二十二碳六烯酸与糖尿病视网膜病变的关联性

Association between Docosahexaenoic Acid Intensity and the Presence of Diabetic Retinopathy

目的:探讨二十二碳六烯酸(DHA)与糖尿病视网膜病变(DR)的关联性,为DR人群筛查及其二级预防提供依据。方法:多中心病例对照研究。纳入温州医科大学和安徽医科大学的2个附属医院年龄≥35岁的2型糖尿病患者197例,由专业医师根据其眼底检查结果诊断为DR 83例(病例组)和单纯糖尿病114例(对照组),采用倾向性评分匹配(1∶1)以控制主要混杂因素的影响。DHA检测使用超高液相色谱质谱联用系统,局部加权回归和多元条件Logistic回归模型分析DHA与DR的关联性,森林图显示各亚组间的异质性检验及与DHA交互作用的结果。结果:最终入选69对研究对象,其中DR患者的DHA水平显著低于对照组(t=3.68,P<0.001),DHA每增加一个四分位数间距,DR患病风险平均降低53%(OR:0.47;95%CI:0.30,0.73),提示DHA与DR患病风险间存在明显的负相关关系,亚组分析结果显示,年龄、性别、体质量指数、糖尿病病程、血压、吸烟及饮酒均不会明显改变DHA与DR间的关联性(P>0.05)。结论:DHA与DR的发生密切相关,是DR的独立保护因素,并有可能可以用于DR的大规模人群筛查并指导其二级预防工作。

Objective:To investigate the association of docosahexaenoic acid(DHA)with the presence of diabetic retinopathy(DR).Methods:This was a multiple-center,hospital-based,case-control study.A total of 197 type 2 diabetes mellitus(T2D)patients aged no less than 35 years old were enrolled from two affiliated hospitals of Wenzhou Medical University and Anhui Medical University.Depending on the fundus photos,they were classified into T2D(controls)and T2D combined with DR(cases).Based on propensity score matching,at a ratio of 1:1,by age,sex,body mass index and glycated hemoglobin,69 pairs of cases and controls were included in the final data analysis.The intensity of DHA was determined using the ultra-performance liquid chromatography-electrospray ionization-tandem mass spectrometry(UPLC-ESI-MS/MS)system.Multiple locally weighted regression and conditional logistic regression models were applied to comprehensively assess the association between DHA and the presence of DR.In addition,the results of a heterogeneity test and the interaction of DHA and the subgroups were displayed by a forest map.Results:A total of 69 pairs of cases and controls were included in the present study.The intensity of DHA in the cases was significantly lower than that of the controls(t=3.68,P=0.001).After adjusting for potential confounding factors including age,triglyceride,hypertension and diabetes duration,the prevalence of DR was significantly reduced by 53%(odds ratio:0.47;95%confidence interval:0.30,0.73)with a per interquartile range elevation of DHA.As is shown in the forest map,associations of DHA with the odds of DR were consistent in each subgroup and no interaction effects between the subgroups and DHA were observed.Conclusions:DHA is an independent protective factor of DR and significantly associated with its initiation and progression.Our findings emphasize the clinical and public policy relevance of early screening for DR as well as its secondary prevention,which perhaps should be confirmed by additional large,longitudinal studies.