中老年糖尿病患者残余胆固醇与糖尿病视网膜病变发病风险的相关性研究

Association between remnant cholesterol levels and incident diabetic retinopathy in middle-aged and older patients with diabetes

目的探讨中老年糖尿病患者中残余胆固醇(RC)与糖尿病视网膜病变(DR)发生风险的关联。方法使用上海泥城前瞻性队列研究数据库,选取基线(2013至2014年)上海市泥城镇55~70岁、有眼底照片和血清胆固醇数据的糖尿病患者1 255例为研究对象。采用多元logistic回归模型计算基线RC水平与DR事件发生的危险比(RR)及95%置信区间(CI)。结果研究对象的年龄中位数为61.9岁,其中女性占60.4%。经过平均4.6年的随访,共有79例(6.3%)发生DR,其中50例(4.0%)为轻度非增殖期DR,29例(2.3%)为需转诊的DR(RDR)。多变量调整的回归分析显示RC每增加1 mmol/L,RDR发生的风险增加40%(RR=1.40,95%CI 1.03~1.90)。以RC下三分位组(<0.63 mmol/L)为参照,上三分位组(≥0.85 mmol/L)发生RDR的风险增加4.59倍(RR=5.59,95%CI 1.51~20.73)。结论中老年糖尿病患者RC水平有助于识别发生RDR的高风险人群。

Objective To investigate the association between remnant cholesterol(RC)and the risk of diabetic retinopathy(DR)in middle-aged and older individuals with diabetes.Methods Based on the Shanghai Nicheng Cohort Study database,the data of 1255 individuals with diabetes aged 55-70 years at baseline(2013-2014)with complete fundus photographs and serum cholesterol data in Nicheng,Shanghai,were analyzed.Multinomial logistic regression models were used to evaluate risk ratios(RRs)and their 95%confidence intervals(CIs)between baseline RC level and incident DR.Results The median age of the subjects was 61.9 years,and 60.4%were women.After a 4.6-year follow-up,79(6.3%)patients developed DR,including 50(4.0%)mild non-proliferative DR and 29(2.3%)referable DR(RDR).Multivariable logistic regression showed that each mmol/L increase of RC was associated with a 40%higher risk of RDR(RR=1.40,95%CI 1.03-1.90).Compared with the lowest tertile of RC(<0.63 mmol/L),the risk of RDR in the highest tertile(≥0.85 mmol/L)increased by 4.59 times(RR=5.59,95%CI 1.51-20.73).Conclusion The RC level may help identify individuals at high risk of incident RDR in middle-aged and older Chinese adults with diabetes.