2型糖尿病患者糖尿病肾病与视网膜病变的相关性

目的探讨2型糖尿病(T2DM)患者糖尿病视网膜病变(DR)对糖尿病肾病(DKD)的诊断价值。方法回顾性分析2020年1月至2020年12月277例T2DM患者临床资料,根据DKD和DR的存在情况,比较患者的临床特征,分析血常规、血糖、血脂、炎症标志物如血小板/淋巴细胞比值(PLR)、中性粒细胞/淋巴细胞比值(NLR)、系统免疫炎症指数(SII)、肾脏损伤指标如肾小球滤过率、尿酸、尿素氮、血肌酐(Scr)、尿微量白蛋白、24 h尿白蛋白、尿白蛋白与肌酐比(UACR)等疾病危险因素的组间一致性。采用Logistic回归模型分别筛查DKD和DR的独立危险因素。结果有54.7%的DKD患者未合并DR,41.1%的DR患者未合并DKD。DR对DKD的阳性预测值为58.9%,阴性预测值为65.8%。DKD、DR均与高收缩压、长病程、较高水平的PLR、Scr、尿素氮、尿微量白蛋白、24 h尿微量白蛋白、UACR及较低水平的白蛋白、Hb、eGFR相关。DKD患者有较高的尿酸,而合并DR患者有较高的舒张压。结论DR与DKD是糖尿病发病率最高的微血管并发症,二者有较多共同危险因素,但在T2DM患者中有显著差异,DR对T2DM患者合并DKD的临床诊断效能欠佳。

Objective To explore the diagnostic value of diabetic retinopathy(DR)in diabetic kidney disease(DKD)in patients with type 2 diabetes.Methods Retrospective analysis of clinical data of 277 patients with T2DM from January to December 2020.According to the presence of DKD and DR,the clinical characteristics of the patients were compared,and the blood routine,blood glucose,blood lipids,inflammatory markers(PLR,NLR,SII),kidney injury indicators(eGFR,uric acid,urea nitrogen,SCr,urinary microalbumin,24-hour urinary albumin)were analyzed.The consistency of disease risk factors was analyzed.Logistic regression model was used to screen the independent risk factors of DKD and DR respectively.Results According to the statistical analysis,54.7%of patients with diabetic kidney disease were not complicated with DR,and 41.1%of patients with DR were not complicated with diabetic nephropathy.The positive predictive value of DR for DKD was 58.9%,and the negative predictive value was 65.8%.DKD and DR were associated with high systolic blood pressure,long course of disease,high level of PLR,Scr,urea nitrogen,urinary microalbumin,24-hour urinary microalbumin,UACR and low level of albumin,Hb,eGFR.Patients in the DKD group had higher uric acid,while patients with DR had higher diastolic blood pressure.Conclusion DR and DKD are microvascular complications with the highest incidence of diabetes.They have many common risk factors,but there are significant differences in patients with type 2 diabetes.The diagnostic efficacy of DR in patients with type 2 diabetes mellitus complicated with DKD is poor.