女性绝经后雌激素水平与糖尿病视网膜病变的相关性分析

The correlation between estrogen and diabetic retinopathy of the postmenopasual patients

目的 观察女性绝经后雌激素水平与糖尿病（DM）视网膜病变（DR）的相关性。 方法 自然绝经1年以上的39例2型DM女性患者和17位正常体检者（对照组）纳入研究。对照组受检者年龄53～82岁，平均年龄（69.80±8.32）岁。DM患者年龄56～84岁，平均年龄（70.50±8.27）岁；DM病程3～23年，平均DM病程（11.40±7.97）年。依据荧光素眼底血管造影检查结果确立DR诊断，并将DM患者分为DR组19例，无DR组（NDR组）20例。3组受检者年龄、绝经年限比较，差异无统计学意义（t=0.347、0.485，P＞0.05）。与NDR组比较，DR组患者DM病程更长，差异有统计学意义（t=2.748，P＜0.05）；空腹血糖（FBG）、糖化血红蛋白（HbA1c）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）明显增高（t=6.130、5.322、4.574、2.426、4.033），高密度脂蛋白胆固醇（HDL-C）明显降低（t=3.917），差异均有统计学意义（P＜0.05）。采用放射免疫法测定患者的雌二醇（E2）水平。对比分析3组受检者的E2水平差异。采用logistic回归分析法分析DR的影响因素。 结果 对照组、DR组与NDR组受检者E2水平分别为（42.38±8.64）、（21.49±9.81）、（32.72±10.51）pg/ml。DR组患者E2水平较NDR组、对照组受检者明显降低，差异有统计学意义（t=3.443、10.110，P＜0.05）。Logistic回归分析法结果显示，DM病程[回归系数=0.166，比值比（OR）=1.181，P=0.016]、FBG（回归系数=1.162，OR=4.014，P=0.001）、TC（回归系数=3.212，OR=10.820，P=0.002）、TG（回归系数=1.649，OR=5.203，P=0.030）和LDL-C（回归系数=1.605，OR=4.976，P=0.003）是DR的危险因素，E2（回归系数=？0.100，OR=0.904，P=0.004）、HDL-C（回归系数=？4.460，OR=0.012，P=0.002）是DR的保护因素。 结论 女性绝经后雌激素水平与DR有相关性，可能是DR的保护因素之一。

Objective To observe the correlation between postmenopausal estrogen levels and diabetic retinopathy （DR） in women. Methods Thirty-nine menopause female patients with type 2 diabetes mellitus and 17 menopause subjects （control group） were enrolled in this study. Control subjects aged from 53 to 82 years, with the mean age of （69.80±8.32） years. Diabetes mellitus patients aged from 56 to 84 years, with the mean age of （70.50±8.27） years; diabetes duration ranged from 3 to 23 years, with the average course of diabetes （11.40±7.97） years. DR diagnosis was according to the results of fundus fluorescein angiography, and thus the 39 patients were divided into DR group （19 patients） and non-DR （NDR） group （20 patients）. There was no significant difference in age and menopause duration between the three groups （t=0.347, 0.485;P〉0.05）. There was significant difference in diabetes course （t=2.748,P〈0.05）. Compared with NDR group, fasting blood glucose （FBG）, glycosylated hemoglobin （HbA1c）, total cholesterol （TC）, triglyceride （TG）, low density lipoprotein cholesterol （LDL-C） were significantly increased （t=6.130, 5.322, 4.574, 2.426, 4.033）, high density lipoprotein cholesterol （HDL-C） was significantly lower （t=3.917）, the difference was statistically significant （P〈0.05）. The level of estradiol （E2） was measured by radioimmunoassay. The differences of E2 levels between the three groups were compared. Logistic regression analysis was used to analyze the influencing factors of DR. Results The levels of E2 in control group, DR group and NDR group were （42.38±8.64）, （21.49±9.81） and （32.72±10.51） pg/ml, respectively. The level of E2 in DR group was significantly lower than that in NDR group and control group （t=3.443, 10.110;P〈0.05）. Logistic regression analysis showed that the duration of diabetes mellitus [coefficients =0.166, odds ratio （OR）=1.181,P= 0.016], FBG （coefficients=1.162,OR=4.014,P=0.001）, TC （coefficients=3.212,OR=10.820,P=0.002）, TG （coefficients=1.649,OR=5.203,P= 0.030） and LDL-C （coefficients=1.605,OR= 4.976,P=0.003） were the risk factors for DR; E2 （coefficients=？0.100,OR=0.904,P=0.004） and HDL-C （coefficients=？4.460,OR=0.012,P=0.002） were the protective factors for DR. Conclusion The estrogen level of postmenopausal women have a certain correlation with the development of DR, it may be one of the protective factor of DR.