影响2型糖尿病视网膜病变进展的相关危险因素研究

目的探讨影响2型糖尿病（T2DM）视网膜病变（DR）进展的危险因素,以利于早期发现病变。方法 260例T2DM患者根据有无视网膜病变及病变程度分为无视网膜病变组（NDR,88例）、T2DM合并非增殖性视网膜病变组（NPDR,92例）和增殖性视网膜病变组（PDR,80例）,检测DR可能相关临床因素并进行统计分析。结果 3组间的年龄、性别、糖化血红蛋白（HbA1C）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、体质指数（BMI）、空腹血糖（FPG）、餐后2 h血糖（2 hPG）差异均无统计学意义（P〉0.05）。3组间糖尿病病程、尿白蛋白肌酐比值（ACR）、血管生成素2（Ang-2）和血管内皮生长因子（VEGF）差异均有统计学意义（P〈0.01）;PDR组病程、ACR、Ang-2、VEGF明显高于NDR组和NPDR组,NPDR组高于NDR组,差异均有统计学意义（P〈0.05,P〈0.01）;与NDR组比较,NPDR组和PDR组载脂蛋白B100（ApoB 100）升高,收缩压升高,差异有统计学意义（P〈0.05,P〈0.01）,但二者在NPDR和PDR组间差异无统计学意义（P〉0.05）;PDR和NPDR组间舒张压差异有统计学意义（P〈0.05）。logistic回归分析显示,糖尿病病程、HbA1C、VEGF、ACR、收缩压与DR独立相关,OR值及95%CI分别为1.823（1.280~2.643）、1.376（1.121~1.843）、1.268（1.116~1.612）、1.205（1.101~1.375）、1.052（1.015~1.091）。结论糖尿病病程、ACR增加、长期血糖控制不佳、血压、血脂控制不良及促新生血管形成的生长因子包括VEGF和Ang2均是导致DR进展的重要因素。

Risk factors associated with diabetic retinopathy progression in patients with type 2 diabetes

Objective To explore risk factors associated with diabetic retinopathy（DR） progression in patients with type 2 diabetes（T2DM） and to find a pathological change in earlier stage. Methods 260 patients with T2 DM were divided into 88 cases without diabetic retinopathy（NDR）,92 cases with non-proliferative retinopathy（NPDR） and 80 cases with proliferative diabetic retinopathy（PDR）. The clinical factors related to DR were detected and analyzed. Results There were no significant differences of age,gender,glycation hemoglobin A1C（HbA1C）,total cholesterol（TC）,triglyceride（TG）,low density lipoprotein cholesterol（LDLC）,high density lipoprotein cholesterol（HDL-C）,body mass index（BMI）,fasting plasma glucose（FPG） and blood glucose level at 2 hour postprandial（2 h PG） among three groups（P〈0.05）. There were significant differences of diabetes duration,albuminto-creatinine ratio（ACR）,serum angiopoietin-2（Ang-2） and vascular endothelial growth factor（VEGF） among three groups（P〈0.01）; the diabetes duration,ACR,Ang-2 and VEGF in PDR group were significantly higher than those in NPDR group,which were significantly higher than those in NDR group（P〈0.05 or P〈0.01）. As compared with NDR group,the apolipoproteins B100（ApoB100） and systolic blood pressure（SBP） in NPDR and PDR group significantly increased（P〈0.05 or P〈0.01）,but there were no significant differences of ApoB100 and SBP between NPDR and PDR groups（P〉0.05）. There was significant difference of diastolic blood pressure（DBP） between NPDR and PDR groups（P〈0.05）. Logistic regression analysis showed that the diabetes duration,HbA1 C,VEGF,ACR and SBP were independently associated with DR,the OR values（95%CI） were 1.823（1.280-2.643）,1.376（1.121-1.843）,1.268（1.116-1.612）,1.205（1.101-1.375） and 1.052（1.015-1.091）,respectively. Conclusion The diabetes duration,increased ACR,chronic hyperglycemia,hypertension,hyperlipemia,and serum Ang-2 or VEGF level