糖尿病视网膜病变相关危险因素分析及预测模型研究  

Analysis of risk factors associated with diabetic retinopathy and the study on the model of prediction

作　　者：卢佳琦 李帅[1] 马桂巧 王军伟 马婵娟[3] Lu Jiaqi;Li Shuai;Ma Guiqiao;Wang Junwei;Ma Chanjuan(The Fifth Clinical College of Medicine,Shanxi Medical University,Taiyuan 030001,China;Shanxi University of Traditional Chinese Medicine,Jinzhong 030619,China;Department of Nephrology,Shanxi Provincial People′s Hospital,Taiyuan 030012,China)

机构地区：[1]山西医科大学第五临床医学院,山西太原030001 [2]山西中医药大学,山西晋中030619 [3]山西省人民医院肾内科,山西太原030012

出　　处：《实用药物与临床》2023年第6期504-508,共5页Practical Pharmacy and Clinical Remedies

基　　金：山西省留学人员科技活动择优资助项目(20220046);山西省回国留学人员科研资助项目(2022-206)。

摘　　要：目的探讨2型糖尿病(T2DM)合并糖尿病视网膜病变(DR)的危险因素,并根据研究中确认的危险因素制定DR的预测模型,为患者提供一种方便、有效的筛查工具。方法收集2019年6月至2022年6月就诊于山西省人民医院诊断为2型糖尿病同时接受眼底检查的患者,符合入选标准者共599例。根据是否合并糖尿病视网膜病变分组,合并DR的患者归为观察组(DR组),共423例;未合并DR的患者归为对照组(非DR组),共176例。比较两组患者的一般特征和临床参数(包括性别、年龄、SBP、DBP、体重指数、吸烟史、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、血清白蛋白、血尿素氮等),进行Logistic回归分析,得出DR的危险因素,并根据其制定一个预测模型。结果DR的危险因素有糖尿病病程>8年(β=0.940,OR=2.559,95%CI:1.777~3.687,P<0.01)、高血压(β=0.541,OR=1.718,95%CI:1.192~2.475,P<0.01)、尿微量白蛋白/尿肌酐比值(UACR)>300 mg/g(β=1.496,OR=4.465,95%CI:2.990~6.667,P<0.01)以及肾小球滤过率(eGFR)<60 ml/(min·1.73 m^(2))(β=0.898,OR=2.455,95%CI:1.637~3.680,P<0.01),根据其回归系数β,按比例计算每一项风险因素的评分权重,建立DR的预测模型:糖尿病病程>8年记2分、患有高血压记1分、eGFR<60 ml(min·1.73 m^(2))记2分、UACR>300 mg/g记3分,相加后总分≥6分(阳性预测值为87.5%)视为DR的高风险人群,此预测模型的ROC曲线下面积为0.712(95%CI:0.667~0.757,P<0.001)。结论糖尿病病程、高血压、UACR、eGFR与DR显著相关,由此建立的风险预测模型对DR有一定的筛查作用。Objective To investigate the risk factors of type 2 diabetes mellitus(T2DM)complicated with diabetic retinopathy(DR),and to develop a prediction model of DR based on the identified risk factors,so as to provide a convenient and effective screening tool for patients.Methods A total of 599 patients diagnosed with type 2 diabetes and receiving fundus examination in Shanxi Provincial People′s Hospital from June 2019 to June 2022 were collected.According to whether they were combined with diabetic retinopathy or not,patients were divided into observation group(DR group,T2DM+DR,n=423)and control group(non-DR group,T2DM,n=176).The general characteristics and clinical parameters of the two groups were compared,and the parameters(including gender,age,SBP,DBP,BMI,history of smoking,ALT,AST,ALB,BUN,etc.)were analyzed by Logistic regression to find out risk factors of DR.A prediction model was developed based on the risk factors of DR to provide a convenient and effective DR screening tool for DM patients.Results Logistic regression analysis showed that the risk factors of DR were as follows:diabetes duration>8 years(β=0.940,OR=2.559,95%CI:1.777~3.687,P<0.01),hypertension(β=0.541,OR=1.718,95%CI:1.192~2.475,P<0.01),UACR>300 mg/g(β=1.496,OR=4.465,95%CI:2.990~6.667,P<0.01)and eGFR<60 ml/(min·1.73 m^(2))(β=0.898,OR=2.455,95%CI:1.637~3.680,P<0.01);according to its regression coefficientβ,the scoring weight of each risk factor was calculated proportionally,and the prediction model of DR was established:2 points were scored for diabetes>8 years,1 point was scored for hypertension,2 points were scored for eGFR<60 ml/(min·1.73 m^(2)),and 3 points were scored for UACR>300 mg/g.Patients with total score≥6 points after addition(positive predictive value was 87.5%)was considered as high-risk population of DR.The area under ROC curve of this prediction model was 0.712(95%CI:0.667~0.757,P<0.001).Conclusion The diabetes course,hypertension,UACR and eGFR are significantly correlated with DR,and the established risk prediction mode

关 键 词：2型糖尿病 糖尿病视网膜病变 预测模型 

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