2型糖尿病视网膜病变的风险评估:基于血清1,5-脱水葡萄糖醇的研究

Risk Assessment of Diabetic Retinopathy in Xinjiang: Based on 1,5- AG

目的基于1,5-脱水葡萄糖醇(1,5-AG)的检测,应用Logistic回归方程分析新疆地区糖尿病视网膜病变(DR)的危险因素,并建立风险概率方程。方法选取2012—2014年在新疆医科大学第一附属医院就诊的新疆地区T2DM患者556例,通过眼底检查将T2DM患者分为T2DM并发DR组252例和T2DM非DR组304例,抽取患者静脉血,检测高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A(Apo A)、载脂蛋白B(Apo B)、脂蛋白(α)〔Lp(α)〕、总胆固醇(TC)、尿素(Urea)、肌酐(Cr)、尿酸(UA)、半胱氨酸蛋白酶抑制剂C(Cys-C)、空腹血糖(FBG)、糖化血红蛋白(Hb A1c)、黄素单核苷酸(FMN)和1,5-AG。采用Logistic回归逐步向前法,分析T2DM患者发生DR的影响因素,拟合出Logistic回归概率方程,并以Hosmer-Lemeshow拟合优度检验和回代检验法考察方程的拟合效果。结果两组患者性别、年龄、HDL-C、LDL-C、Apo A、Apo B、Lp(α)、TC、Urea、Cr、UA和汉族比例、T2DM家族史、心脑血管病史比较,差异均无统计学意义(P>0.05);两组患者T2DM病程、Cys-C、FBG、Hb A1c、FMN、1,5-AG和高血压患病率比较,差异均有统计学意义(P<0.05)。Logistic回归分析结果显示,高血压、T2DM病程、Hb A1c、1,5-AG为DR发生的影响因素(P<0.05)。基于Logistic回归分析结果,建立拟合的风险概率方程Logit(P)=-4.723+0.459(Hb A1c)+1.420(高血压)+1.006(T2DM病程)-0.019(1,5-AG)。回归方程检验χ2=7.732,P=0.005;Hosmer-Lemeshow拟合优度检验χ2=8.961,P=0.346;同时,回代检验符合率为78.0%,方程评价效能较好。风险概率方程诊断DR的ROC曲线下面积为0.86,最佳诊断点为0.42,灵敏度为83.9%,特异度为77.1%。结论 T2DM病程、高血压、Hb A1c以及1,5-AG为新疆地区DR发生的危险因素,概率方程的建立有利于对T2DM患者发生DR的风险进行评估,对于减少新疆地区T2DM人群DR的发病具有一定临床意义。

Objective This study used Logistic regression analysis,based on 1,5- anhydroglucitol（ 1,5- AG）,to analyze the risk factors of diabetic retinopathy（ DR） in Xinjiang,to establish risk probability equation. Methods From 2012 to 2014, in the First Affiliated Hospital of Xinjiang Medical University,556 T2DM patients were divided, by fundus examination,into groups A（ T2DM complicated by DR, n = 252）,B（ T2DM without DR, n = 304）. Venous blood was drawn to detect the levels of high- density lipoprotein cholesterol（ HDL- C）,low- density lipoprotein cholesterol（ LDL- C）,apolipoprotein A（ Apo A）, apolipoprotein B（ Apo B）, lipoprotein（ a） 〔Lp（ α） 〕, total cholesterol（ TC）, urea,creatinine（ Cr）,uric acid（ UA）,cystatin C（ Cys- C）,fasting blood glucose（ FBG）,glycosylated hemoglobin（ Hb A1c）,Flavin mononucleotide（ FMN）,1,5- AG. This study used Logistic stepwise forward method to analyze the factors influencing DR development in T2DM patients,to fit Logistic regression probability equation and used Hosmer- Lemeshow test of goodness of fit and back substitution method to explore the fitting effect of the equation. Results There was no significant difference in gender,age,HDL- C,LDL- C, Apo A, Apo B, Lp（ α）, TC, Urea, Cr, UA, Han nationality,T2DM family history,cardiovascular disease history between 2 groups（ P〈0. 05）,and there was in T2DM duration,Cys- C,FBG,Hb A1 c,FMN,1,5- AG and hypertension prevalence（ P〈0. 05）. Logistic regression analysis showed that hypertension,T2DM duration,Hb A1 c,1,5- AG were factors influencing DR development（ P〈0. 05）. The risk probability fitting equation based on Logistic regression analysis Logit（ P） =- 4. 723 ＋ 0. 459（ Hb A1c） ＋ 1. 420（ hypertension） ＋ 1. 006（ T2DM duration）- 0. 019（ 1,5- AG）. Regression test χ2= 7. 732,P = 0. 005; Hosmer- Lemeshow test of goodness of fit χ2= 8. 961,P = 0. 346;back substitution coincidence rate was 78. 0%, the assessment efficacy was good. The ROC curve under the area of risk probability equation diagnosing DR was 0. 86,the best diagnosis point was 0. 42,the sensitivity was 83. 9%,specificity was 77. 1%. Conclusion T2DM duration,hypertension,Hb A1 c,1,5- AG are the risk factors of DR development in Xinjiang.The establishment of probability equation is in favor of DR risk assessment,which is of some significance in reducing the DR development of T2DM patients in Xinjiang.