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

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%...

The relationship between the urinary albumin/creatinine ratio within the normal range and the diabetic retinopathy in patients with type 2 diabetes

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 P_trend<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 P_trend<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.