尿白蛋白/肌酐比值对2型糖尿病视网膜病变的影响及其截断值的判定

Effect of urinary albumin/creatinine ratio on type 2 diabetic retinopathy and its cut-off value for early diabetic retinopathy diagnosis

目的评估尿白蛋白/肌酐比值(urinary albumin/creatinine ratio,UACR)对2型糖尿病患者糖尿病视网膜病变(diabetic retinopathy,DR)的影响,并通过应用受试者工作特征(receiver operating characteristic,ROC)曲线估算UACR用于诊断DR的截断值。方法对2490例2型糖尿病患者进行前瞻性队列研究,随访3至10年不等,平均随访时间7年。每年进行1次散瞳眼底检查,收集并分析患者病史和临床资料。根据UACR水平将患者分为3组:Q1组即尿白蛋白正常组(UACR<30 mg/g)、Q2组即微量尿白蛋白组(30 mg/g≤UACR≤299 mg/g)及Q3组即大量尿白蛋白组(UACR>300 mg/g),采用Cox模型探讨UACR等因素对DR的影响,绘制ROC曲线以评价UACR对DR的诊断价值。结果校正年龄、性别、病程后,Cox回归显示,UACR是影响DR发生的危险因素(HR=1.108,95%CI 1.023~1.241,P<0.001)。UACR分组分析显示,Q3组患者发生增殖期DR风险最高(HR=3.128,95%CI 2.025~4.831,P<0.001),Q2组患者次之(HR=1.918,95%CI 1.355~2.714,P<0.001),而Q1组患者最低。ROC曲线分析结果显示,对于增殖期DR,UACR曲线下面积为0.746(95%CI 0.681~0.812,P<0.001),诊断截断值为54.12 mg/g,灵敏度为0.769,特异度为0.653。结论UACR能够预测2型糖尿病患者增殖期DR的发生,可作为预测DR进展的指标。

Objective To evaluate the effect of urinary albumin creatinine ratio(UACR)on diabetic retinopathy(DR)in patients with type 2 diabetes.Receiver operating characteristic(ROC)curve was applied to find the cut-off value of UACR for diagnosing DR.Methods A prospective cohort study of 2490 patients with type 2 diabetes was conducted with a mean follow-up of 7 years ranging from 3 to 10 years.Dilated fundus examination was performed once a year,and patient history and clinical data were collected and analyzed.Patients were divided into three groups according to the UACR:Q1,normal urinary albumin group(UACR<30 mg/g),Q2,microalbuminuria group(30 mg/g≤UACR≤299 mg/g),and Q3,macroalbuminuria group(UACR>300 mg/g),respectively.Cox regression analysis was used to explore the influence of UACR and other factors on DR,and ROC curve was drawn to evaluate the value of UACR in diagnosis of DR.Results Cox regression analysis showed that UACR was the risk factor of DR(HR=1.108,95%CI 1.023-1.241,P<0.001).It showed that the patients in Q3 group had the highest risk of proliferative DR(HR=3.128,95%CI 2.025-4.831,P<0.001),the patients in Q2 group followed(HR=1.918,95%CI 1.355-2.714,P<0.001),and the patients in Q1 group were the lowest.ROC curve analysis showed that area under UACR curve was 0.746(95%CI 0.681-0.812,P<0.001),and the cut-off value,sensitivity,and specificity for the diagnosis of PDR were 54.12mg/g,0.769,and 0.653,respectively.Conclusion The UACR can predict the progression of PDR in type 2 diabetes patients,therefore it may be used as a preliminary predictor for the progression of DR.