血糖控制达标2型糖尿病患者发生糖尿病视网膜病变的影响因素  

Influencing factors of diabetic retinopathy in patients with type 2 diabetes mellitus with standard glycemic control

作　　者：汤庆丽 沈烨宇[1] 徐婉文 唐于荣[1] Qing-Li Tang;Ye-Yu Shen;Wan-Wen Xu;Yu-Rong Tang(Department of Ophthalmology,BenQ Hospital,Nanjing Medical University,Nanjing 210019,Jiangsu Province,China)

机构地区：[1]南京医科大学附属明基医院眼科,中国江苏省南京市210019

出　　处：《国际眼科杂志》2021年第11期1952-1956,共5页International Eye Science

摘　　要：目的:探究血糖控制达标2型糖尿病(T2DM)患者发生糖尿病视网膜病变(DR)后血清视黄醇结合蛋白4(RBP4)、炎症指标中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)水平及影响患者发生DR的因素。方法:回顾性分析2017-02/2020-02我院收治的142例血糖控制达标的T2DM患者的临床资料,根据眼底造影检查结果将患者分为眼底正常组(N组,74例)、非增殖期糖尿病视网膜病变组(NPDR组,36例)和增殖期糖尿病视网膜病变组(PDR组,32例)。比较三组患者的一般资料和血液检查指标;多因素Logistic回归分析影响患者发生DR的因素;构建预测患者发生DR的列线图预测模型并评价其预测效能。结果:PDR组患者的DM病程、血清生长激素(GH)、胰岛素样生长因子-Ⅰ(IGF-Ⅰ)、低密度脂蛋白胆固醇(LDL-C)、尿微量白蛋白(UA)、视黄醇结合蛋白4(RBP4)水平、NLR、PLR明显高于N组和NPDR组,C肽(C-P)、2h C-P明显低于N组和NPDR组(P<0.05);DM病程>12a、IGF-Ⅰ>145μg/L、C-P<0.75ng/mL、UA>245ng/mL、RBP4>54mg/L、NLR>1.8、PLR>110均是导致患者发生DR的危险因素;列线图模型预测的区分度和校准度较高,具有良好的预测效能。结论:除DM病程、IGF-Ⅰ、C-P、UA等常见的危险因素外,RBP4、NLR、PLR增加也是DR发生的危险因素,可能参与了DR的发生和发展。AIM:To explore the serum retinol binding protein 4(RBP4),inflammatory index neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR)in patients with type 2 diabetes mellitus(T2DM)after diabetic retinopathy(DR)levels and factors affecting the occurrence of DR in patients.METHODS:The clinical data of 142 patients with T2DM who reached the standard of blood glucose control in our hospital from February 2017 to February 2020 were analyzed retrospectively.According to the results of fundus angiography,the patients were divided into Normal group(n=74),NPDR group(n=36)and PDR group(n=32).Compared the general data and blood test indexes of the three groups,and analyzed the factors affecting the occurrence of DR by multivariate Logistic regression analysis.Constructed a line chart prediction model to predict the occurrence of DR and evaluated its predictive efficiency.RESULTS:The course of DM,serum GH,IGF-I,LDL-C,UA,RBP4,NLR and PLR in PDR group were significantly higher than those in Normal group and NPDR group,while C-P and 2h C-P were significantly lower than those in Normal group and NPDR group.The course of disease>12a,IGF-I>145μg/L,C-P<0.75ng/mL,UA>245ng/mL,RBP4>54mg/L,NLR>1.8 and PLR>110 were independent risk factors for DR.The line chart model has high degree of differentiation and calibration,and has good prediction efficiency.CONCLUSION:In addition to the common risk factors such as the course of DM,IGF-I,C-P and UA,the increase of RBP4,NLR and PLR is also related to DR,which may be involved in the occurrence and development of DR.

关 键 词：2型糖尿病 糖尿病视网膜病变 视黄醇结合蛋白4 中性粒细胞与淋巴细胞比值 血小板与淋巴细胞比值 

分 类 号：R587.2[医药卫生—内分泌] R774.1[医药卫生—内科学]