2型糖尿病患者糖尿病视网膜病变程度与肾功能指标的相关性

目的　观察2型糖尿病患者糖尿病视网膜病变（diabetic retinopathy，DR）程度与肾功能相关指标间的关系。方法　回顾性分析2016年1月至10月来本院眼科就诊的189例（189眼）2型糖尿病患者，根据DR诊断标准将其分为无视网膜病变组（NDR组101眼）和视网膜病变组（DR组88眼）。DR组根据病变程度分为轻度非增生型DR组（轻度NPDR组31眼）、中度NPDR组（26眼）、重度NPDR组（19眼）和增生型DR组（PDR组12眼），检测患者肾功能相关指标，分析2型糖尿病患者DR病变程度与肾功能相关指标的关系。结果　DR组患者尿白蛋白/尿肌酐比值（urinary albumin/creatinine，UACR）、血清肌酐（serum creatinine，Scr）、胱抑素C（serum cystatin C，sCys-C）表达水平［（281.36±98.37）mg·g^-1、（78.31±16.08）μmol·L^-1、（1.17±0.32）mmol·L^-1］显著高于NDR组［（183.16±84.17）mg·g^-1、（62.47±15.21）μmol·L^-1、（0.83±0.21）mmol·L^-1］，差异均有统计学意义（均为P＜0.05）；而DR组患者肾小球滤过率（glomerular filtration rate，GFR）表达水平（80.81±23.21）mL·min^-1显著低于NDR组（89.83±20.13）mL·min^-1，差异有统计学意义（P＜0.05）。随着病情加重DR患者UACR、Scr和sCys-C表达水平逐渐增加，而GFR表达水平逐渐降低，四组间差异有统计学意义（P＜0.05）。PDR组患者各指标与轻度NPDR组和中度NPDR组差异均有统计学意义（均为P<0.05）。DR病变程度与UACR、Scr和sCys-C均呈正相关（均为P＜0.05），与GFR呈负相关（P＜0.05）。结论　2型糖尿病患者DR的病变程度与肾功能指标密切相关，UACR、Scr和sCys-C升高及GFR降低是DR发生的危险因素。

Correlation between the degree of diabetic retinopathy and renal function in patients with type 2 diabetes mellitus

Objective　To investigate the relationship between the degree of diabetic retinopathy （DR） and renal function in patients with type 2 diabetes mellitus （T2DM）.Methods　Totally 189 cases of patients （189 eyes） with T2DM from January 2016 to October 2016 were enrolled in the study.According to the diagnostic criteria of DR，the patients were divided into non-DR group （NDR group，101 eyes） and DR group （88 eyes）.And the patients in the DR group was subgrouped into mild non-proliferative DR （NPDR） group （31 eyes），moderate NPDR group （26 eyes），severe NPDR group （19 eyes） and proliferative DR （PDR） group （12 eyes） according to the severity.And the renal function related variables were detected，and the relationship between the degree of DR and renal function in T2DM patients was evaluated.Results　The levels of urinary albumin/creatinine ratio （UACR），serum creatinine （SCr） and serum cystatin C （sCys-C） was （281.36±98.37）mg·g^-1，（78.31±16.08）μmol·L^-1 and （1.17±0.32）mmol·L^-1 in group DR，which were significantly higher than those in group NDR ［（183.16±84.17）mg·g^-1，（62.47±15.21）μmol·L^-1 and （0.83±0.21）mmol·L^-1］ （all P<0.05），while the level of glomerular filtration rate （GFR） was （80.81±23.21）mL·min^-1 in DR group，which was lower than that of group NDR （89.83±20.13）mL·min^-1 （P<0.05）.The levels of UACR，Scr and sCys-C increased gradually， while the level of GFR decreased gradually with the degree of DR progressing，and there were statistical differences in the levels of UACR，Scr，sCys-C and GFR in the four groups （all P<0.05）.Furthermore，the differences in above variables in PDR group with mild NPDR and moderate NPDR were statistically significant （all P<0.05）.Spearman rank correlation analysis showed that the degree of DR was positively correlated with UACR，Scr and sCys-C （all P＜0.05），and negatively correlated with GFR （P＜0.05）.Conclusion　The degree of DR in T2DM patients is closely related to the index of renal function，and elevated UACR，Scr and Cys-C and decreased GFR are the risk factors for DR.