糖尿病患者视网膜病变程度与血糖波动的关系及其影响因素  

Relationship between severity of diabetic retinopathy and blood glucose fluctuations and its influencing factors

作　　者：张琳琪 居悦俊 陈可[2] 王冠怡 孔颖宏 Zhang Linqi;Ju Yuejun;Chen Ke;Wang Guanyi;Kong Yinghong(Department of Endocrinology,Affiliated Changshu Hospital of Nantong University,Changshu Jiangsu 215500,China;Department of Ophthalmology,Affiliated Changshu Hospital of Nantong University,Changshu Jiangsu 215500,China)

机构地区：[1]南通大学附属常熟医院内分泌科,江苏常熟215500 [2]南通大学附属常熟医院眼科,江苏常熟215500

出　　处：《眼科》2025年第2期137-141,共5页Ophthalmology in China

摘　　要：目的分析2型糖尿病(T2DM)患者视网膜病变(DR)程度与血糖波动的关系及其影响因素。设计回顾性病例系列。研究对象采用方便抽样方法选取2021年2月至2023年4月常熟医院收治的168例T2DM患者。方法按是否有DR及其严重程度分为无DR组(NDR)88例、非增生性DR组(NPDR)59例和增生性DR组(PDR)21例。比较三组基本资料、实验室检查指标和14天动态血糖监测(CGM)结果,采用多因素Logistic回归分析DR病情进展的影响因素,绘制受试者工作特征曲线(ROC),评估血糖在目标范围内的时间(TIR)、平均血糖波动幅度(MAGE)对DR病情进展的预测效能。主要指标TIR、平均血糖(MBG)、血糖水平标准差(SDBG)、MAGE。结果三组的年龄、糖尿病病程、空腹血糖(FPG)、糖化血红蛋白(HbA1c)水平比较,NDR组<NPDR组<PDR组(P均<0.05)。三组TIR值比较,NDR组(79.78%±14.03%)>NPDR组(67.51%±12.75%)>PDR组(50.17%±10.18%)(P均<0.05)。三组MBG比较,NDR组的(8.15±1.76)mmol/L<NPDR组的(8.77±1.89)mmol/L<PDR组的(9.79±2.16)mmol/L(P均<0.05)。三组SDBG比较,NDR组的(1.84±0.48)mmol/L<NPDR组的(2.39±0.62)mmol/L<PDR组的(2.68±0.75)mmol/L(P均<0.05)。三组的MAGE比较,NDR组的(4.33±1.04)mmol/L<NPDR组的(5.48±1.34)mmol/L<PDR组的(6.67±1.69)mmol/L(P均<0.05)。ROC曲线分析显示:TIR<60.22%、MAGE>6.17 mmol/L、HbA1c>8.83%均能预测PDR(P均<0.05),曲线下面积分别为0.918、0.684、0.680,其中TIR的预测效能最高(Z=3.105,3.401;P=0.002,0.001),其敏感度为90.48%,特异度为82.31%;多因素Logistic回归分析显示:MAGE>6.17 mmol/L,TIR<60.22%均为PDR的独立危险因素(P均<0.05)。结论T2DM患者DR病情严重程度与血糖波动密切相关,MAGE>6.17 mmol/L,TIR<60.22%会增加NDR和NPDR发展为PDR的风险,且TIR、MAGE可作为PDR发生的预测指标。Objective To analyze the relationship between severity of diabetic retinopathy(DR)and blood glucose fluctuations in patients with type 2 diabetes mellitus(T2DM)and its influencing factors.Design Retrospective case series.Participants Using convenience sampling method to select 168 T2DM patients admitted to Changshu Hospital from February 2021 to April 2023.Methods According to the severity of DR,the patients were divided into 88 cases in non-DR group(NDR),59 cases in non-proliferative DR group(NPDR)and 21 cases in proliferative DR group(PDR).The basic data,laboratory indicators and 14-day continuous glucose monitoring(CGM)results were compared among the three groups.The influencing factors of progression of DR were explored by multivariate Logistic regression analysis,and receiver operating characteristic curve(ROC)was drawn.The predictive efficiency of time in range(TIR)and mean amplitude of glycemic excursions(MAGE)on predicting the progression of DR was assessed.Main Outcome Measures TIR,mean blood glucose(MBG),standard deviation of blood glucose level(SDBG),MAGE.Results Age,diabetes course,fasting plasma glucose(FPG)and glycosylated hemoglobin(HbA1c)levels were manifested as NDR group<NPDR group<PDR group(all P<0.05).The TIR value was expressed as NDR group(79.78%±14.03%)>NPDR group(67.51%±12.75%)>PDR group(50.17%±10.18%)(all P<0.05),while the MBG level revealed NDR group[(8.15±1.76)mmol/L]<NPDR group[(8.77±1.89)mmol/L]<PDR group[(9.79±2.16)mmol/L](all P<0.05).The SDBG level showed NDR group[(1.84±0.48)mmol/L]<NPDR group[(2.39±0.62)mmol/L]<PDR group[(2.68±0.75)mmol/L](all P<0.05).The MAGE level was considered as NDR group[(4.33±1.04)mmol/L]<NPDR group[(5.48±1.34)mmol/L]<PDR group[(6.67±1.69)mmol/L](all P<0.05).ROC curve analysis found that TIR<60.22%,MAGE>6.17 mmol/L and HbA1c>8.83%could all predict PDR(all P<0.05),and the areas under the curves were 0.918,0.684 and 0.680,and TIR had the highest prediction efficiency(Z=3.105,3.401;P=0.002,0.001),and its sensitivity and specificity were 90.48%and 8

关 键 词：2型糖尿病 糖尿病视网膜病变 

分 类 号：R58[医药卫生—内分泌]