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目的探讨糖尿病视网膜病变(DR)患者尿微量白蛋白(m Alb)/肌酐(Cr)比值的变化及意义。方法将173例2型糖尿病(T2DM)患者分为无糖尿病视网膜病变(NDR)组76例、非增生性糖尿病视网膜病变(NPDR)组58例、增生性糖尿病视网膜病变(PDR)组39例,另选取健康体检者40名作为正常对照组。检测各组空腹血糖(FPG)、总胆固醇(TC)、餐后2 h血糖(2 h PG)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、C反应蛋白(CRP)、糖化血红蛋白(Hb A1c)及尿m Alb、Cr,计算尿m Alb/Cr比值,同时收集相关临床资料(包括身高、体重、腰围、臀围及糖尿病病程等)。采用Spearman秩相关分析及多元线性回归模型分析尿m Alb/Cr比值与其他临床参数的关系,采用Logistic回归分析评估DR的风险因素。结果 NDR组、NPDR组及PDR组尿m Alb/Cr比值依次增高,各组之间差异均有统计学意义(P<0.05)。T2DM患者尿m Alb/Cr比值与糖尿病病程、FPG、2 h PG、LDL-C、Hb A1c及CRP呈正相关(r值分别为0.372、0.227、0.276、0.231、0.294及0.308,P<0.05);多元线性回归分析显示糖尿病病程、CRP及Hb A1c与尿m Alb/Cr比值呈独立正相关(β值分别为0.194、0.169、0.183,P值分别为0.007、0.018、0.013)。Logistic回归分析显示尿m Alb/Cr比值、糖尿病病程、Hb A1c及CRP是DR的独立风险因素{比值比(OR)[95%可信区间(CI)]分别为1.212(1.083~1.417)、1.036(1.012~1.063)、1.469(1.140~1.892)、1.330(1.011~1.273)}。结论尿m Alb/Cr比值与DR的发展密切相关,是DR的风险因素。CRP及Hb A1c可能通过损伤肾脏功能参与DR的发生与发展。
Objective To investigate the changes of urinary albumin (m Alb) / creatinine (Cr) ratio in patients with diabetic retinopathy (DR) and its significance. Methods Totally 173 T2DM patients were divided into 76 cases of non-diabetic retinopathy (NDR), 58 cases of non-proliferative diabetic retinopathy (NPDR), 39 cases of proliferative diabetic retinopathy (PDR) Select 40 healthy subjects as a normal control group. The fasting blood glucose (FPG), total cholesterol (TC), 2 h postprandial blood glucose (2 h PG), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol LDL-C, CRP, Hb A1c and urine m Alb, Cr were calculated, and the relative clinical data (including height, weight, waist circumference, hip circumference and diabetes mellitus Duration, etc.). Spearman rank correlation analysis and multivariate linear regression model were used to analyze the relationship between urinary Alb / Cr ratio and other clinical parameters. Logistic regression analysis was used to evaluate the risk factors of DR. Results The urinary Alb / Cr ratios of NDR group, NPDR group and PDR group increased in turn, with statistical significance (P <0.05). The ratio of urinary Alb / Cr in T2DM patients was positively correlated with duration of diabetes, FPG, 2h PG, LDL-C, Hb A1c and CRP (r = 0.372,0.227,0.276,0.231,0.294 and 0.308, respectively; P <0.05). Multivariate linear regression analysis showed that the duration of diabetes, CRP, Hb A1c and urine m Alb / Cr ratio were independently and positively correlated (β values were 0.194,0.169,0.183, P values were 0.007,0.018,0.013, respectively). Logistic regression analysis showed that the urinary Alb / Cr ratio, duration of diabetes, Hb A1c and CRP were independent risk factors for odds ratio (OR) [95% confidence interval (CI)] of 1.212 (1.083-1.417) and 1.036 (1.012-1.063), 1.469 (1.140-1.892), 1.330 (1.011-1.273)}. Conclusion The urinary m Alb / Cr ratio is closely related to the development of DR and is a risk factor for DR. CRP and Hb A1c may participate in the occurrence and development of DR through impairing renal function.