2型糖尿病视网膜病变相关危险因素分析

Analysis of Risk Factors for Diabetic Retinopathy in Type 2 Diabetes Patients

目的探讨不同性别2型糖尿病(T2DM)患者视网膜病变(DR)发生的危险因素。方法回顾性分析2015年1月至2016年12月南京医科大学附属无锡人民医院内分泌科收治的2682例住院T2DM患者的临床资料,其中确诊合并DR的所有资料完整的T2DM患者共1323例(男712例、女611例)作为研究组(DR组);选取同期住院性别、年龄匹配但无DR的1359例(男740例、女619例)T2DM患者作为对照(非DR组)。比较不同性别DR组和非DR组的临床资料及其他糖尿病慢性微血管并发症情况,分析DR的危险因素。结果男性DR组吸烟史、糖尿病病程、糖化血红蛋白(HbA 1c)、空腹血糖(FBG)、餐后2 h血糖(2 h PG)、高血压病史、高血压病程、收缩压、舒张压、他汀服用史、三酰甘油(TG)、尿酸(UA)、血清肌酐(Scr)、胱抑素C(CysC)及糖尿病周围神经病变(DPN)、蛋白尿发生率均高于非DR组(P<0.05),DR组糖尿病起病年龄、空腹C肽(FC)、餐后2 h C肽(2 h CP)、估算的肾小球滤过率(eGFR)低于非DR组(P<0.05)。女性DR组糖尿病病程、HbA 1c、FBG、2 h PG、高血压病史、收缩压、他汀服用史、TG、低密度脂蛋白胆固醇(LDL-C)、UA、Scr、CysC、DPN及蛋白尿发生率均高于非DR组(P<0.05),DR组糖尿病起病年龄、FC、2 h CP、eGFR低于非DR组(P<0.05)。Logistic回归分析显示:男性和女性T2DM患者糖尿病起病年龄低、蛋白尿及DPN存在均为DR发生的危险因素(P<0.05),吸烟史、他汀服用史、高TG血症、eGFR及2 h CP值低为男性DR发生的其他危险因素,而糖尿病病程长及LDL-C控制不佳是女性DR发生的其他危险因素(P<0.05)。结论不同性别T2DM患者的DR发生均与多种临床危险因素相关,但存在差异,临床工作中应制订定不同的策略,针对性地进行干预。

Objective To analyze risk factors in different gender for diabetic retinopathy(DR)in patients with type 2 diabetes mellitus(T2DM).Methods From Jan.2015 to Dec.2016,the clinical data of 2682 inpatients with T2DM in Endocrinology Department of Wuxi People′s Hospital Affiliated to Nanjing Medical University were retrospectively analyzed.These patients were divided into four groups based on the results of DR examination and gender(DR group male 712 cases,female 611 cases;non-DR group male 740 cases,female 619 cases).Their basic clinical data and other diabetic chronic microvascular complications in different groups were compared,and the DR risk factors were analyzed.Results The history of smoking,the course of diabetes,the history of glycosylated hemoglobin(HbA1c),fasting blood glucose(FBG),2 h postprandial blood glucose(2 h PG),hypertension history,the course of hypertension,systolic blood pressure,diastolic blood pressure,statins usage history,triglyceride(TG),uric acid(UA),serum creatinine(Scr),cystatin C(CysC)and diabetic peripheral neuropathy(DPN),albuminuria in male DR group were all higher than those in non-DR group(P<0.05),and diabetes onset age,fasting C-peptide(FC),2 h postprandial C-peptide(2 h CP),estimated glomerular filtration rate(eGFR)of the DR group were lower than those of the non-DR group(P<0.05).Course of diabetes,HbA 1c,FBG,2 h PG,hypertension history,systolic blood pressure,statin usage history,TG,low-density lipoprotein cholesterol(LDL-C),UA,Scr,CysC,DPN and albuminuria in the female DR group were all higher than those of the non-DR group(P<0.05),and diabetes onset age,FC,2 h CP,eGFR were lower than those of the non-DR group(P<0.05).Logistic regression analysis showed that the low onset age of diabetes,the existence of albuminuria and DPN were the risk factors of DR regardless of gender(P<0.05);the history of smoking,the history of statins usage and hyper TG,low eGFR and 2 h CP were other risk factors for DR in men,while the long course of diabetes and poor control of LDL-C were the other risk factors of DR in women(P<0.05).Conclusion DR is related to many clinical risk factors regardless of the gender,but the risk factors are not completely the same.It is important to adopt appropriate control strategies according to the specific conditions.