血清1,5-脱水葡萄糖醇——新疆地区2型糖尿病视网膜病变的危险因素

1,5-anhydroglucitol:a risk factor of retinopathy in patients with type 2 diabetes mellitus in Xinjiang autonomous region

目的探讨血清1，5-脱水葡萄糖醇（1，5-AG）是否为新疆地区糖尿病视网膜病变（DR）的危险因素。方法收集2012-2014年在新疆医科大学第一附属医院门诊就诊的2型糖尿病（T2DM）患者556例，分为DR组和非DR组，检测两组患者血清1，5-AG、糖化血红蛋白（HbA4c）、随机血糖（RBG）、血尿素氮（BUN）、尿酸（UA）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、总胆固醇（TC）和肌酐（cr）等生物化学指标。结果两组间的年龄，性别和民族构成，以及有无T2DM家族史和心脑血管病史的差异均无统计学意义（P值均〉0．05）；DR组患者的T2DM病程显著长于非DR组（P〈0．01），有高血压史患者的构成比显著高于非DR组（P〈0．01）。DR组患者的血清1，5-AG水平显著低于非DR组（P〈0．05）。DR组患者的胱抑素C（CysC）、RBG、果糖胺（FMN）和HbA4c水平均显著高于非DR组（P值分N〈0．05、0．01）。在新疆地区T2DM人群中，性别、民族、T2DM家族史、心脑血管病史、年龄，以及FMN、CysC、RBG水平与DR发病均不相关（P值均〉0．05）；高血压史（OR=4．137，95％CI为1．44911．810）、HbA1c（OR=1．582，95％CI为1．155-2．167）、T2DM病程（OR=1．736，95％CI为1．545-4．838）和血清1，5-AG水平（OR=0．981，95％CI为0．969-0．993）均与DR发病相关（P值均〈0．01）。血清1，5-AG水平的R0c的AUC为0．712，阳性界值为76．40，灵敏度和特异度分别为71．4％和60．7％。结论高血压史、Hb＆c、T2DM病程和血清1，5-AG水平与DR发病密切相关，血清1，5-AG可作为新疆地区DR发生的危险因素。

Objective To explore whether 1,5-anhydroglucitol （1,5-AG） is a risk factor of diabetic retinopathy （DR） in Xinjiang autonomous region. Methods A total of 556 outpatients with type 2 diabetes mellitus （T2DM） visiting our hospital from 2012 to 2014 were divided into DR group and non-DR group. Serum 1,5-AG, glycosylated hemoglobin （HbAlc）, random blood glucose （RBG）, blood urea nitrogen （BUN）, uric acid （UA）, high density lipoprotein-cholesterol （HDL-C）, low density lipoprotein-cholesterol （LDL-C）, triglycerides （TC）, creatinine （Cr） and other indicators were tested. Results There were no significant differences in terms of gender, age, nationality, family history of T2DM, or cardio-cerebrovascular disease history between two groups （all P〈0.05）. There were more patients with hypertension history and patients had a longer T2DM duration in DR group than non-DR group （both P〈0.01）. Serum 1,5-AG in DR group was significantly lower than that in non-DR group （ P〈0.05）, while the levels of cystatin C （CysC）, RBG, fructosamine （FMN） and HbA1c in DR group were significantly higher than those in non-DR group （P〈0.05, 0.01）. Gender, nationality, family history, cardiocerebrovascular disease history, age, and the levels of FMN, CysC and RBG were not associated with DR （all P〉0. 05）, while hypertension history （ OR = 4. 137,95 % CI = 1. 449 - 11.810）, HbA1 c （ OR = 1. 582,95 % CI = 1. 155-11.2. 167）, T2DM duration （OR =2. 736,95% CI = 1. 545-4. 838） and 1,5-AG level were significantly associated with DR in Logistic regression analysis （all P〈0. 01）. The area under the ROC curves of serum 1,5-AG （ OR = 0.981,95 % CI = 0. 969 - 0. 993） was 0.712, with the sensitivity being 71.4 %, specificity being 60.7% and positive value being 76.40. Conclusion There are close correlation between DR and hypertension history, HbA1c, T2DM duration, serum 1,5-AG. Serum 1,5-AG may be considered as a risk factor of DR in Xinjiang autonomous region.