早期糖尿病视网膜病变进展的危险因素  

Risk factors for progression of early diabetic retinopathy

作　　者：邵阳 王鑫[1] 李圣恩 张怡[1] 姚静[1] 张文怡 王建明[1] 周爱意[1] SHAO Yang;WANG Xin;LI Sheng-En(Department of Ophthalmology,The Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,Shanxi,China)

机构地区：[1]西安交通大学第二附属医院眼科,陕西西安710004 [2]西安市高陵区医院眼科

出　　处：《吉林医学》2024年第10期2346-2352,共7页Jilin Medical Journal

基　　金：陕西省重点研发计划[项目编号:2023-YBSF-585]。

摘　　要：目的:探讨2型糖尿病(T2DM)患者中早期糖尿病视网膜病变(DR)发生和进展的危险因素。方法:回顾性收集长期随访的344例T2DM患者的临床及检查资料,根据ETDRS DR严重程度分级标准(DRSS)对患者视网膜并发症情况进行分级记录,对照无DR的糖尿病患者,分析早期DR发生的危险因素。根据DR患者的随访资料,记录患者DR严重程度分级进展情况,采用二分类Logistic回归筛选有关DR早期进展的影响因素。对于进展的患者,进一步讨论进展级数较高的相关因素并绘制受试者工作特征(ROC)曲线进行预测。结果:糖尿病病程、胰岛素治疗及餐后2 hC肽(2 hCP)水平是影响早期DR发生的独立危险因素。有较高的载脂蛋白A(APOA)和间接胆红素(IBIL)水平的DR患者,更易在2年内发生进展。在发生进展的DR患者中,高密度脂蛋白(HDL)水平是进展级数2级及以上的影响因素,对于预测DR快速进展的ROC曲线下面积(AUC)为0.621,最佳截断值为1.585 mmol/L。结论:糖尿病病程较长的患者,发生DR的风险较大,采用胰岛素治疗及餐后2 hCP水平较低的患者,提示胰岛功能较差且血糖控制不佳,对于这类患者应加强随访。APOA、IBIL和HDL水平影响DR的早期及快速进展,可通过控制这些危险因素减缓早期DR进展,进而降低严重威胁视力的DR并发症的发生率。Objective To explore the risk factors for occurrence and progression of early diabetic retinopathy(DR)in patients with type 2 diabetes mellitus (T2DM). Method A total of 344 T2DM patients with or without early diabetic retinopathy (DR) who were followedfor a long period of time were included. The clinical information and biochemical indicators were collected retrospectively to analyzerisk factors for early presence of DR. The level of DR was categorized according to ETDRS diabetic retinopathy severity scale(DRSS). Based on the severity scale of DR recorded on the follow-up information, a binary logistic regression method was used to selectthe risk factors for earlier progression of DR. A further exploration was performed to find the related factors for aggravation of highlevels of DR in patients with progression and ROC curve was used to predict the value of selected factors. Results Duration of diabetes,insult treatment and postprandial 2hC peptide were independent risk factors for presence of early DR. The DR patients with a higherlevel of apolipoprotein a (AOPA) and indirect bilirubin (IBIL) were more likely to have DR progression within two years. For patientswith progression, high density lipoprotein (HDL) was proved to be risk factor for aggravation more than 2 levels. The results of ROCcurve showed that the area under the curve (AUC) of HDL predicting the rapid aggravation of early DR was 0. 621 and the best cut-offvalue was 1. 585 mmol/ L. Conclusion Follow-up should be strengthened for patients with longer duration of diabetes who are at a greaterrisk of developing DR and patients with insulin therapy and low postprandial 2hC peptide levels which may indicate poor islet functionand poor glycemic control. APOA, IBIL and HDL were associated with the early and rapid aggravation of DR. The occurrence ofvision-threatening complications might be reduced by controlling these related factors promptly.

关 键 词：2型糖尿病 早期糖尿病视网膜病变 危险因素 

分 类 号：R587.1[医药卫生—内分泌]