2型糖尿病患者糖尿病视网膜病变与冠状动脉粥样硬化的关系

目的 观察探讨2型糖尿病患者糖尿病视网膜病变(DR)与冠状动脉粥样硬化（CAS）的关系及DR的其他危险因素。方法 确诊为DR的2型糖尿病患者118例（DR组），性别、年龄与之匹配的非DR 2型糖尿病患者120例（非DR组）及健康正常者86名（对照组）纳入研究。测定所有受检者的体重指数（BMI）和血压，禁食12 h后查静脉血空腹血糖、糖化血红蛋白、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇和肌酐。计算肾小球虑过率估计值。在无尿路感染情况下收集受检者24 h尿液，测定尿白蛋白排泌率（UAER）。同时行冠状动脉64层螺旋CT成像检查，观察3组受检者CAS发生率。以是否并发DR为应变量，各项临床指标和实验室指标为自变量，进行Logistic 回归分析确定相关危险因素；进一步再以CAS为应变量，DR为因素变量，对有关危险因素进行控制，行协方差分析，观察DR与CAS的相关性。结果 DR组CAS发生率明显高于非DR组及对照组，差异有统计学意义（χ²=26.9、35.5, P＜0.05 ）。Logistic 回归分析结果显示，收缩压、BMI、CAS、心肌梗塞和UAER是DR主要危险因素［比值比（OR）=1.02、0.89、4.50、3.89、1.34，P＜0.05），其中BMI与DR呈负相关。进一步协方差分析结果显示，DR与CAS呈显著相关（OR=5.31，95% 可信区间 2.62～10.60，P＜0.05）。结论 2型糖尿病患者DR与CAS呈独立相关。2型糖尿病患者DR的其他危险因素包括收缩压、BMI、心肌梗塞及UAER

Relationship between diabetic retinopathy and coronary atherosclerosis in type 2 diabetes patients

Objective To investigate the relationship between diabetic retinopathy (DR) and coronary atherosclerosis (CAS) in type 2 diabetes patients and other risk factors of DR. Methods A total of 118 patients of type 2 diabetes with DR (DR group), 120 patients of type 2 diabetes without DR matched in age and sex (non-DR group), and 86 normal controls (control group) were enrolled in this study. The body mass index (BMI), blood pressure (BP), fasting blood-glucose (FPG), glycosylated haemoglobin (HbA1C), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterin (LDL-C), creatinine, estimate glomerular filtration rate (eGFR) and urinary albumin excretion rate(UAER) in all the subjects were measured. Meanwhile, the incidence of CAS in the three groups was detected by 64 slice multidetector computed tomography angiography (MDCTA). Assume concurrent DR as dependent variable, clinical indicators and laboratory parameters as independent variable, the risk factors were determined by Logistic regression analysis. In addition, CAS as dependent variable, DR as fixed factor, analysis of covariance was used to investigate the relationship between CAS and DR. Results The incidence of CAS in DR group was higher than that in non DR group and control group, the differences were statistically significant (χ²=26.9,35.5; P＜0.05). The results of Logistic regression analysis showed that systolic BP, BMI, CAS, myocardial infarction and UAER were key risk factors for DR ［odds ratio (OR)=1.02, 0.89, 4.50, 3.89, 1.34;P＜0.05］. There was a negative relationship between BMI and DR. The results of analysis of covariance showed that there was significant correlation between CAS and DR (OR=5.31, 95% confidence interval=2.62-10.60; P＜0.05). Conclusion CAS is independently associated with DR in type 2 diabetes patients. In addition, the other risk factors for DR include systolic BP, BMI, myocardial infarction and UAER.