2型糖尿病病人估算肾小球滤过率与糖尿病视网膜病变的相关性研究

Correlation between estimated glomerular filtration rate and diabetic retinopathy in type 2 diabetic patients

目的探讨2型糖尿病病人估算肾小球滤过率(eGFR)与糖尿病视网膜病变(DR)的相关性。方法2018年10月至2019年4月武汉大学人民医院内分泌科收治的204例2型糖尿病病人,根据其是否并发糖尿病视网膜病变,将其分为无视网膜病变(NDR)组88例,视网膜病变(DR)组116例。分别对两组研究对象的预估肾小球滤过率(eGFR)、糖化血红蛋白(HbA1c)、空腹血糖(FPG)等生化指标进行检测,对比分析两组研究对象的检测水平。Spearman相关性分析分析eGFR与DR危险因素的相关性。logistic回归分析eGFR与DR发生的相关性。结果DR组HbA1c为9.65(7.93,11.15)mmol/L、尿素(urea)为6.12(4.73,7.66)mmol/L、血清肌酐(Scr)为62.00(53.00,93.50)μmol/L、尿酸(UA)为360.00(309.25,429.50)μmol/L、收缩压(SBP)为(133.19±18.46)mm Hg,较NDR组(8.19±1.70)mmol/L、(5.30±1.39)mmol/L、(57.64±15.40)μmol/L、304.00(261.00,347.50)μmol/L、(126.98±13.90)mm Hg显著升高;DR组ALB为40.60(38.50,42.50)g/L、eGFR为96.79(72.17,107.45)m L/min较NDR组白蛋白41.60(39.60,44.60)g/L、(107.67±13.97)m L/min显著降低,均差异有统计学意义(P<0.05)。Spearman相关性分析显示,eGFR与年龄(r_(s)=-0.422)、HbA1c(r_(s)=-0.336)及SBP(r_(s)=-0.190)呈显著的负相关(P<0.05)。多因素logistic回归分析显示eGFR、HbA1c、ALB、urea、UA是DR发生的危险因素(P<0.05)。结论eGFR水平降低是2型糖尿病病人发生视网膜病变的危险因素。

Objective To investigate the correlation between estimated glomerular filtration rate(eGFR)and diabetic retinopathy(DR)in type 2 diabetes patients.Method Two hundred and four patients with type 2 diabetes admitted to Department of Endocrinology,Renmin hospital of Wuhan university from October 2018 to April 2019 were assigned into the without diabetic retinopathy group(NDR group,88 cases)and the diabetic retinopathy group(DR group,116 cases)according to whether they were complicated with diabetic retinopathy or not.Estimated glomerular filtration rate(eGFR),glycosylated hemoglobin(HbA1c),fasting plasma glucose(FPG)and other serum biochemical parameters were given to research objects in two groups.The detection levels of research objects in two groups were compared.Spearman analysis was performed to investigate the correlations between eGFR and the risk factors of DR.Logistic regression was performed to investigate the risk factor of DR.Results The levels of HbA1c[9.65(7.93,11.15)mmol/L],urea[6.12(4.73,7.66)mmol/L],serum creatinine(Scr)[62.00(53.00,93.50)μmol/L],uric acid(UA)[360.00(309.25,429.50)μmol/L],systolic blood pressure(SBP)[(133.19±18.46)mmHg]in DR group were significantly increased than the levels of HbAlc[(8.19±1.70)mmol/L],urea[(5.30±1.39)mmol/L],Scr[(57.64±15.40)μmol/L],UA[304.00(261.00,347.50)μmol/L],SBP[(126.98±13.90)mmHg]in NDR group.The levels of albumin(ALB)[40.60(38.50,42.50)g/L],eGFR[96.79(72.17,107.45)mL/min]in the DR group were significantly reduced than the levels of ALB[41.60(39.60,44.60)g/L],eGFR[(107.67±13:97)mL/min]in NDR group,and the difference was statistically significant(P<0.05).Spearman correlation analysis showed that eGFR was negatively correlated with age(r_(s)=-0.422),HbAlc(r_(s)=-0.336),SBP(r_(s)=-0.190)(P<0.05).Logistic regression analysis showed that eGFR,HbAlc,ALB,urea,UA were risk factors for the development of DR(P<0.05).Conclusion Decreased eGFR levels may be a risk factor for DR in patients with type 2 diabetes.