糖化血红蛋白变异性对2型糖尿病视网膜病变的影响及其最佳临界值的确定  

Effect of Glycosylated Hemoglobin Variability on Type 2 Diabetic Mellitus Retinopathy and Determination of the Optimal Critical Value

作　　者：缪康琪 王天天 张云飞[1] 胡艳美 马晓君[1] MIAO Kangqi;WANG Tiantian;ZHANG Yunfei;HU Yanmei;MA Xiaojun(Department of Endocrinology and Metabolism,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院内分泌与代谢病科,河南郑州450052

出　　处：《河南医学研究》2022年第14期2512-2517,共6页Henan Medical Research

基　　金：河南省医学科技攻关(重点)项目(SBGJ202002069);河南省高等学校重点科研项目(20A320034)。

摘　　要：目的探讨糖化血红蛋白(HbA1c)变异性对2型糖尿病(T2DM)患者糖尿病视网膜病变(DR)的影响,同时分析HbA1c变异性的影响因素,并通过受试者工作特征(ROC)曲线找出HbA1c变异性用于早期诊断DR的最佳临界值。方法选取2019年1月至2021年3月就诊于郑州大学第一附属医院的206例T2DM患者为研究对象,以第1次眼底检查记录日期作为基线,收集资料并对患者进行随访。根据是否有视网膜病变将患者分为两组:合并DR组(110例)和无糖尿病视网膜病变(NDR)组(96例)。本研究采用HbA1c标准差(HbA1c-SD)作为HbA1c变异性的表达方式。根据每位研究对象的HbA1c测量值计算其平均值(HbA1c-Mean)及其HbA1c-SD。依据HbA1c-Mean是否高于7%和HbA1c-SD是否高于0.89%将患者分为4组:Q1组(HbA1c-Mean<7%,且HbA1c-SD<0.89%)、Q2组(HbA1c-Mean<7%,且HbA1c-SD≥0.89%)、Q3组(HbA1c-Mean≥7%,且HbA1c-SD<0.89%)和Q4组(HbA1c-Mean≥7%,且HbA1c-SD≥0.89%)。绘制ROC曲线以评价HbA1c变异性指标对DR早期诊断的价值。结果多元线性回归结果显示,使用胰岛素治疗能提高HbA1c变异性(P<0.05),年龄、性别、病程、饮酒等对HbA1c变异性无影响(P>0.05)。二元logistic回归分析结果显示,HbA1c-Mean、HbA1c-SD是发生DR的独立危险因素。进行分层后显示Q4组发生DR的风险最高(OR=2.793,P=0.031)。ROC曲线分析结果显示,HbA1c变异性曲线下面积(AUC)为0.590(95%CI:0.510~0.670),分析HbA1c变异性用于诊断DR的最佳临界值为0.625(敏感度为0.673,特异度为0.573)。结论HbA1c变异性是T2DM患者发生DR的独立危险因素;当HbA1c-Mean相同或相似时,HbA1c-SD总体均值越高,T2DM患者发生DR的风险越大;HbA1c-SD用于诊断DR的最佳临界值为0.625。Objective To investigate the effect of glycosylated hemoglobin(HbA1c)variability on diabetic retinopathy(DR)in patients with type 2 diabetes mellitus(T2DM),and to analyze the influencing factors of HbA1c variability,and to find the optimal critical value of HbA1c variability for the diagnosis of early DR by receiver operating characteristic(ROC)curve.Methods A total of 206 patients with T2DM who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2019 to March 2021 were selected as the subjects.Data were collected and patients were followed up based on the record date of the first fundus examination.According to whether there was DR,the patients were divided into two groups:DR group(110 cases)and non-diabetic retinopathy(NDR)group(96 cases).In this study,the standard deviation of HbA1c(HbA1c-SD)was used as the expression of HbA1c variability.The mean of HbA1c(HbA1c-Mean)and HbA1c-SD were calculated according to the HbA1c measurement of each subject.Patients were divided into 4 groups according to whether HbA1c-Mean was higher than 7%and HbA1c-SD was higher than 0.89%:Q1 group(HbA1c-Mean<7%,and HbA1c-SD<0.89%),Q2 group(HbA1c-Mean<7%,and HbA1c-SD≥0.89%),Q3 group(HbA1c-Mean≥7%,and HbA1c-SD<0.89%)and Q4 group(HbA1c-Mean≥7%,HbA1c-SD≥0.89%).ROC curves were drawn to evaluate the value of HbA1c variability in early diagnosis of DR.Results Multiple linear regression showed that insulin could increase the HbA1c variability(P<0.05),and age,gender,course of disease and alcohol consumption had no influence on HbA1c variability(P>0.05).Binary logistic regression analysis showed that HbA1c-Mean and HbA1c-SD were independent risk factors for DR.Stratification showed that Q4 group had the highest risk of DR(OR=2.793,P=0.031).ROC curve analysis showed that the area under the curve(AUC)of HbA1c variability was 0.590(95%CI:0.510-0.670),and the optimal critical value of HbA1c variability for the diagnosis of DR was 0.625(sensitivity was 0.673,specificity was 0.573).Conclusion HbA1c variability

关 键 词：2型糖尿病 糖尿病视网膜病变 糖化血红蛋白变异性 

分 类 号：R587.2[医药卫生—内分泌]