2型糖尿病患者糖尿病视网膜病变与实验室检验指标的相关性研究

The Relationship Between Diabetic Retinopathy and Laboratory Indexes in Patients with Type 2 Diabetes Mellitus

目的探讨2型糖尿病患者实验室检验指标与2型糖尿病视网膜病变(DR)进展的相关性。方法回顾提取解放军总医院医疗大数据平台2013年至2017年51023例2型糖尿病患者数据资料,分为NDR(无DR)组、BDR(背景期DR)组和PDR(增殖期DR)组,对各组间患者的基本资料及37项实验室检验指标进行统计学比较分析。结果BDR组和PDR组收缩压和舒张压较NDR组高;DR患者中,尤其PDR组,平均年龄更低,女性、未婚者、农村居住人口、不稳定职业者之中DR所占比率更高(均P<0.01)。37项实验室检验指标水平在NDR、BDR与PDR三组间的差异均具有统计学意义(均P<0.01):①空腹及餐后2h血糖、糖化血红、血清蛋白值、三酰甘油、血尿素氮、血清肌酐、纤维蛋白原和磷脂在BDR组最高;②血清C肽值、尿肌酐值、总胆红素、直接胆红素、总蛋白、碱性磷酸酶、谷氨酰转肽酶、乳酸脱氢酶、谷丙转氨酶、谷草转氨酶值、部分活化凝血酶原时间和红细胞压积则由NDR组到BDR组、PDR组依次下降;③低密度、高密度脂蛋白值、24 h尿微量蛋白、Alb/Cr、血小板、凝血酶原活动度和血沉在组间依次增高;④白球比值在PDR组最高。Logistic回归分析中,糖化血红蛋白(OR=1.15)、血清肌酐(OR=1.13)、凝血酶原活动度(OR=1.13)、血尿素氮(OR=1.07)、纤维蛋白原(OR=1.06)和低密度脂蛋白(OR=1.05)(P<0.05)是DR的危险因素(P<0.01);而红细胞压积(OR=0.80,P<0.01)、谷氨酰胺转肽酶(OR=0.90,P<0.01)、间接胆红素(OR=0.94)、乳酸脱氢酶(OR=0.94)和年龄(OR=0.94)是DR的保护因素(P<0.05)。结论早期监测与干预2型糖尿病患者红细胞压积和代表血糖水平、肾功能、凝血功能、血脂、肝功能等的部分标志性实验室检验指标,有助于预防和延缓DR进展。

Objective To investigate the relationship between the progress of diabetic retinopathy(DR)and laboratory test indexes in patients with type 2 diabetes mellitus.Methods The dataset of 51,023 patients with type 2 diabetes from the medical big data platform of PLA General Hospital during 2013-2017 were retrospectively extracted.These patients were divided into NDR(no DR)group,background DR(BDR)group and proliferative DR(PDR)group.The general information and 37 laboratory test indexes of patients from each group were statistically analyzed.Results Compared with NDR group,systolic blood pressure and diastolic blood pressure were higher in both BDR and PDR groups;For DR patients,especially the PDR,the average age was lower,also,the proportion of DR among women,the unmarried,rural residents and unstable occupation were higher(P<0.01).The differences of 37 laboratory test indexes among NDR,BDR and PDR groups were statistically significant(P<0.01):①Indexes of fasting and 2-hour postprandial blood glucose,glycosylated hemoglobin,serum protein,triglyceride indextriglyceride index,indexes of blood urea nitrogen and serum creatinine,fibrinogen index and phospholipids index were the highest in BDR group;②Serum C-peptide index,urinary creatinine index,indexes of total bilirubin,direct bilirubin,total protein,alkaline phosphatase,glutamyltranspeptidase,lactate dehydrogenase,alanine aminotransferase,aminotransferase and glutamic oxaloacetic transaminase,the time of partially activated prothrombin index and hematocrit index decreased from NDR group to BDR group and PDR group gradually(P<0.01);③Indexes of low-density lipoprotein and high-density lipoprotein,indexes of 24-hour urinary microprotein and ALB/Cr,indexes of the activity of platelet and prothrombinindexes of the activity of platelet and prothrombin and erythrocyte sedimentation rate increased gradually among groups(P<0.01);④The ratio of white blood cell was the highest in PDR group(P<0.01).Logistic regression analysis showed that glycosylated hemoglobin(OR=1.15),serum creatinine(OR=1.13),prothrombin activity(OR=1.13),blood urea nitrogen(OR=1.07),fibrinogen(OR=1.06)and low density lipoprotein(OR=1.05,P<0.05)were all risk factors for DR(P<0.01),while hematocrit(OR=0.80,P<0.01),glutamine transferase(OR=0.90,P<0.01),indirect bilirubin(OR=0.94),lactate dehydrogenase(OR=0.94)and age(OR=0.94)were protective factors(P<0.05).Conclusion Early monitoring and intervention of hematocrit and some laboratory markers representing blood glucose level,renal function,coagulation function,blood lipid and liver function in patients with type 2 diabetes are helpful to prevent and delay the development and progress of DR.