2型糖尿病合并糖尿病视网膜病变患者发生视力残疾的危险因素及干预措施

Risk Factors and Intervention Measures of Visual Disability in Type 2 Diabetes Mellitus Patients with Diabetic Retinopathy

目的基于logistic回归模型探讨2型糖尿病(T2DM)合并糖尿病视网膜病变(DR)患者发生视力残疾的危险因素,以期早期发现病变及时给予针对性干预措施。方法采用回顾性调查分析法选取2020年5月至2022年11月郑州大学第一附属医院收治的T2DM合并DR患者367例纳入研究,根据是否发生视力残疾分为发生组(90例)、未发生组(277例)。比较两组一般资料、生化指标资料[糖化血红蛋白(HbA1c)、空腹血糖(FBG)、胰岛素抵抗指数(HOMA-IR)、餐后2 h血糖(2 h PG)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、和肽素、几丁质酶-3样蛋白-1(YKL-40)、中期因子(MK)、载脂蛋白B100(ApoB100)、血管内皮生长因子A(VEGFA)、Toll样受体4(TLR4)],logistic多因素回归分析T2DM合并DR患者发生视力残疾的危险因素。结果发生组病程长于未发生组,收缩压、HbA1c、FBG、和肽素、YKL-40、MK、VEGFA、TLR4水平均高于未发生组(P<0.05);logistic回归分析显示,病程、收缩压(SBP)、HbA1c、FBG、和肽素、YKL-40、MK、VEGFA、TLR4是T2DM合并DR患者发生视力残疾的危险因素(P<0.05)。结论T2DM合并DR患者发生视力残疾的危险因素为病程、SBP、HbA1c、FBG、和肽素、YKL-40、MK、VEGFA、TLR4,基于此构建的模型预测效能良好,临床可用于指导视力残疾防治措施的制定,以期降低视力残疾的发生风险。

Objective To explore the risk factors for visual disability in patients with type 2 diabetes mellitus(T2DM)complicated with diabetic retinopathy(DR)based on logistic regression model,with a view to early detection of the disease and timely targeted intervention measures.Methods A total of 367 patients with T2DM complicated with DR admitted to the First Affiliated Hospital of Zhengzhou University from May 2020 to November 2022 were selected and included in the study.They were divided into the occurrence group(90 cases)and the non occurrence group(277 cases)according to whether visual disability occurred.The general data and biochemical index data[hemoglobin A1c(HbA1c),fasting blood glucose(FBG),Homa-insulin resistance(HOMA-IR),2-hour postprandial blood glucose(2 h PG),total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),copeptin,chitinase-3-like protein-1(YKL-40),midkine(MK),apolipoprotein B100(ApoB100),vascular endothelial growth factor A(VEGFA),Toll like receptor 4(TLR4)]of the two groups were compared,and the risk factors of visual disability in T2DM patients with DR were analyzed by logistic regression analysis.Results The course of disease in the occurrence group was longer than that in the non occurrence group,and the levels of systolic blood pressure(SBP),HbA1c,FBG,copeptin,YKL-40,MK,VEGFA and TLR4 in the occurrence group were higher than those in the non occurrence group(P<0.05).Logistic regression analysis showed that the course of disease,SBP,HbA1c,FBG,copeptin,YKL-40,MK,VEGFA,TLR4 were the risk factors for visual disability in T2DM patients with DR(P<0.05).Conclusion The risk factors for visual disability in patients with T2DM and DR are disease duration,SBP,HbA1c,FBG,peptide,YKL-40,MK,VEGFA and TLR4.The model constructed based on these factors has good predictive performance and can be used clinically to guide the development of measures to prevent and treat visual disability,with a view to reducing the risk of visual disability.