2型糖尿病患者葡萄糖在目标范围内时间与视网膜病变相关性的队列研究  

Association between time in range and diabetic retinopathy among patients with type 2 diabetes mellitus: a cohort study

作　　者：王亚昕 陆静毅[1] 戴冬君 沈赟[1] 张磊[1] 陆蔚[1] 朱玮[1] 包玉倩[1] 周健[1] Wang Yaxin;Lu Jingyi;Dai Dongjun;Shen Yun;Zhang Lei;Lu Wei;Zhu Wei;Bao Yuqian;Zhou Jian(Department of Endocrinology and Metabolism,Shanghai Jiao Tong University Affiliated Sixth People′s Hospital,Shanghai Clinical Center for Diabetes,Shanghai Diabetes Institute,Shanghai Key Laboratory of Diabetes Mellitus,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院内分泌代谢科,上海市糖尿病临床医学中心,上海市糖尿病研究所,上海市糖尿病重点实验室,200233

出　　处：《中华糖尿病杂志》2021年第11期1061-1067,共7页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：科技部重点研发计划(2018YFC2001004);上海市教育委员会高峰高原学科建设计划(20161430)。

摘　　要：目的探讨2型糖尿病(T2DM)患者基线葡萄糖在目标范围内时间(TIR)与视网膜病变(DR)发生风险的关系。方法为前瞻性队列研究。选取2005年4月至2019年5月在上海交通大学附属第六人民医院内分泌代谢科入院检查治疗且基线时无DR的T2DM患者,利用持续葡萄糖监测(CGM)数据计算TIR,并进行前瞻性随访,最终纳入1057例患者。将患者根据接近TIR四分位数切点分为≤50%、51%~70%、71%~85%、>85%组共4组。采用Cox比例风险回归模型分析TIR与DR发生风险的相关性。结果经过中位数7.7年的随访,266例患者出现DR。以每千人年为单位计算TIR>85%、71%~85%、51%~70%、≤50%4组DR发生率分别为26.0/千人年(63/2419.7人年)、28.0/千人年(57/2032.9人年)、40.5/千人年(79/1950.8人年)和42.0/千人年(67/1594.1人年),具有统计学意义(log-rank P=0.013)。Cox比例风险回归分析结果显示,在校正性别、年龄、糖尿病病程、是否吸烟、体重指数、血压、血脂和估算的肾小球滤过率后,与基线TIR>85%的患者相比,基线TIR在71%~85%、51%~70%及≤50%的患者DR的发生风险分别增加了2%(HR=1.02,95%CI 0.71~1.46)、42%(HR=1.42,95%CI 1.01~1.99)及46%(HR=1.46,95%CI 1.02~2.07),具有统计学意义(趋势P=0.01)。TIR每降低10%,DR发生风险增加7%(HR=1.07,95%CI 1.02~1.13)。结论T2DM患者TIR水平降低可增加其DR发生风险,进一步证实TIR可成为重要血糖控制评价指标。Objective To investigate the association between time in range(TIR)and diabetic retinopathy(DR)among patients with type 2 diabetes mellitus(T2DM).Methods This study was designed as a prospective cohort study.A total of 1057 patients with T2DM were prospectively recruited from April 2005 to May 2019 from Department of Endocrinology and Metabolism,Shanghai Jiao Tong University Affiliated Sixth People′s Hospital.TIR was measured with continuous glucose monitoring(CGM)at baseline.Cox proportion hazard regression analysis was used to determine the association between TIR and the risk of DR.Results During a median follow-up of 7.7 years,266 patients developed DR.The incidence rates of DR were 26.0(63/2419.7),28.0(57/2032.9),40.5(79/1950.8)and 42.0(67/1594.1)per 1000 person-years in TIR>85%,71%-85%,51%-70%,and≤50%,respectively(log-rank P=0.013).Cox proportion hazard regression analysis showed that after adjusting for sex,age,diabetes duration,smoking,body mass index,blood pressure,blood lipids,and estimated glomerular filtration rate,hazard ratios(HR)for DR across different levels of TIR(>85%,71%-85%,51%-70%,and≤50%)were 1.00,1.02[95% confidence interval(CI)0.71-1.46],1.42(95% CI 1.01-1.99)and 1.46(95% CI 1.02-2.07),which had statistically significant differences(P for trend=0.01),respectively.When TIR was considered as a continuous variable,the multivariable-adjusted HR for DR associated with each 10%decrease in TIR was 1.07(95% CI 1.02-1.13).Conclusion The current prospective cohort study indicated an association of lower TIR with an increased risk of DR among patients with T2DM,supporting the validity of TIR as an optimal marker of glucose control.

关 键 词：糖尿病 2型 葡萄糖在目标范围内时间 糖尿病性视网膜病变 队列研究 

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