葡萄糖目标范围内时间和糖化血红蛋白水平与糖尿病视网膜病变风险的相关性研究

Study on the correlation between the time within the glucose target range,the level of glycosylated hemoglobin and the risk of diabetic retinopathy

目的观察并分析葡萄糖目标范围内时间(TIR)和糖化血红蛋白(HbA1c)与糖尿病视网膜病变(DR)发生风险的相关性。方法回顾性临床研究。2020年3月至2021年8月于潍坊医学院附属医院内分泌代谢病科住院治疗的2型糖尿病(T2DM)患者91例纳入研究。所有患者均行欧堡免散瞳超广角激光扫描检眼镜、HbA1c及持续葡萄糖监测(CGM)检查。根据检查结果同时结合DR临床诊断标准,将患者分为无DR(NDR)组、DR组,分别为50、41例。采用回顾性CGM系统行连续7~14 d皮下组织间液葡萄糖监测,计算TIR。二元logistic回归分析法分析T2DM患者TIR、HbAlc与DR的相关性;同时生成一个新的指标即预测概率值(PRE_1),以代表TIR和HbA1c预测发生DR的联合指标。采用受试者工作特征曲线(ROC曲线)分析TIR、HbAlc和PRE_1预测DR发生的价值。结果NDR组、DR组患者TIR分别为(81.58±15.51)%、(67.27±22.09)%,HbA1c分别为(8.03±2.16)%、(9.01±2.01)%。两组患者TIR、HbA1c比较,差异均有统计学意义(t=3.501、-2.208,P=0.001、0.030)。二元logistic回归分析结果显示,TIR、HbA1c与DR呈显著相关(比值比=0.960、1.254,P=0.002、0.036)。ROC曲线分析结果显示,TIR、HbA1c和PRE_1预测发生DR风险的ROC曲线下面积(AUC)分别为0.704、0.668、0.707[95%可信区间(CI)0.597~0.812,P=0.001;95%CI 0.558~0.778,P=0.006;95%CI 0.602~0.798,P=0.001)。TIR、HbA1c和PRE_1预测发生DR风险的AUC之间之间两两比较,差异均无统计学意义(P>0.05)。HbAlc与TIR之间的线性方程为HbAlc(%)=11.37-0.04×TIR(%)。结论TIR、HbA1c均与DR相关且均可预测发生DR的风险,两者联合使用对发生DR的预测价值并无提高。TIR与HbAlc存在线性相关关系。

Objective To observe and analyze the correlation between time within target glucose range(TIR)and hemoglobin A1c(HbA1c)and the risk of diabetic retinopathy(DR).Methods A retrospective clinical study.From March 2020 to August 2021,91 patients with type 2 diabetes mellitus(T2DM)who were hospitalized in Department of Endocrinology and Metabolic Diseases,Affiliated Hospital of Weifang Medical University,were included in the study.All patients underwent Oburg's no-dilatation ultra-wide-angle laser scan ophthalmoscopy,HbA1c and continuous glucose monitoring(CGM)examinations.According to the examination results and combined with the clinical diagnostic criteria of DR,the patients were divided into non-DR(NDR)group and DR group,with 50 and 41 cases respectively.The retrospective CGM system was used to monitor the subcutaneous interstitial fluid glucose for 7 to 14 consecutive days,and the TIR was calculated.Binary logistic regression was used to analyze the correlation between TIR,HbAlc and DR in patients with T2DM0.At the same time,a new indicator was generated,the predicted probability value(PRE_1),which was generated to represent the combined indicator of TIR and HbA1c in predicting the occurrence of DR.The receiver operating characteristic curve(ROC curve)was used to analyze the value of TIR,HbAlc and PRE_1 in predicting the occurrence of DR.Results The TIR of patients in the NDR group and DR group were(81.58±15.51)%and(67.27±22.09)%,respectively,and HbA1c were(8.03±2.16)%and(9.01±2.01)%,respectively.The differences in TIR and HbA1c between the two groups of patients were statistically significant(t=3.501,-2.208;P=0.001,0.030).The results of binary logistic regression analysis showed that TIR,HbA1c and DR were significantly correlated(odds ratio=0.960,1.254;P=0.002,0.036).ROC curve analysis results showed that the area under the ROC curve(AUC)of TIR,HbA1c and PRE_1 predicting the risk of DR were 0.704,0.668,and 0.707,respectively[95%confidence interval(CI)0.597-0.812,P=0.001;95%CI 0.558-0.778,P=0.006;95%CI 0.602-0.798,P=0.001].There was no statistically significant difference between TIR,HbA1c and PRE_1 predicting the AUC of DR risk(P>0.05).The linear equation between HbAlc and TIR was HbAlc(%)=11.37-0.04×TIR(%).Conclusions TIR and HbA1c are both related to DR and can predict the risk of DR.The combined use of the two does not improve the predictive value of DR.There is a linear correlation between TIR and HbAlc.