新诊断2型糖尿病患者视网膜微血管异常的临床特征及危险因素研究  

Clinical Characteristics and Risk Factors of Retinal Microvascular Abnormalities in Newly Diagnosed Inpatients with T2DM

作　　者：金春花[1] 李连喜[2] 李梅芳[2] 张蓉[2] 李婷婷[2] 贾丽丽[3] 包玉倩[2] 贾伟平[2] 

机构地区：[1]上海市松江区中心医院内分泌科,201600 [2]上海交通大学附属第六人民医院内分泌代谢科,上海市糖尿病研究所,上海市糖尿病重点实验室,上海市糖尿病临床医学中心,上海市代谢病临床医学中心 [3]上海交通大学附属第六人民医院眼科

出　　处：《中国全科医学》2015年第5期493-497,共5页Chinese General Practice

基　　金：国家自然科学基金面上项目(81170759)

摘　　要：目的分析新诊断2型糖尿病患者视网膜微血管异常的临床特征及危险因素。方法选取2007年1月—2009年6月在上海交通大学附属第六人民医院内分泌代谢科住院的新诊断2型糖尿病患者586例,均进行免散瞳眼底摄片,按伴或不伴视网膜微血管异常将患者分为2型糖尿病伴视网膜微血管异常组(300例)和不伴视网膜微血管异常组(286例),收集患者临床资料,包括血压、体质量、腰围、臀围;空腹血糖和空腹C肽、餐后2 h血糖和餐后2 h C肽、糖化血红蛋白(Hb A1c)、肾功能、肝功能、血脂、C反应蛋白水平。采用Logistic回归分析糖尿病视网膜微血管异常的危险因素。结果 2型糖尿病伴视网膜微血管异常组和不伴视网膜微血管异常组收缩压、空腹血糖、丙氨酸氨基转移酶(ALT)、尿清蛋白、肾小球滤过率(e GFR)、性别、高血压患病率、降压药服用率比较,差异均有统计学意义(P<0.05),校正性别和年龄后,两组仅高血压患病率和降压药服用率间差异有统计学意义(P<0.05)。新诊断2型糖尿病患者视网膜微血管异常患病率为51.2%(300/586),其中男性为44.6%(166/372),女性为62.6%(134/214),男女间患病率比较,差异无统计学意义(χ2=17.600,P=0.105)。不同年龄段新诊断2型糖尿病患者视网膜微血管异常患病率比较,差异有统计学意义(χ2=150.71,P<0.001)。新诊断2型糖尿病患者,无论是男性或女性,单纯视网膜动脉硬化患病率均明显高于单纯视网膜病变和同时发生视网膜动脉硬化及视网膜病变的患者(χ2=134.25,P<0.001;χ2=89.19,P<0.001)。Logistic回归分析结果显示,新诊断2型糖尿病患者微血管异常的发生与年龄、高血压、低密度脂蛋白胆固醇、e GFR相关(P<0.05)。结论新诊断2型糖尿病患者视网膜微血管异常患病率高,年龄、高血压、低密度脂蛋白胆固醇、e GFR是糖尿病视网膜微血管异常发生的独立危险因素。Objective To investigate the clinical characteristics and risk factors of retinal microvascular abnormalities（ RAMs） in newly diagnosed inpatients with type 2 diabetes mellitus（ T2DM）. Methods From January 2007 to June 2009,in the Sixth People＇ s Hospital Affiliated to Shanghai Jiao Tong University,586 newly diagnosed T2DM inpatients were divided,according to accompaniment of RAMs or not, into groups A（ accompanied by RAMs, n = 300）, B（ not accompanied by RAMs,n = 286）. The clinical data were determined. Logistic regression analysis was used to analyze the risk factors of RAMs.Results There was significant difference in systolic blood pressure, fasting glucose, alanine aminotransferase, cleared proteinuria,e GFR,gender, prevalence of hypertension, proportion of antihypertensive drug use between 2 groups（ P〈0. 05）,but the difference was noted in only hypertension prevalence and proportion of antihypertensive drug after adjusting gender and age（ P〈0. 05）. The RAMs incidence was 51. 2%（ 300 /586） in new T2DM patients,44. 6% males（ 166 /372）,62. 6% females（ 134 /214）,there was no difference in incidence between genders（ χ^2= 17. 600,P = 0. 105）. There was difference in RAMs incidence between new T2DM patients at different ages（ χ^2= 150. 71,P〈0. 001）. The incidence of simple retinal arteriosclerosis was higher in new T2DM patients（ either males or females） than in those with simple retinopathy or simultaneously with retinal arteriosclerosis and simple retinopathy（ χ^2= 134. 25, P〈0. 001; χ^2= 89. 19, P〈0. 001）.Logistic regression analysis showed that RAMs incidence was closely related to age, hypertension, LDL- C, e GFR（ P〈0. 05）. Conclusion The RAMs incidence is high in new T2DM patients. Age, hypertension, LDL- C, e GFR are independent risk factors of RAMs.

关 键 词：糖尿病视网膜病变 视网膜动脉硬化 视网膜微血管异常 疾病特征 危险因素 

分 类 号：R587.26[医药卫生—内分泌]