糖尿病视网膜病变的相关危险因素分析

Analysis of the related risk factors of diabetic retinopathy

目的对糖尿病视网膜病变的高危因素进行探讨，为糖尿病视网膜病变的发病机制及防治提供科学依据。方法临床病例回顾性系列研究。收集吉林省四平市中心医院自2012年2月至2013年1月内分泌科诊断为2型糖尿病的患者126例，经眼科医师进行“眼底检查及荧光素眼底血管造影”，将其分为无糖尿病视网膜病变组（NDR组）51例和糖尿病视网膜病变组（DR组）75例，详细记录两组患者的病史、年龄、性别、血压、血糖、病程等基本信息，并对其监测空腹血糖、餐后2h血糖（2hBG）、糖化血红蛋白（HbAlc）、甘油三酯（TG）、血清总胆固醇（TC）、高、低密度脂蛋白（HDL、LDL）、收缩压（SBP）、舒张压（DBP）、24h尿微量蛋白、血尿素（BU）、血肌酐（cr）等指标。比较两组间差异，并通过多因素分析方法分析各因素与糖尿病视网膜病变之间的相关性。结果糖尿病视网膜病变的发生率为59．5％。糖尿病视网膜病变组的病程、年龄、收缩压、舒张压、空腹血糖、甘油三酯与低密度脂蛋白在糖尿病视网膜病变患者与无视网膜病变患者问差异有统计学意义（P〈0．05）。将单因素分析统计学意义的相关因素血压、空腹血糖、甘油三酯采用Logistic回归模型进行多因素分析。结果显示，空腹血糖和甘油三酯与糖尿病视网膜病变的关系仍然具有显著性，差异有统计学意义（P〈0．05），空腹血糖与甘油三酯是糖尿病视网膜病变的危险因素，OR分别为4．210（95％cI：1．612，10．997）、1．562（95％CI：1．021，2．391）。结论（1）四平市中心医院126例患者糖尿病视网膜病变的发生率为59．5％。（2）病程、年龄、收缩压、舒张压、空腹血糖、甘油三酯与低密度脂蛋白在糖尿病视网膜病变患者与无视网膜病变患者差异有统计学意义。（3）糖尿病视网膜病变的发生与空腹血糖和甘油三酯有关，空腹血糖和甘油三酯是糖尿病视网膜病变的危险因素。

Objective To discuss the risk factors of diabetic retinopathy, and offer intervening measures, to provide scientific evidence for causes and pathogenesis of diabetic retinopathy and also provide comprehensive prevention and control. Methods A total of 126 patients diagnosed Type 2 diabetes mellitus by endocrinologist were collected from Hospital of Siping City, Jilin Province be- tween February 2012 and January 2013, who were then divided into NDR group （51 patients） and DR group （75 patients） through fluorescence fundus angiography operated by ophthalmologist. Basic data such as medical history, age, gender, blood glucose were recorded in details. Other indicators such as fasting blood-glucose （FBG）, postprandial blood glucose 2H （2hBG）, glycated hemoglobin （HbAlc）, triglycerides （TG）, total cholesterol （TC）, high and tow density lipoprotein （HDL and LDL）, systolic blood pressure （SBP）, diastolic blood pressure （DBP）, 24-hour urine protein, blood urea nitrogen （BUN）, creatinine （Cr） were also monitored. Differences between two groups were com- pared. The correlationship between various factors and diabetic retinopathy was analyzed by multivari- ate analysis. Result The incidence of diabetic retinopathy was 59.5%. There Were significant differ- ence between diabetic patients with retinopathy and those without retinopathy （P 〈0.05） in thecourse of disease, age, systolic pressure, diastolic pressure, fasting blood-glucose, triglycerides, low density lipoprotein. Uni- variate analysis was statistically significant factors related to blood pressure, fasting blood glucose, triglycerides using multi- factor-analyses logistic regression models. Results display that blood pressure, fasting blood-glucose and triglycerides had significant relationship with diabetic retinopathy. Fasting blood-glucose and triglycerides were the risk factors of diabetic ret- inopathy （P 〈0.05）, OR ratios were 4.210 （95CI%： 1.612, 10.997）, 1.562 （95CI%： 1.021, 2.391）. Conclusions The inci- dence of diabetic retinopathy of 126 patients from Siping is 59.5%. The course of disease, age, systolic pressure, diastolic pressure, fasting blood-glucose, triglycerides, low density lipoprotein are significantly different between NDR group and DR group. The occurrence of DR has a relationship with fasting blood-glucose and triglycerides, they are the risks factor of diabetic retinopathy.