may be helpful for predicting the onset of DR in diabetic patients.Thus,the evaluation of eGFR has clinical significance for the early diagnosis of DR.