摘要
目的探讨住院2型糖尿病(T2DM)患者发生视网膜病变的危险因素并分析其胆红素水平。方法对2021年1—12月在首都医科大学宣武医院内分泌科住院并行免散瞳眼底照相的T2DM患者进行回顾性研究,收集患者糖尿病病程、体重指数(BMI)、肌酐、总胆红素、直接胆红素、间接胆红素、糖化血红蛋白(HbA1c)、超敏C反应蛋白(hs-CRP)、尿白蛋白/肌酐比值(UACR)等资料,按照糖尿病性视网膜病变(DR)的诊断和分期标准,将患者分为非糖尿病性视网膜病变(NDR)组和DR组。采用t检验、Mann‐WhitneyU检验或χ^(2)检验比较两组间一般临床资料;采用多因素logistic回归分析法分析DR的危险因素。结果共纳入患者1 027例,其中,DR组245例,NDR组782例。住院T2DM患者DR的患病率约为23.9%(245/1 027)。与NDR组相比,DR组患者的糖尿病病程更长,HbA1c、肌酐、UACR、hs-CRP均更高,而总胆红素、直接胆红素和间接胆红素均更低,差异均有统计学意义(均P<0.05)。多因素logistic回归分析结果显示,校正性别、年龄和BMI后,HbA1c(OR=1.199,95%CI 1.112~1.293)、糖尿病病程(OR=1.063,95%CI 1.034~1.093)、肌酐(OR=1.007,95%CI 1.002~1.013)、UACR(OR=1.389,95%CI 1.280~1.507)、hs-CRP(OR=1.260,95%CI 1.108~1.432)是DR发病的主要危险因素,总胆红素(OR=0.927,95%CI 0.873~0.983)、直接胆红素(OR=0.831,95%CI 0.701~0.985)及间接胆红素(OR=0.898,95%CI 0.825~0.976)是其保护因素;进一步校正HbA1c后,糖尿病病程(OR=1.063,95%CI 1.033~1.093)、肌酐(OR=1.008,95%CI 1.002~1.013)、UACR(OR=1.382,95%CI 1.272~1.502)及hs-CRP(OR=1.214,95%CI 1.065~1.384)仍是DR的独立风险因素,总胆红素(OR=0.922,95%CI 0.867~0.980)、直接胆红素(OR=0.827,95%CI 0.694~0.984)及间接胆红素(OR=0.889,95%CI 0.815~0.969)仍是其保护因素。结论 HbA1c、糖尿病病程、肌酐、UACR及hs-CRP是DR的风险因素,而胆红素可能是其保护因素。
Objective To investigate the influencing factors and bilirubin levels of diabetic retinopathy(DR)in hospitalized patients with type 2 diabetes mellitus(T2DM).Methods T2DM patients who were hospitalized in the Department of Endocrinology from January to December 2021 in Xuanwu Hospital of Capital Medical University were retrospectively enrolled.All included patients underwent non-mydriatic fundus photography.The data of duration of diabetes,body mass index(BMI),creatinine,total bilirubin,direct bilirubin,indirect bilirubin,glycated hemoglobin A1c(HbA1c),high-sensitivity C-reactive protein(hs-CRP)and urinary albumin to creatinine ratio(UACR)were collected.The patients were divided into non-diabetic retinopathy(NDR)group and DR group according to the diagnostic and staging criteria of DR.The t-test,Mann-Whitney U test andχ^(2) test were used to compare the general clinical data between the two groups;multivariate logistic regression analysis was used to analyze the risk factors of DR.Results A total of 1027 patients were enrolled,including 245 patients with DR and 782 patients with NDR.The prevalence of DR in hospitalized T2DM patients was approximately 23.9%(245/1027).Compared with the NDR group,the DR group had a longer duration of diabetes,higher HbA1c,creatinine,UACR,hs-CRP levels,and lower total bilirubin,direct bilirubin and indirect bilirubin concentrations.The differences were statistically significant(all P<0.05).Multivariate logistic regression analysis showed that after adjusting for gender,age and BMI,HbA1c(OR=1.199,95%CI 1.112-1.293),duration of diabetes(OR=1.063,95%CI 1.034-1.093),creatinine(OR=1.007,95%CI 1.002-1.013),UACR(OR=1.389,95%CI 1.280-1.507)and hs-CRP(OR=1.260,95%CI 1.108-1.432)were the main risk factors for DR,total bilirubin(OR=0.927,95%CI 0.873-0.983),direct bilirubin(OR=0.831,95%CI 0.701-0.985)and indirect bilirubin(OR=0.898,95%CI 0.825-0.976)were protective factors for DR;after further adjustment for HbA1c,diabetes duration(OR=1.063,95%CI 1.033-1.093),creatinine(OR=1.008,95%CI 1.002-1.0
作者
付俊玲
穆志静
孙丽娜
修双玲
Fu Junling;Mu Zhijing;Sun Lina;Xiu Shuangling(Department of Endocrinology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)
出处
《中华糖尿病杂志》
CAS
CSCD
北大核心
2022年第9期947-953,共7页
CHINESE JOURNAL OF DIABETES MELLITUS
基金
北京市属医院科研培育计划项目(PX2020034)
2021年度宣武医院国家自然青年培育项目(QNPY2020014)
首都医科大学校培育基金(PYZ21033)
糖尿病防治研究北京市重点实验室开放基金资助项目(10025220102)
北京市属医学科研院所公益发展改革试点项目——老年患者慢病智能化管理及创新模式研究(11000022T000000461062)。
关键词
糖尿病
2型
糖尿病性视网膜病变
胆红素
炎症指标
Diabetes mellitus,Type 2
Diabetic retinopathy
Bilirubin
Inflammatory markers
