HbA1C变异性的影响因素及其对2型糖尿病视网膜病变的作用

The influencing factors of HbA1C variability and its effect on diabetic retinopathy in patients with type 2 diabetes

目的评估2型糖尿病患者HbA1C变异性与糖尿病视网膜病变(DR)的关系以及探讨HbA1C变异性的影响因素。方法2型糖尿病患者每年进行散瞳眼底扩张检查,依据检查结果分为有视网膜病变(DR)组597例,无视网膜病变(NDR)组2789例,平均随访4年(2~5年)。根据患者所有记录的HbA1C测量值计算其平均值(A1C-Mean)和标准差(A1C-SD),其中HbA1C变异性表达为A1C-SD。收集并分析所有患者的病史和临床资料。根据A1C-Mean高于或低于7%和A1C-SD高于或低于总体均值0.76%,患者被分为4组:Q1(A1C-Mean<7%,A1C-SD<0.76%);Q2(A1C-Mean<7%,A1C-SD≥0.76%);Q3(A1C-Mean≥7%,A1C-SD<0.76%);Q4(A1C-Mean≥7%,A1C-SD≥0.76%)。结果多元线性回归结果显示,运动、胰岛素的使用(P<0.01)、吸烟(P=0.004)为HbA1C变异性的影响因素。Cox回归分析中,校正年龄、性别、病程后,结果显示A1C-SD(HR=1.303,P<0.01)是DR的独立危险因素。对患者进行分层后发现Q4组患者发生DR风险最高(HR=1.676,P<0.01),而Q1组患者最低。另外,Q2组患者(HR=1.437,P=0.005)发生DR的风险高于Q3组患者(HR=1.361,P<0.01)。结论HbA1C变异性是2型糖尿病患者DR的独立危险因素,并且当A1C-SD总体均值>0.75%时,可能在DR的发生发展中发挥着比平均HbA1C更大的作用。

Objective To investigate the relationship between HbA1C variability and diabetic retinopathy(DR)in patients with type 2 diabetes and to explore the influencing factors of HbA1C variability.Methods Type 2 diabetic patients who received dilated funduscopic examination annually,were stratified into two groups based on the presence or absence of DR,with a median follow-up period of 4 years(2-5 years).Intrapersonal means and SDs of all recorded HbA1C measurements were calculated.A1C-SD represented the measure of HbA1C variability.In addition,medical history and clinical data of all subjects were collected and analyzed.Subjects were divided into four quartiles based on their A1C-Mean and A1C-SD data:Q1(A1C-Mean<7%,A1C-SD<0.76%);Q2(A1C-Mean<7%,A1C-SD≥0.76%);Q3(A1C-Mean≥7%,A1C-SD<0.76%);Q4(A1C-Mean≥7%,A1C-SD≥0.76%).Results Multivariate linear regression showed that exercise,insulin(P<0.01),and smoking(P=0.004)are the influencing factors of HbA1C variability.Adjusted for age,sex,and diabetes duration,Cox regression analysis revealed that HbA1C variability was an independent risk factor for DR.Meanwhile,patients in Q4 group had the highest DR prevalence(HR=1.676,P<0.01)while Q1 group had the lowest.In addition,patients in Q2 group(HR=1.437,P=0.005)had a higher risk of DR than those in Q3 group(HR=1.361,P<0.01).Conclusions HbA1C variability is an independent predictor of DR in patients with type 2 diabetes.It may play a greater role in DR development than mean HbA1C does when the mean value of HbA1C variability index is above 0.75%.