糖尿病及糖尿病前期人群血尿酸/高密度脂蛋白胆固醇比值与糖尿病视网膜病变的相关性

Association between serum uric acid/high density lipoprotein cholesterol and diabetic retinopathy in diabetic and pre-diabetic people

目的探讨糖尿病及糖尿病前期人群血尿酸/高密度脂蛋白胆固醇比值(UHR)与糖尿病视网膜病变(DR)的相关性。方法本研究为横断面研究。采用2010至2011年北京市昌平区一项有关慢性疾病和危险因素的健康调查的研究数据,筛选出符合入选、排除标准的糖尿病前期和糖尿病患者2507例,男性1212例,女性1295例。分别按照有无DR分将患者为DR组和无DR(NDR)组,采用独立样本t检验、卡方检验、多因素logistic回归进行病例对照研究并了解UHR和DR有无独立相关性。绘制受试者工作特征曲线,评价UHR对DR的诊断价值。结果尿酸相关指标与DR的关系存在性别差异,在女性中均无明显相关性;而在男性中,DR组患者的年龄、糖尿病病程、空腹血糖、糖化血红蛋白、收缩压、舒张压、甘油三酯、血尿酸、UHR水平及糖尿病、高血压病史比例均明显高于NDR组患者,差异均有统计学意义(均P<0.05)。logistic回归分析发现,血尿酸[OR(95%CI):1.054(1.004~1.106),P=0.033]、UHR[OR(95%CI):1.391(1.061~1.823),P=0.017]是影响DR发生的相对危险因素;在调整了年龄、户籍、文化水平、吸烟、饮酒、体育锻炼、腰围、高血压史、收缩压、舒张压、总胆固醇等危险因素后,UHR仍与DR相关[OR(95%CI):1.438(1.084~1.908),P=0.012]。受试者工作特征曲线分析,UHR曲线下面积为0.610(95%CI:0.514~0.707,P=0.030)。UHR预测DR的截断值为0.24时灵敏度及特异度最高,分别为78.8%和58.7%。结论男性糖尿病前期和糖尿病患者UHR水平与DR患病风险呈明显相关性,UHR水平升高,DR患病风险随之增加;但女性则无此关系。UHR有助于诊断DR及筛查有DR风险的人群。

Objective To evaluate the relationship between the blood uric acid/high-density lipoprotein cholesterol ratio(UHR)and diabetes retinopathy(DR)in diabetic and pre-diabetic population.Methods A cross-sectional study.The data from a health survey from 2010 to 2011 on chronic diseases and risk factors in Changping District in Beijing was used in this study.Total of 2507 pre-diabetic and diabetic patients who met the inclusion and exclusion criteria were screened out in this study,included 1212 men and 1295 women.The patients were divided into DR group and non-DR(NDR)group according to whether DR was present or not.Independent sample t-test,chi-square test and multivariate logistic regression were used for case-control study to investigate whether there was independent correlation between UHR and DR.The receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic value of UHR for DR.Results There were gender differences in the relationship between uric acid related indicators and DR,no significant correlation was found in women.In males,the age,duration of diabetes,fasting blood glucose(FPG),glycosylated hemoglobin(HbA1c),systolic blood pressure(SBP),diastolic blood pressure(DBP),triglyceride(TG),serum uric acid,UHR levels and the proportion of diabetes and hypertension history in DR group were all significantly higher than those in NDR group(all P<0.05).Logistic regression analysis showed that SUR(OR=1.054,95%CI:1.004-1.106,P=0.033)and UHR(OR=1.391,95%CI:1.061-1.823,P=0.017)were the relative risk factors of DR.After adjusting for age,registered residence,education level,smoking,drinking,physical exercise,waist circumference,hypertension history,SBP,DBP,total cholesterol and other risk factors,UHR was still associated to DR[OR(95%CI):1.438(1.084-1.908),P=0.012].The area under the ROC curve of UHR was 0.610(95%CI:0.514-0.707,P=0.030).When the cut-off value of UHR for predicting DR was 0.24,the sensitivity and specificity were the highest,which was 78.8%and 58.7%,respectively.Conclusion UHR is significantly correlated with the risk of DR in men with pre-diabetes and diabetes,but not in women.The risk of DR increases with the elevated level of UHR.UHR is helpful to diagnose DR and screen people with DR risk.