摘要
目的评估糖化血红蛋白(HbA1c)变异性对2型糖尿病(T2D)患者糖尿病视网膜病变(diabetic retinopathy,DR)的作用,并通过应用受试者工作特征(ROC)曲线找出糖化血红蛋白(HbA1c)变异性用于诊断早期DR的截断值(cut-off值)。方法对3386例T2D患者进行纵向队列研究,随访2~5 a,平均4.0 a,每年行一次散瞳眼底检查。依据患者所有记录的HbA1c值计算其平均值(A1c-Mean)和标准差(A1c-SD),其中HbA1c变异性表达为A1c-SD。收集并分析患者病史和临床资料。采用线性混合效应模型探讨HbA1c变异性等因素对DR的影响,绘制ROC曲线以评价HbA1c变异性对DR早期的诊断价值。结果混合效应结果显示,Alc-Mean、A1c-SD与DR的发展均呈正相关(β=0.049、0.031,均为P<0.05)。ROC曲线分析结果显示,HbA1c变异性曲线下面积(AUC)为0.630,用于诊断早期DR的cut-off值为0.625,敏感度为0.781,特异度为0.573。结论HbA1c变异性能够预测T2D患者DR的发生,可作为初步预测DR的指标。
Objective To evaluate the effect of glycosylated hemoglobin(HbA1c)variability on diabetic retinopathy(DR)in patients with type 2 diabetes(T2D)and the cut-off value of HbA1c variability for predicting DR using receiver operating characteristic curve(ROC).Methods It was a longitudinal cohort study.A total of 3386 patients with T2D were followed up with a median period of 4.0 years(2-5 years)and received dilated funduscopic examination annually.Intrapersonal mean of all recorded HbA1c values(A1c-mean)and the standard deviation(A1c-SD)were calculated.A1c-SD represented the measure of HbA1C variability.Medical history and clinical data were collected and analyzed.Linear mixed-effect models with unstructured variance-covariance matrices were carried out to longitudinally assess the effects of HbA1c variability on the DR risk.ROC curve was drawn to evaluate the value of HbA1c variability in early diagnosis of DR.Results Linear mixed-effect models revealed that A1c-mean and A1c-SD were positively associated with DR development(β=0.049,0.031,both P<0.05).The area under the ROC curve for HbA1c variability was 0.630,cut-off value for early diagnosis of DR was 0.625,the sensitivity was 0.781,and the specificity was 0.573.Conclusion HbA1c variability can predict the occurrence of DR in patients with type 2 diabetes,so it can be considered as a preliminary indicator of DR.
作者
胡佳琪
周倩倩
徐慧君
袁晓丹
李洮俊
楼青青
HU Jiaqi;ZHOU Qianqian;XU Huijun;YUAN Xiaodan;LI Taojun;LOU Qingqing(College of Nursing,Nanjing University of Chinese Medicine,Nanjing 210023,Jiangsu Province,China;College of Nursing,Huzhou University,Huzhou 313000,Zhejiang Province,China;Lee’s Clinic,Pingdong 90000,Taiwan Province,China;Department of Health Education,Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine,Nanjing 210028,Jiangsu Province,China)
出处
《眼科新进展》
CAS
北大核心
2020年第10期967-971,共5页
Recent Advances in Ophthalmology
基金
江苏省干部保健科研课题资助(编号:BJ18031)。
