无微量清蛋白尿存在的2型糖尿病患者视网膜病变危险因素分析

Analysis of risk factors for diabetic retinopathy without proteinuria in type 2 diabetic patients

目的糖尿病视网膜病变(DR)是糖尿病患者最主要的慢性微血管并发症之一。文中探讨无微量清蛋白尿存在的2型糖尿病(T2DM)患者DR发生、发展的相关危险因素。方法回顾性分析2015年1月至2018年12月于南京医科大学附属无锡人民医院内分泌科住院并诊断为单纯性糖尿病视网膜病变(仅DR,无糖尿病周围神经病变存在及尿微量清蛋白)的T2DM患者169例(DR组),并选取同期住院年龄、性别匹配的无微血管并发症的患者208例作为对照(NO-DR组),比较2组患者临床基本资料情况。DR危险因素的分析采用二分类多因素logistic回归分析法。DR组按照眼底检查结果分为轻度非增殖性糖尿病视网膜病变(NPDR)组(60例)、中度NPDR组(82例)和重度DR组(27例),其中重度DR组包括重度NPDR 20例及增殖性糖尿病视网膜病变(PDR)7例。各危险因素与DR分期相关性行Spearman等级相关分析。结果DR组患者的糖尿病病程、糖化血红蛋白、收缩压、舒张压、餐后血糖、三酰甘油、血肌酐、胱抑素C及他汀服用率显著高于NO-DR组(P<0.05);DM起病年龄、肾小球滤过率(GFR)值、空腹C肽、餐后C肽低于NO-DR组(P<0.05)。Logistic回归分析显示,GFR降低(OR:0.912,P≤0.001)、高TG血症(OR:1.369,P<0.05)、SBP升高(OR:1.041,P<0.01)及起病年龄低下(OR:0.914,P≤0.001)为DR发生的危险因素。相关性分析结果显示,GFR与DR程度呈负相关(r=-0.513,P<0.001),三酰甘油(r=0.110,P<0.033)及收缩压(r=0.231,P<0.001)与DR程度均呈正相关。结论除传统因素外,低起病年龄是T2DM患者单纯性DR发生的高危因素。eGFR下降、三酰甘油升高及收缩压控制不佳不仅与DR的发生相关,还与其进展有关。eGFR下降早于蛋白尿发生,是DR发生的预警因子。

Objective To analyze risk factors for diabetic retinopathy without proteinuria in type 2 diabetic patients.Methods The clinical data of type 2 diabetic patients were retrospectively analyzed.These patients were divided into two groups based on the results of fundus examination.Basic clinical data were compared in simple diabetic retinopathy(DR,without albumin-uria and DPN)group including 169 cases and non-diabetic retinopathy(NO-DR,without microvascular complications)group including208 cases.Logistic regression analysis was used to analyze the risk factors of DR.Among DR,60 patients were mild non-proliferation DR(NPDR),82 patients were moderate NPDR,20 patients were severe NPDR and 7 patients were proliferation DR(PDR).Severe NPDR and PDR were combined into severe DR group.The correla-tion between risk factors and DR staging were analyzed by Pearsoncorrelation analysis.Results The results showed that duration of diabetes,HbA1 c,systolic blood pressure,diastolic blood pres-sure,postprandial blood glucose,triglyceride,serum creatinine,cystatin C and ratio of statin were higher in DR group,but age at on-set of diabetes,CKD-EPI formula estimated GFR,fasting c-peptide and postprandial c-peptide were lower in DR group than that in NDR group(P<0.05).Logistic regression analysis showed that young age at onset of diabetes(OR:0.914,P≤0.001),hypertriglyceri-demia(OR:1.369,P<0.05),high systolic pressure(OR:1.041,P<0.01)and reduced GFR(OR:0.912,P≤0.001)were the risk fac-tors of DR.Pearson correlation analysis demonstrated that GFR was negatively correlated to DR staging(r=-0.513,P<0.001),TG(r=0.110,P<0.033)and SBP(r=0.231,P<0.001)were positive correlated to DR staging.Conclusion In addition to the traditional factors,simple diabetic retinopathy in type 2 diabetic patients was related to young age at onset of diabetes,high systolic pressure,hy-pertriglyceridemia and reduced eGFR.eGFR decline occurred before the proteinuria and associated with the development of DR was a predicted factor of DR.