晶状体糖基化终末产物在糖尿病视网膜病变中的临床应用价值  

Clinical value of advanced glycation end products in the diabetic retinopathy

作　　者：姚佳舒 刘钰 桑苗苗 李伟[2] 袁扬[1] 邱山虎[3] 王多劳 孙子林[1] Yao Jiashu;Liu Yu;Sang Miaomiao;Li Wei;Yuan Yang;Qiu Shanhu;Wang Duolao;Sun Zilin(Department of Endocrinology,Zhongda Hospital,Institute of Diabetes,School of Medicine,Southeast University,Nanjing 210009,China;Department of Endocrinology,Suzhou Hospital of Anhui Medical University(Suzhou Municipal Hospital of Anhui Province),Suzhou 234000,China;Department of General Practice,Zhongda Hospital,Institute of Diabetes,School of Medicine,Southeast University,Nanjing 210009,China;Department of Clinical Sciences,Liverpool School of Tropical Medicine,Pembroke Place,Liverpool 28372,UK)

机构地区：[1]东南大学附属中大医院内分泌科东南大学糖尿病研究所,南京210009 [2]安徽医科大学附属宿州医院(安徽省宿州市立医院)内分泌科,宿州234000 [3]东南大学附属中大医院全科东南大学糖尿病研究所,南京210009 [4]利物浦热带医学院临床科学系,英国利物浦28372

出　　处：《中华糖尿病杂志》2022年第7期696-703,共8页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：国家重点研发计划(2016YFC1305700)。

摘　　要：目的:探讨晶状体自发荧光强度比值(LFR)与糖尿病视网膜病变(DR)的关系及其在中国DR人群中的筛查价值。方法:为横断面研究。自2020年5月至2021年1月,从中国8个不同省份的社区居民中筛选糖尿病患者590例,收集上述研究对象的人口学特征、吸烟史、疾病史,测量收缩压、舒张压、身高、体重,检测空腹血糖、餐后2 h血糖、糖化血红蛋白(HbA 1c)、血脂等指标,并计算体重指数、估算的肾小球滤过率。运用晶状体荧光显微镜测定受检眼LFR,采用基于DR早期治疗研究(ETDRS)评分对眼底图像进行分级。按LFR三分位水平分为3组:LFR最低组( Q1组,LFR<20.20%,196例)、LFR中间组( Q2组,LFR 20.20%~25.88%,198例)和LFR最高组( Q3组,LFR≥25.89%,196例)。采用logistic回归分析探讨LFR与DR之间的关联,并以受试者工作特征曲线(ROC)评价LFR单独或联合HbA 1c筛查DR的效能。 结果:随着LFR水平的升高,DR的患病率呈上升趋势[ Q1组5.10%(10/196), Q2组11.62%(23/198), Q3组30.10%(59/196);趋势性 P值<0.001]。以ETDRS评分≥31为参考标准,校正年龄、性别、体重指数、收缩压、舒张压、HbA 1c、空腹血糖、餐后2 h血糖、高密度脂蛋白胆固醇、甘油三酯、估算的肾小球滤过率、吸烟史后,LFR每增加1个标准差,DR患病风险增加2.34倍(95%CI 1.68~3.26)。当以ETDRS评分≥31为参考标准时,LFR筛查DR的曲线下面积(AUC)为0.783,灵敏度为64.15%,特异度为84.36%,将LFR与HbA 1c联合后,AUC提升至0.865,灵敏度提升至94.34%。 结论:LFR与DR患病风险正相关,且对于DR筛查表现出较高的AUC及特异度,联合HbA 1c可提高其筛查效能。Objectives To investigate the relationship between lens fluorescence ratio(LFR)and diabetic retinopathy(DR),and to explore its role in the screening of DR in Chinese population.Methods A cross-sectional study design was used.A total of 590 diabetic patients aged 20 to 70 years in eight provinces of China between May 2020 and January 2021 were enrolled.Questionnaire survey,smoking and past medical history were collected.Systolic blood pressure,diastolic blood pressure,height,and weight were measured,and fasting blood glucose(FPG),2-hour postprandial blood glucose,glycated hemoglobin A1c(HbA1c),blood lipids and other indicators were detected.Estimated glomerular filtration rate(eGFR)and body mass index were calculated.Grading of fundus images was based on the Early Treatment Diabetic Retinopathy Study(ETDRS)score.LFR was measured by the biomicroscopy.All subjects were grouped according to the tertile of LFR levels:the lowest LFR group(group Q1,LFR<20.20%,196 cases),the intermediate LFR group(group Q2,LFR 20.20%-25.88%,198 cases),the highest LFR group(group Q3,LFR≥25.89%,196 cases).The logistic regression analyses were used to examine the association of LFR and DR.Receiver operating characteristic curve(ROC)was used to evaluate the screening efficacy of LFR alone and combined HbA1c in screening DR.Results The prevalence of DR[5.10%(10/196)in group Q1,11.62%(23/198)in group Q2,and 30.10%(59/196)in Q3,respectively;P value for trend<0.001]increased with increasing LFR levels.Based on ETDRS score≥31,the odds of DR was 2.34 for one SD increase(95%CI 1.68-3.26)after adjustment for confounders including age,gender,body mass index,systolic blood pressure,diastolic blood pressure,HbA1c,FPG,2-hour postprandial blood glucose,high-density lipoprotein cholesterol,triglycerides,eGFR,smoking history.Based on ETDRS score≥31,the area under the curve(AUC)of LFR was 0.783,the sensitivity and specificity were 64.15%and 84.36%,respectively.The AUC increased to 0.865 and the sensitivity increased to 94.34%after combining LFR with H

关 键 词：糖尿病并发症 糖尿病视网膜病变 血红蛋白A 糖基化 糖基化终末产物 晶状体自发荧光强度比值 

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