| 正常范围内尿白蛋白/肌酐比值与2型糖尿病患者糖尿病视网膜病变的关系 |
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| 引用本文： | 王坤,刘欢欢,李洮俊,楼青青.正常范围内尿白蛋白/肌酐比值与2型糖尿病患者糖尿病视网膜病变的关系[J].眼科新进展,2022,0(9):714-718. |
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| 作者姓名： | 王坤 刘欢欢 李洮俊 楼青青 |
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| 作者单位： | 210023 江苏省南京市，南京中医药大学护理学院（王坤）；570311 海南省海口市，海南省人民医院内分泌科（刘欢欢）；90000 台湾省屏东市，台湾李氏联合诊所（李洮俊）；570102 海南省海口市，海南医学院第一附属医院（楼青青） |
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| 基金项目： | 国家重点研发计划(编号:2021YFE0204800)；海南省重点研发计划(编号:ZDYF2021SHFZ236)。 |
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| 摘 要： | 目的探讨正常范围内尿白蛋白/肌酐比值(UACR)与2型糖尿病患者糖尿病视网膜病变(DR)的关系。方法本研究共纳入1780例2型糖尿病患者,平均随访时间7.5年,所有患者每年由专业眼科医师进行眼底散瞳检查。根据UACR四分位数将患者分为4组:Q1组患者UACR<6.24 mg·g^(-1)(n=443);Q2组患者6.24 mg·g^(-1)≤UACR<10.21 mg·g^(-1)(n=446);Q3组患者10.21 mg·g^(-1)≤UACR<16.79 mg·g^(-1)(n=446);Q4组患者UACR≥16.79 mg·g^(-1)(n=445)。使用Cox回归分析评价正常范围内不同水平的UACR与DR发病之间的关系。结果Cox回归分析结果显示:无论在未校正还是校正模型中,随着UACR的升高,DR的发病率也随之显著升高(均为P_(趋势)<0.05)。以Q1组为对照,在未校正任何因素的情况下(模型1),Q4组发生DR的风险将升高44.3%;在校正年龄、性别、糖尿病病程、治疗方法后(模型2),Q4组发生DR的风险将升高46.9%;在模型2的基础上进一步校正体重指数、收缩压、舒张压、糖化血红蛋白、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、血肌酐、预估肾小球滤过率(模型3),Q4组发生DR的风险将升高52.0%(均为P_(趋势)<0.05)。累积风险图显示:无论在未校正还是校正模型中,Q4组患者发生DR的累积风险一直保持最高,校正模型中Q4组患者DR发病累积风险高于Q1组,差异有统计学意义(均为P<0.05)。结论正常范围内的UACR的高值可能是DR发病的风险因素,当UACR达到16.79 mg·g^(-1)时,更应高度关注DR发病的可能性。
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| 关 键 词： | 糖尿病视网膜病变 2型糖尿病 尿白蛋白/肌酐比值 回归分析 |
The relationship between the urinary albumin/creatinine ratio within the normal range and the diabetic retinopathy in patients with type 2 diabetes |
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| WANG Kun,LIU Huanhuan,LI Taojun,LOU Qingqing.The relationship between the urinary albumin/creatinine ratio within the normal range and the diabetic retinopathy in patients with type 2 diabetes[J].Recent Advances in Ophthalmology,2022,0(9):714-718. |
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| Authors: | WANG Kun LIU Huanhuan LI Taojun LOU Qingqing |
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| Affiliation: | 1.College of Nursing,Nanjing University of Chinese Medicine,Nanjing 210023,Jiangsu Province,China2.Department of Endocrinology,Hainan General Hospital,Haikou 570311,Hainan Province,China3.Lee’s Clinic,Pingdong 90000,Taiwan Province,China4.The First Affiliated Hospital of Hainan Medical University,Haikou 570102,Hainan Province,China |
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| Abstract: | Objective To investigate the relationship between the urinary albumin/creatinine ratio (UACR) within the normal range and the diabetic retinopathy (DR) in patients with type 2 diabetes. Methods A total of 1,780 patients with type 2 diabetes were included in this study. The average follow-up length was 7.5 years. All patients had an annual mydriasis funduscopy by a professional ophthalmologist. According to the UACR quartiles, patients were divided into four groups: Q1 group, with UACR<6.24 mg·g-1 (n=443), Q2 group, with 6.24 mg·g-1 ≤ UACR < 10.21 mg·g-1 (n=446), Q3 group, with 10.21 mg·g-1 ≤ UACR < 16.79 mg·g-1 (n=446), and Q4 group, with UACR ≥ 16.79 mg·g-1 (n=445). The relationship between different levels of UACR within the normal range and the occurrence of DR was evaluated by the Cox regression analysis method. Results The Cox regression results showed that the prevalence of DR increased significantly with the increase of UACR in both uncorrected and corrected models (both Ptrend<0.05). Compared with Q1 group, the risk of DR in Q4 group increased by 44.3% without correction of any factors (Model 1), by 46.9% after correction of age, gender, duration of diabetes, and treatment (Model 2), and by 52.0% after further correction of body mass index, systolic blood pressure, diastolic blood pressure, glycosylated hemoglobin, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, serum creatinine, and estimated glomerular filtration rate (Model 3) on the basis of Model 2 (all Ptrend<0.05). The cumulative risk diagram showed that the cumulative risk of DR in Q4 group was always the highest in both uncorrected and corrected models, and was higher than that in Q1 group (all P<0.05). Conclusion The high UACR within the normal range may be a risk factor of DR. When the UACR reaches 16.79 mg·g-1, more attention should be paid to DR. |
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| Keywords: | diabetic retinopathy type 2 diabetes urinary albumin/creatinine ratio regression analysis |
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