黑龙江省住院2型糖尿病患者视网膜病变患病率及其相关因素分析

Prevalence and related factors of retinopathy in hospitalized patients with type 2 diabetes mellitus in Heilongjiang Province

目的调查黑龙江省住院2型糖尿病(T2DM)患者糖尿病视网膜病变(DR)的患病率及影响因素。方法横断面研究。回顾性收集2018年1至12月在黑龙江省15家医院内分泌科住院治疗且临床资料完整的T2DM患者。收集患者的一般资料及实验室指标等相关信息,以免散瞳眼底摄片结果将研究对象分为DR组和无DR组。调查黑龙江省住院T2DM患者DR的患病率并采用logistic回归模型分析DR的相关因素。结果共纳入15418例T2DM患者。黑龙江省住院T2DM患者DR患病率为34.5%(5312例),经年龄、性别标准化后DR患病率为25.6%。与无DR组相比,DR组患者的年龄、病程、吸烟饮酒史、家族史、合并高血压的比例更高,DR组患者的空腹血糖、糖化血红蛋白(HbA_(1c))、总胆固醇、低密度脂蛋白胆固醇(LDL-C)、肌酐、钾、钠、纤维蛋白原也更高,差异有统计学意义(均P<0.05);DR组的红细胞计数、血红蛋白、血小板、空腹C肽、甘油三酯(TG)、丙氨酸转氨酶、天门冬氨酸转氨酶、总胆红素、血尿酸、钙、镁、血尿酸/肌酐比值、TG/高密度脂蛋白胆固醇(HDL-C)比值低于无DR组,差异有统计学意义(均P<0.05)。多因素logistic回归分析显示,病程(OR=1.097,95%CI为1.089~1.104)、家族史(OR=1.262,95%CI为1.150~1.384)、饮酒史(OR=1.241,95%CI为1.130~1.364)、高血压(OR=1.326,95%CI为1.214~1.447)、HbA_(1c)≥7%(OR=1.415,95%CI为1.274~1.572)为DR的独立危险因素。根据血尿酸/肌酐比值、TG/HDL-C比值的四分位数分为4组(Q1~Q_(4)组),调整年龄、病程、家族史、高血压、吸烟史、饮酒史、HbA_(1c)≥7%后,血尿酸/肌酐比值中Q_(3)、Q_(4)组患DR的风险是Q1组的0.884、0.796;TG/HDL-C比值中Q_(3)、Q_(4)组患DR的风险是Q1组的0.837、0.680。结论黑龙江省住院T2DM患者DR患病率较高。糖尿病病程、家族史、HbA_(1c)≥7%、高血压、饮酒史是DR的独立危险因素,血尿酸/肌酐比值是DR的独立保护因素。

Objective To investigate the prevalence of retinopathy in hospitalized patients with type 2 diabetes mellitus(T2DM)in Heilongjiang province and analyze its related factors.Methods This study was a cross sectional study.Hospitalized T2DM patients with complete clinical data in 15 hospitals in Heilongjiang province from January to December 2018 were retrospectively enrolled.We collected the general data and laboratory indicators and divided the patients into diabetic retinopathy(DR)group and no DR group according to non-mydriatic fundus photography.We investigated the prevalence of retinopathy among hospitalized T2DM patients in Heilongjing province and logistic regression was used to conduct univariate and multivariate analyses on DR.Results Fifteen thousand four hundred and eighteen hospitalized T2DM patients were included in the study.The prevalence of DR in hospitalized T2DM patients in Heilongjiang province was 34.5%(n=5312),the age-gender-standardised prevalence of DR was 25.6%.Compared to no DR group,the DR group had more family history of diabetes,smoking and drinking history,and hypertension,older age,longer course of disease,higher fasting blood glucose,glycosylated hemoglobin A_(1c)(HbA_(1c)),total cholesterol,low-density lipoprotein cholesterol(LDL-C),creatinine(Cr),potassium,sodium,and fibrinogen,lower red blood cell count,hemoglobin,platelets,fasting C peptide,triglycerides(TG),alanine aminotransferase,aspartate aminotransferase,total bilirubin,blood uric acid(SUA),calcium and magnesium,SUA/Cr and TG/high-density lipoprotein cholesterol(HDL-C),the differences were statistically significant(P<0.05).Multivariate logistic regression analysis showed that the course of diabetes(OR=1.097,95%CI 1.089 to 1.104),family history(OR=1.262,95%CI 1.150 to 1.384),hypertension(OR=1.326,95%CI 1.214 to 1.447),drinking history(OR=1.241,95%CI 1.130 to 1.364),and HbA_(1c)≥7%(OR=1.415,95%CI 1.274 to 1.572)were independent risk factors for DR.For SUA/Cr compared with Q1,the risk of DR in patients in Q_(3) and Q_(4) groups was 0.884 and 0.796,respectively.For TG/HDL-C,the risk of DR in patients in the Q_(3) and Q_(4) groups was 0.837 and 0.680,respectively,compared with the Q1 group.Conclusions The prevalence of DR was relatively high in hospitalized T2DM patients in Heilongjiang province.Diabetes course,family history,HbA_(1c)≥7%,hypertension,and drinking history were independent risk factors for DR,and SUA/Cr was an independent protective factor for DR.