2型糖尿病患者眼脉络膜厚度与微量白蛋白尿负相关

Choroidai thickness is negatively correlated with microalbuminuria in patients with type 2 diabetes

目的探讨2型糖尿病患者眼脉络膜厚度与微量白蛋白尿之间的关系。方法回顾性收集2015年3月至2016年3月北京医院内分泌科因患2型糖尿病入院患者的临床资料，有眼科光学相干断层扫描（OCT）检查和8h尿白蛋白排泄率（UAER）结果者入组。根据8hUAER结果将患者分为微量白蛋白尿组（65例）和尿蛋白正常组（196例）。通过OCTNI]量数据计算黄斑中心凹下脉络膜厚度（SFCT）。采用ANOVA方差分析比较组间SFCT的差异，采用Logistic回归分析微量白蛋白尿与2型糖尿病相关因素以及SFCT之间的关系，采用Spearman相关分析微量白蛋白尿与SFCT的相关性。结果微量白蛋白尿组糖化血红蛋白（HbA1c）水平明显高于尿蛋白正常组『（9．5±1．9）％比（8．7±1．9）％，F=7．606，P=0．006】，两组之间内生肌酐清除率（Ccr）差异无统计学意义『（114±35）比（111±45）ml／min，F=0．387，P=0．5341。微量白蛋白尿组SFCT显著小于尿蛋白正常组[（249±91）比（289±89）μm，F=9．117，P=0．0031。Logistics回归分析显示SFCT和HbA1c对是否出现微量白蛋白尿影响最大俨值分别为0．007和0．001）。相关性分析显示SFCT与微量白蛋白尿的Spearman相关系数为-0．190（P=0．002，双侧），两者具有显著负相关性。偏相关性分析剔除HbA1c影响之后，SFCT与微量白蛋白尿的相关系数为～0．194（P=0．002，双侧），两者仍具有显著的负相关性。结论2型糖尿病患者脉络膜厚度与微量白蛋白尿之间呈负相关，提示脉络膜厚度测定可以作为2型糖尿病患者早期肾脏病变的辅助检查方法之一。

Objective To investigate the relationship between subfoveal choroidal thickness （SFCT） and microalbuminuria in diabetic patients. Methods Clinical data of in-patients with type 2 diabetes who underwent optical coherence tomography （OCT） and g hours urinary albumin excretion rate （UAER） in department of endocrinology of Beijing Hospital from March 2015 to March 2016 were collected. All subjects were divided into normal albuminuria group （n=196） and microalbuminuria group （n=65） based on UAER. SFCT was calculated from OCT measurement. Differences of SFCT between the two groups were analyzed by ANOVA. Logistic regression and Spearman Correlation analysis were used to analyze the correlation between microalbuminuria and SFCT. Results The difference in glycated hemoglobin A,~ （HbAlo） between microalbuminuria group and normal albuminuria group was statistically significant[（9.5 ± 1.9）% vs （8.7 ± 1.9）%, F=7.606, P=0.006]. There was no significant difference of creatinine clearance rate （Ccr） between two groups [（114 ± 35） vs （111 ± 45） ml/min, F=0.387, P=0.534]. SFCT was thinner in microalbuminuria group compared with normal albumnuria group [（249±91） vs （289＋89）μm, F=9.117, P= 0.003]. Logistics regression analysis showed that SFCT and HbAlc had the most significant influence on microalbuminuria （P=0.007 and P=0.001, respectively）. Correlation analysis showed that Spearman correlation coefficient of SFCT and microalbuminuria was - 0.190 （P=0.002, two tailed）, indicating significant negative correlation. After eliminating HbAIo, partial correlation analysis showed the correlation coefficient of SFCT and microalbuminuria was - 0.194 （P=0.002, two tailed）, still indicating significant negative correlation. Conclusion There is a strong negative correlation of SFCT and microalbuminuria in type 2 diabetes patients which suggesting that SFCT may become a useful diagnostic marker for early phase of diabetic nephropathy.