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目的探讨糖化血红蛋白(HbA1c)与糖尿病视网膜病变(DR)的关系及其诊断阈值。设计以社区人群为基础的横断面研究。研究对象北京社区糖尿病研究中2642例20~80岁已确诊的2型糖尿病患者,其中2007例(76.0%)受试者(1199例女性)参与研究,平均年龄(64.1±9.0)岁。方法全体参与医师经过专门培训,按照统一要求调查并填写调查表,同时对患者进行体格检查及相关的实验室检查,HbA1c用美国伯乐公司高压液相仪测定,并对所有患者用45°免散瞳彩色眼底照相机留取后极部眼底照片一张。DR的严重程度参照Airlie House分级法。采用ROC曲线分析HbA1c诊断DR的最佳阈值。主要指标HbA1c在DR中的诊断阈值(敏感性、特异性、AUC)。结果本人群中DR患病率为(24.7±1.0)%(95%CI,22.8~26.6)。在二元逻辑回归分析中,DR的出现与较高的HbA1c浓度(OR=1.23;95%CI,1.14~1.33)有关,随着HbA1c增高,DR患病率呈上升趋势。当HbA1c≥6.5%时,诊断DR的ROC曲线下面积最大(59.2%),且敏感性(75.1%)和特异性(43.4%)高。在二元逻辑回归分析中,DR还与其他方面有关:较轻的年龄(OR=0.97;95%CI,0.95~0.98)、较长的糖尿病病程(OR=1.10;95%CI,1.08~1.12)、较高的收缩压(OR=1.01;95%CI,1.01~1.02)、较低的体重指数(OR=0.95;95%CI,0.92~0.98)和升高的血尿素氮浓度(OR=1.01;95%CI,1.00~1.01)。结论当糖化血红蛋白≥6.5%时与糖尿病视网膜病变显著相关,提示糖化血红蛋白为6.5%或许可以作为筛查糖尿病视网膜病变的阈值。
Objective To investigate the relationship between glycated hemoglobin (HbA1c) and diabetic retinopathy (DR) and its diagnostic threshold. Design community-based cross-sectional study. Participants A total of 2642 patients with type 2 diabetes who were diagnosed between the ages of 20 and 80 years were included in the Beijing Community Diabetes Study. Of the 2007 (76.0%) subjects (1199 women), the average age was (64.1 ± 9.0) years. Methods All the participating physicians were specially trained to investigate and fill in the questionnaire according to the unified requirements. At the same time, the patients were subjected to physical examination and related laboratory tests. HbA1c was measured by high-pressure liquid-phase instrument from Boulogne America. All patients were treated with 45 ° dispersion-free Pupil color fundus camera to take a posterior pole fundus photo. The severity of DR refers to the Airlie House classification. ROC curve analysis of HbA1c diagnosis of the optimal threshold of DR. The main indicators HbA1c diagnostic threshold in DR (sensitivity, specificity, AUC). Results The prevalence of DR in our population was (24.7 ± 1.0)% (95% CI, 22.8-26.6). In binary logistic regression analysis, the occurrence of DR was associated with higher HbA1c concentration (OR = 1.23; 95% CI, 1.14-1.33). The prevalence of DR increased with the increase of HbA1c. When HbA1c≥6.5%, the area under the ROC curve of diagnosis DR was the largest (59.2%), and the sensitivity (75.1%) and specificity (43.4%) were high. In binary logistic regression analysis, DR was also associated with other aspects: younger age (OR = 0.97; 95% CI, 0.95-0.98), longer duration of diabetes (OR = 1.10; 95% CI, 1.08-1.12 (OR = 1.01; 95% CI, 1.01 ~ 1.02), lower body mass index (OR = 0.95; 95% CI, 0.92-0.98) and elevated blood urea nitrogen (OR = 1.01; 95% CI, 1.00-1.01). Conclusions When glycosylated hemoglobin is more than 6.5%, it is significantly associated with diabetic retinopathy, suggesting that a HbA1c level of 6.5% may serve as a threshold for screening diabetic retinopathy.