2型糖尿病患者血尿酸/肌酐比值与糖尿病视网膜病变的相关性研究  

Association of serum uric acid to creatinine ratio with diabetic retinopathy in type 2 diabetes mellitus

作　　者：江雨璐 黄宏[1] 张宁[2] 吕吉莉 许梦菲 刘丽丽[3] Jiang Yulu;Huang Hong;Zhang Ning;Lyu Jili;Xu Mengfei;Liu Lili(Department of Ophthalmology,Nanjing Drum Tower Hospital,Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Endocrinology,Nanjing Drum Tower Hospital,Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Gynecology,Nanjing Drum Tower Hospital,Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院眼科,南京210008 [2]南京大学医学院附属鼓楼医院内分泌科,南京210008 [3]南京大学医学院附属鼓楼医院妇科,南京210008

出　　处：《中华糖尿病杂志》2025年第1期148-152,共5页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：南京鼓楼医院临床研究专项资金项目面上项目(2023-LCYJ-MS-19)。

摘　　要：目的探讨2型糖尿病(T2DM)患者血尿酸(SUA)/肌酐(Scr)比值(SUA/Scr)与糖尿病视网膜病变(DR)的关系。方法该研究为横断面研究。回顾性分析2021年12月至2023年12月在南京大学医学院附属鼓楼医院眼科门诊和内分泌科门诊就诊的434例T2DM患者的临床资料,根据眼底照相结果分为单纯T2DM组(231例)和DR组(203例),DR组又进一步分为非增殖型DR(NPDR)组(122例)和增殖型DR(PDR)组(81例)。测定所有研究对象的SUA和Scr,计算SUA/Scr。根据T2DM患者的SUA/Scr三分位数值将研究对象分为低SUA/Scr组(SUA/Scr<4.37,146例)、中SUA/Scr组(SUA/Scr 4.37~5.46,146例)和高SUA/Scr组(SUA/Scr>5.46,142例)。采用logistic回归分析法分析SUA/Scr与DR发生及严重程度的关系,绘制受试者工作特征(ROC)曲线评估SUA/Scr和SUA预测DR发生的价值。结果PDR组SUA/Scr水平显著高于NPDR组和单纯T2DM组(分别为6.54±1.55、5.54±1.32和4.36±0.98,P<0.01),并且NPDR组SUA/Scr水平显著高于单纯T2DM组。多因素logistic回归分析显示,SUA/Scr是NPDR和PDR的影响因素,OR值分别为4.046(95%CI 2.450~6.680)和4.253(95%CI 1.429~7.363)。随着SUA/Scr水平的升高,NPDR的发生率逐渐升高,分别为18.5%(27/146)、22.6%(33/146)和43.7%(62/142),PDR的发生率也逐渐升高,分别为1.4%(2/146)、13.7%(20/146)和41.5%(59/142)。ROC曲线分析显示,SUA/Scr的ROC曲线下面积大于SUA,当SUA/Scr截断值取5.01时,诊断DR的灵敏度为74.9%,特异度为76.6%。结论SUA/Scr是DR发生及发展的影响因素,可能作为识别T2DM患者发生DR风险的有效工具。ObjectiveTo investigate the relationship between serum uric acid(SUA)to serum creatinine(Scr)ratio(SUA/Scr)and diabetic retinopathy(DR)in patients with type 2 diabetes mellitus(T2DM).MethodsThis was a cross-sectional study.A total of 434 T2DM patients were enrolled in the ophthalmology and endocrinology departments of Nanjing Drum Tower Hospital from December 2021 to December 2023,and divided into the T2DM group(231 cases)and DR group(203 cases)according to the photographic results.The DR group was further divided into non-proliferative diabetic retinopathy(NPDR)group(122 cases)and proliferative diabetic retinopathy(PDR)group(81 cases).SUA and Scr levels were measured in all patients,and SUA/Scr was calculated.T2DM patients were divided into low SUA/Scr group(SUA/Scr<4.37,146 cases),medium SUA/Scr group(SUA/Scr 4.37-5.46,146 cases)and high SUA/Scr group(SUA/Scr>5.46,142 cases)according to the SUA/Scr tripartite.The logistic regression model was used to examine the association of SUA/Scr with DR and its severity.The diagnostic value of SUA/Scr and SUA in predicting DR was evaluated using the area under the receiver operating characteristics(ROC)curve(AUC).ResultsThe SUA/Scr levels in the PDR group were significantly higher than those in the NPDR group and T2DM group(6.54±1.55 vs.5.54±1.32 vs.4.36±0.98,P<0.01).Multivariate logistic regression analysis showed that SUA/Scr was an influencing factor for NPDR(OR=4.046,95%CI 2.450-6.680,P<0.05)and PDR(OR=4.253,95%CI 1.429-7.363,P<0.05).SUA/Scr levels tended to be higher in the T2DM group than in the control group,although the difference did not reach statistical significance.With the increase of SUA/Scr levels,the incidence of NPDR[18.5%(27/146)vs.22.6%(33/146)vs.43.7%(62/142),P<0.05]and PDR[1.4%(2/146)vs.13.7%(20/146)vs.41.5%(59/142),P<0.05]gradually increased.ROC curve analysis showed that the area under ROC curve of SUA/Scr was larger than that of SUA.When the cut-off value of SUA/Scr was 5.01,the sensitivity for diagnosing DR was 74.9%and the specificity was 76.6

关 键 词：糖尿病 2型 糖尿病视网膜病变 血尿酸/肌酐比值 

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