2型糖尿病患者发生颈动脉粥样硬化与增殖期糖尿病视网膜病变的相关性研究  

Carotid Atherosclerosis and Proliferative Diabetic Retinopathy in Type 2 Diabetics

作　　者：陈一文[1] 张雪莲[2] CHEN Yiwen;ZHANG Xuelian(Department of Geriatrics,Beijing Tongren Hospital,CMU,Beijing 100730,China;Department of Endocrinology,Beijing Tongren Hospital,CMU,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院老年医学科暨干部医疗科,北京市100730 [2]首都医科大学附属北京同仁医院内分泌科,北京市100730

出　　处：《中国全科医学》2022年第23期2843-2848,共6页Chinese General Practice

基　　金：国家自然科学基金资助项目(81300726);首都临床特色应用研究项目(Z151100004015021)。

摘　　要：背景血糖控制不佳的糖尿病患者发生糖尿病视网膜病变(DR)与颈动脉粥样硬化(CAS)的风险均增加,而CAS是冠心病、脑卒中的危险因素,了解DR与CAS之间的关系可以为改善糖尿病并发症提供新的临床决策方案。目的探讨病程长且血糖控制不佳的2型糖尿病(T2DM)患者发生CAS与增殖期糖尿病视网膜病变(PDR)的相关性。方法本研究为回顾性病例对照研究,分析2014年10月至2015年11月在首都医科大学附属北京同仁医院内分泌科连续住院的T2DM患者〔糖化血红蛋白(HbA_(1c))≥7.5%,估算肾小球滤过率(eGFR)≥60 ml·min^(-1)·(1.73 m^(2))^(-1),糖尿病病程≥10年〕158例,根据视网膜病变情况将患者分为无DR(NDR)组(n=105)和PDR组(n=53);根据CAS严重程度将患者分为颈动脉正常组(n=48)和CAS组(n=110)。记录患者的临床特征及实验室检查指标。结果NDR组收缩压(SBP)、尿微量白蛋白排泄率(UAER)低于PDR组,静息心率(HR)慢于PDR组,eGFR高于PDR组(P<0.05)。颈动脉正常组年龄、高血压病史所占比例、冠心病病史所占比例、脂蛋白a、PDR发生率低于CAS组(P<0.05)。NDR组CAS发生率为61.9%(65/105),低于PDR组的84.9%(45/53)(P=0.012)。多因素Logistic回归分析结果显示,高龄〔OR=1.194,95%CI(1.040,1.372)〕、既往有高血压病史〔OR=2.690,95%CI(1.206,6.000)〕、脂蛋白a水平升高〔OR=1.079,95%CI(1.038,1.122)〕、PDR〔OR=2.990,95%CI(1.127,7.934)〕是T2DM患者发生CAS的危险因素(P<0.05)。结论合并PDR的病程长且血糖控制不佳的T2DM患者发生CAS的比例较高。Background The risks of diabetic retinopathy and carotid atherosclerosis(CAS)may be increased in diabetics with poor glycemic control,and CAS is a risk factor for both coronary heart disease and stroke.Understanding the relationship between diabetic retinopathy and CAS may offer insights into the development of new clinical decisionmaking strategies for improving diabetic complications.Objective To assess the correlation between CAS and proliferative diabetic retinopathy(PDR)in patients with type 2 diabetes mellitus(T2DM)with a long duration of diabetes and poor glycemic control.Methods A retrospective,case-control design was adopted.One hundred and fifty-eight T2DM patients〔glycosylated hemoglobin(HbA_(1c))≥7.5%,glomerular filtration rate(eGFR)≥60 ml·min^(-1)·(1.73 m^(2))^(-1),and diabetes duration≥10 years;53 with PDR,and other 105 without;48 with normal carotid arteries and other 110 with CAS〕were consecutively recruited from Department of Endocrinology,Beijing Tongren Hospital,CMU,from October 2014 to November 2015.Clinical characteristics and laboratory indices were recorded.Results Compared with patients without diabetic retinopathy,those with PDR had higher systolic blood pressure,24-hour urinary microalbumin excretion rate,and resting heart rate,as well as lower eGFR(P<0.05).Compared with patients with normal carotid artery,those with CAS had older age,higher prevalence of hypertension and coronary heart disease,higher Lp(a)and incidence of PDR(P<0.05).The prevalence of CAS in patients without diabetic retinopathy was lower than that of those with PDR〔61.9%(65/105)vs 84.9%(45/53)〕(P=0.012).Multivariate Logistic regression analysis showed that older age〔OR=1.194,95%CI(1.040,1.372)〕,history of hypertension〔OR=2.690,95%CI(1.206,6.000)〕,increased lipoprotein a level〔OR=1.079,95%CI(1.038,1.122)〕and PDR〔OR=2.990,95%CI(1.127,7.934)〕were associated with increased risk of CAS in T2DM(P<0.05).Conclusion The prevalence of CAS may be increased in T2DM patients with PDR,long course of T

关 键 词：糖尿病 2型 糖尿病视网膜病变 颈动脉疾病 颈动脉粥样硬化 病例对照研究 

分 类 号：R587.1[医药卫生—内分泌]