2 型 糖尿病并发视网膜病变的多重危险因素探讨

目的探讨2型糖尿病患者并发视网膜病变的多重危险因素。方法选取2010年1月～2013年6月在岳阳市第二医院就诊的2型糖尿病患者368例及体检中心正常对照个体285例，根据有无眼底病变，分为三组：单纯糖尿病组（DM组，188例），糖尿病视网膜病变组（DR组，180例）与正常对照组（NC组，285例）。检测各组临床与生化指标，对糖尿病患者易于发生视网膜病变的危险因素进行Logistic回归分析。结果①DM组与DR组的空腹血糖、餐后血糖、糖化血红蛋白（HbA_1c）、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）均显著高于NC组，而DM组与DR组的空腹C肽与餐后C肽均显著低于NC组，差异均有统计学意义（P〈0．05）。与DM比较，DR组病程、空腹血糖、餐后血糖、HbAhTC、TG、LDL-C均显著增高，而空腹C肽与餐后C肽均显著降低，差异均有统计学意义（P〈0．05）。DR组合并糖尿病肾病的比例47．2％（85／180）1显著高于DM组10．6％（20／188）]，差异有高度统计学意义（χ2=60．555，P=0．000）。DM组与DR组BMI、HDL-C、收缩压、舒张压之间差异无统计学意义（P〉0．05）。②Logistic回归分析显示，病程（OR=4．258，P=0．001）、HbA_1c（OR=1．298，P=0．002）、TC（OR=1．477，P=0．005）、LDL-C（OR=2．187，P=0．008），合并糖尿病。肾病（OR=1．812，P=0．000）与糖尿病视网膜病变发生相关。结论病程、HbA_1c、LDL-C、合并糖尿病肾病与2型糖尿病患者易于发生视网膜病变相关，且均为危险因素。

Investigation of multiple risk factors related to diabetic retinopathy in type 2 diabetes mellitus

Objective To investigate multiple risk factors related to the development of diabetic retinopathy in type 2 diabetes. Methods 368 patients of type 2 diabetes mellitus were recruited from outpatients and inpatients of the Second Hospital of Yueyang City between January 2010 and June 2013. And 285 normal controls were recruited from the med- ical examination center. All subjects were divided according to the fundus lesions status into type 2 diabetes without retinopathy group （DM group, 188 cases）, diabetic retinopathy group （DR group, 180 cases） and normal control group （NC group, 285 cases）. Clinical characteristics were collected and biochemical indexes were measured for all patients. Logistic regression analysis was conducted for risk factors prone to development of diabetic retinopathy. Results ①The fasting blood-glucose, postprandial blood sugar, HbA lc, TC, TG, LDL-C in DM group and DR group were all higher than those in NC group; fasting C-peptide, postprandial C-peptide in DM group and DR group were all lower than those in NC group, the differences were statistically significant （P 〈 0.05）. The disease duration, fasting blood-glucose, postprandial blood sugar, HbAlo, TC, TG, LDL-C in DR group were all higher than those in DM group; fasting C-pep- tide, postprandial C-peptide in DR group were all lower than those in DM group, the differences were statistically sig- nificant （P 〈 0.05）. The percentage of diabetic nephropathy in DR group 47.2% （85/180）] was markedly higher than that in DM group 10.6% （20/188）], the difference was statistically significant （χ2 = 60.555, P = 0.000）. The differences of BMI, HDL-C, systolic blood pressure, diastolic blood pressure between DM group and DR group was not statistically significant （P 〉 0.05）. ②The disease duration （OR = 4.258, P = 0.001）, HbAIo （OR = 1.298, P = 0.002）, TC （OR = 1.477, P = 0.005）, LDL-C （OR = 2.187, P = 0.008）, complicated with diabetic nephropathy （OR = 1.812, P = 0.000） were related to diabetic retinopathy according to the Logistic regression analysis. Conclusion Disease duration, HbAlc, TC, LDL-C and complicated with diabetic nephropathy may be the independent risk factors for type 2 diabetes patients prone to retinopathy.