视网膜血管直径与糖尿病肾脏病的相关性研究

Correlation between retinal vessel caliber and diabetic kidney disease

目的探讨视网膜血管直径与糖尿病肾脏病(DKD)的相关性。方法选择2021年1至12月在河北省人民医院内分泌科住院治疗的309例2型糖尿病(T2DM)患者作为研究对象。收集患者的身高、体重、体重指数(BMI)、收缩压、舒张压、糖化血红蛋白(HbA1c)、血脂、尿微量白蛋白/肌酐比值(UACR)、估算的肾小球滤过率(eGFR)等指标。根据UACR和eGFR将T2DM患者分为非DKD组(212例)和DKD组(97例)。所有患者进行免散瞳彩色眼底照相, 采用全自动计算机图像分析软件测量视网膜血管参数(视网膜颞侧上静脉直径、鼻侧上动脉直径), 计算视网膜中央静脉等效值(CRVE)等指标。进一步按照视网膜颞侧上静脉直径水平的五分位数分为Q1组(<136.13 μm, 68例), Q2组(136.13~148.42 μm, 56例), Q3组(148.43~160.72 μm, 62例), Q4组(160.73~177.12 μm, 64例)和Q5组(>177.12 μm, 59例)。组间差异的比较采用独立样本t检验、Mann-WhitneyU检验。采用多因素logistic回归分析法探究视网血管直径与DKD的关系。结果 DKD组视网膜颞侧上静脉直径[分别为(161.87±22.47)和(152.93±21.98)μm]、CRVE[分别为(191.75±20.18)和(187.09±17.52)μm]均显著高于非DKD组, 鼻侧上动脉直径[分别为(84.62±15.09)和(88.15±13.94)μm]显著低于非DKD组(均P<0.05)。多因素logisitc回归分析结果显示, 视网膜颞侧上静脉扩张、CRVE升高是DKD的独立影响因素(OR=1.187, 95%CI 1.068~1.320, P=0.001;OR=1.018, 95%CI 1.002~1.034, P=0.027)。多因素logistic回归分析结果显示, 以Q1组为参照, Q2、Q4、Q5组视网膜颞侧上静脉扩张是DKD发生的影响因素(OR=5.194, 95%CI 2.025~13.326;OR=3.477, 95%CI 1.360~8.891;OR=4.895, 95%CI 1.912~12.530;趋势P值=0.007)。结论视网膜颞侧上静脉扩张、CRVE升高是T2DM合并DKD患者的独立影响因素。

Objective To assess the correlation between retinal vessel caliber and diabetic kidney disease(DKD)in patients with type 2 diabetes mellitus(T2DM).Methods A total of 309 T2DM patients who were hospitalized in the Department of Endocrinology of Hebei General Hospital from January to December 2021 were assigned to two groups according to urine microalbumin/creatinine ratio(UACR)and estimated glomerular filtration rate(eGFR),including non-DKD group(212 cases)and DKD group(97 cases).Height,weight,body mass index(BMI),systolic blood pressure,diastolic blood pressure,glycated hemoglobin A1c(HbA1c),total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL-C),UACR and eGFR were recorded.The retinal vascular parameters(venula temporalis retinae superior and arteriola nasalis retinae superior)were measured by the automated retina image analysis system.Central retinal vein equivalent value(CRVE)was calculated.According to the quintile of the diameter level of the retinal superior temporal vein,the patients were divided into Q1 group(<136.13μm,68 cases),Q2 group(136.13-148.42μm,56 cases),Q3 group(148.43-160.72μm,62 cases),Q4 group(160.73-177.12μm,64 cases)and Q5 group(>177.12μm,59 cases).The t test or Mann-Whitney U test was used for comparison between two groups,and ordered logistic regression analysis was used to evaluate the correlation between retinal vascular diameter and DKD.Results There were statistically significant differences in the level of venula temporalis retinae superior[(161.87±22.47)vs.(152.93±21.98)μm],CRVE[(191.75±20.18)vs.(187.09±17.52)μm]and arteriola nasalis retinae superior[(84.62±15.09)vs.(88.15±13.94)μm]between groups(all P<0.05).Multivariate logistic regression showed that widened venula temporalis retinae superior and widened CRVE were independent influencing factors for DKD(OR=1.187,95%CI 1.068-1.320,P=0.001;OR=1.018,95%CI 1.002-1.034,P=0.027),logistic regression analysis showed that widened venula temporalis retinae superior was an independent influencing factor for DKD in the Q2,Q4 and Q5 group(OR=5.194,95%CI 2.025-13.326;OR=3.477,95%CI 1.360-8.891;OR=4.895,95%CI 1.912-12.530;P value for trend=0.007).Conclusion Widened venula temporalis retinae superior and widened CRVE were independent influencing factors for DKD in T2DM patients.