血尿酸/高密度脂蛋白胆固醇比值与2型糖尿病视网膜病变的相关性研究

The relationship between serum uric acid/high density lipoprotein cholesterol and type 2 diabetic retinopathy

目的探讨血尿酸/高密度脂蛋白胆固醇比值(UHR)与DR的相关性。方法选取2018年3月至2020年10月于徐州医科大学附属医院内分泌科住院的T2DM患者644例,按照眼底照相结果分为单纯T2DM组(T2DM,n=389)与DR组(n=255)。DR组分为非增殖期视网膜病变亚组(NPDR,n=171)与增殖期视网膜病变亚组(PDR,n=84)。收集所有患者一般临床资料及生化指标,计算UHR、单核细胞/高密度脂蛋白胆固醇比值(MHR)、eGFR和胰岛素抵抗指数等。结果与T2DM组比较,DR组年龄、DM病程、高血压比例、SBP、HbA_(1)c、FPG、血肌酐(Scr)、血尿酸(SUA)、UHR、MHR升高,谷草转氨酶、谷丙转氨酶、eGFR、总胆红素、HDL-C水平降低(P<0.05)。与NPDR亚组比较,PDR亚组DM病程、FPG、Scr、SUA、UHR、MHR水平升高(P<0.05或P<0.01),HDL-C水平降低(P<0.05)。Logistic回归分析显示,SUA、UHR、MHR是DR发生的影响因素。受试者工作特征曲线(ROC)显示,与SUA、MHR比较,UHR的ROC曲线下面积最大,灵敏度为62.7%,特异度为67.6%。结论SUA、UHR、MHR与DR密切相关,均是DR的危险因素;UHR对DR的预测价值优于SUA和MHR。

Objective To investigate the relationship between serum uric acid/high density lipoprotein cholesterol(UHR)and diabetic retinopathy(DR).Methods A total of 644 patients with type 2 diabetes mellitus(T2DM)were enrolled in this study from Department of Endocrinology,Affiliated Hospital of Xuzhou Medical University during March 2018 to October 2020.All the patients were divided into two groups according to the results of fundus examination:patients with diabetes alone(T2DM group,n=389)and patients with diabetes and DR(DR group,n=255).DR group was further divided into non-proliferative retinopathy group(NPDR group,n=171)and proliferative retinopathy group(PDR group,n=84).General clinical data and biochemical indexes were collected.UHR,monocyte/high-density lipoprotein cholesterol(MHR),estimated glomerular filtration rate(eGFR)and insulin resistance index(HOMA-IR)were calculated.Results Age,DM duration,hypertension,SBP,HbA_(1)c,FPG,Scr,SUA,UHR and MHR were higher,while AST,ALT,eGFR,TB and HDL-C were lower in DR group than in T2DM group(P<0.05).Compared with NPDR subgroup,the duration of DM,FPG,Scr,SUA,UHR and MHR levels increased in PDR subgroup(P<0.05),while HDL-C decreased(P<0.05).Logistic regression analysis showed that SUA,UHR and MHR were the influencing factors for DR.Receiver operating characteristic(ROC)curve showed that compared with SUA and MHR,UHR had the largest area under the ROC curve,with sensitivity 62.7% and specificity 67.6%.Conclusion SUA,UHR and MHR were closely related to DR,and were all independent risk factors for DR.The predictive value of UHR on DR was better than that of SUA and MHR.