2型糖尿病患者单核细胞/高密度脂蛋白胆固醇比值与糖尿病视网膜病变相关性的研究

Correlation between monocyte to high density lipoprotein⁃cholesterol ratio and diabetic retinopathy in type 2 diabetes mellitus

目的探讨T2DM患者单核细胞/HDL-C比值(MHR)与DR的相关性。方法选取2019年10月至2021年10月于河南科技大学第一附属医院内分泌科住院治疗的T2DM患者1357例,根据眼底照相结果分为单纯T2DM组(n=699)和DR组(n=658)。比较各组一般资料及生化指标,Spearman相关分析MHR与其他指标的相关性,Logistic回归分析DR的影响因素,受试者工作特征(ROC)曲线评估MHR及传统危险因素对DR的预测价值,重分类分析评估MHR对DR的识别能力。将DR组分为轻度、中度、重度3个亚组,比较各亚组间MHR水平差异。结果与T2DM组比较,DR组年龄、DM病程、Ins治疗率、SBP、HbA1c、Scr、中性粒细胞计数、单核细胞计数、MHR升高(P<0.05),HDL-C、eGFR、血红蛋白(Hb)降低(P<0.05)。Spearman相关分析显示,MHR与年龄、DM病程、BMI、FPG、HbA1c、Scr呈正相关(P<0.05),与eGFR呈负相关(P<0.05)。Logistic回归分析显示,校正年龄、性别、DM病程、BMI、HbA1c、SBP、eGFR、Hb、吸烟史、Ins治疗后,MHR是DR的危险因素,随着MHR分组等级增加,DR风险增加(P_(趋势)=0.0013)。年龄、性别、DM病程、BMI、HbA1c、eGFR作为分层变量,进行分层分析及交互作用检验显示,各分层项目中MHR与DR的关系稳定存在。ROC曲线分析显示,将MHR加入传统危险因素模型后,ROC曲线下面积增至0.736,对DR的预测能力提高12.2%。随着DR严重程度增加,MHR呈升高趋势(P<0.05)。结论高MHR与DR发生相关,该相关性稳定存在且独立于DR传统危险因素。MHR可提高危险因素对DR的风险识别能力。

Objective To investigate the relationship between monocyte to high density lipoproteincholesterol ratio(MHR)and diabetic retinopathy(DR).Methods A total of 1357 hospitalized patients with type 2 diabetes mellitus(T2DM)was selected from the Department of Endocrinology in First Affiliated Hospital of Henan University of Science and Technology from October 2019 to October 2021.All the patients were divided into two groups based on fundus photography results:T2DM group(n=699)and DR group(n=658).General data and biochemical indexes were compared between two groups.Spearman correlation analysis was used toanalyze the correlation between MHR and other major indicators.Risk factors for DR were identified using logistic regression analysis.The receiver operating characteristic(ROC)curve was used to assess the predictive value of MHR and traditional risk factors on DR.Reclassification analyses for MHR to discriminate the risk stratification of DR was performed.DR group was further divided into three subgroups:mild DR,moderate DR and severe DR.The differences in MHR levels were evaluated among the three subgroups.Results Compared with T2DM group,the age,duration of DM,proportion of Ins treatment,SBP,HbA1c,Scr,neutrophil count,Monocyte count,MHR were increased(P<0.05),while the HDL-C,eGFR,hemoglobin level(Hb)were decreased in DR group(P<0.05).Spearman correlation analysis showed that MHR was positively correlated with age,DM duration,BMI,FPG,HbA1c,Scr(P<0.05),and negatively correlated with eGFR(P<0.05).Logistic regression models revealed that MHR was an independent risk factor for DR after adjusting for factors such asage,gender,BMI,DM duration,HbA1c,SBP,eGFR,Hb,smoking history,and insulin treatment.As the MHR grouping level increased,the risk of DR increased(P for trend=0.0013).The interaction testing showed that the relationship between MHR and DR remained stable in each stratified project such as age,gender,DM duration,BMI,HbA1c,and eGFR.After introducing MHR into the established model of traditional risk factors,the AUC was increased to 0.736 and risk identification improvement of DR was 12.2%.As the severity of DR increased,the MHR level showed an upward trend(P<0.05).Conclusion MHR was positively and independently correlated with the development of DR.MHR can improve the recognition ability of risk factors for DR.