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中国人民解放军总医院
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中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
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中华老年多器官疾病杂志编辑委员会
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创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
浦丹凤,王霞娟,马坚,邵耀明,刘国萍.糖尿病视网膜病变合并糖尿病肾病的危险因素及其预测价值[J].中华老年多器官疾病杂志,2019,18(1):30~35
糖尿病视网膜病变合并糖尿病肾病的危险因素及其预测价值
Risk factors for diabetic retinopathy complicated with diabetic nephropathy and their predictive values
投稿时间:2018-08-30  修订日期:2018-11-07
DOI:10.11915/j.issn.1671-5403.2019.01.007
中文关键词:  糖尿病,2型;糖尿病视网膜病变;糖尿病肾病
英文关键词:diabetes mellitus, type 2; diabetic retinopathy; diabetic nephropathy
基金项目:
作者单位E-mail
浦丹凤 南京医科大学附属无锡市人民医院内分泌科,无锡 214023  
王霞娟 南京医科大学附属无锡市人民医院内分泌科,无锡 214023  
马坚 南京医科大学附属无锡市人民医院 检验科,无锡 214023  
邵耀明 南京医科大学附属无锡市人民医院 检验科,无锡 214023  
刘国萍 南京医科大学附属无锡市人民医院内分泌科,无锡 214023 wxlgp2005@sina.com 
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中文摘要:
      目的 探讨糖尿病视网膜病变(DR)合并糖尿病肾病(DN)的危险因素及预测价值。方法 回顾性分析2017年5月至2018年5月南京医科大学附属无锡市人民医院内分泌科收治的2型糖尿病(T2DM)患者1 969例,其中糖尿病视网膜病变(DR)合并糖尿病肾病(DN)患者609例,单纯DR患者746例,未并发DN和DR患者614例,比较3组患者的血糖、血压、肝功能和肾功能指标水平,分析DR合并DN的危险因素及预测价值。采用SPSS 18.0统计软件对数据进行分析。组间比较采用单因素方差分析或χ2检验。多因素logistic回归分析DR合并DN的危险因素。受试者工作特征(ROC)曲线分析因素预测DR合并DN的价值。结果 除高密度脂蛋白胆固醇(HDL-C)水平和左侧颈动脉内膜中层厚度(IMT)外,3组患者其余指标差异均具有统计学意义(P<0.05)。多因素logistic回归分析结果显示年龄(OR=0.966,5%CI 0.932~1.000; P=0.049)、白蛋白(ALB)(OR=0.872, 95%CI 0.837~0.908; P<0.001)、服用他汀类药物(OR=0.400,5%CI 0.265~0.606; P<0.001)是DR合并DN的保护因素,高血压病程(OR=1.021,5%CI 1.005~1.037;P=0.011)、收缩压(OR=1.018,5%CI 1.007~1.029; P=0.002)、空腹血糖(OR=1.054,5%CI 1.002~1.108; P=0.040)、甘油三酯(OR=1.133,5%CI 1.021~1.256; P=0.019)、低密度脂蛋白胆固醇(OR=1.355, 95%CI 1.017~1.805; P=0.038)、血尿酸(OR=1.124,5%CI 1.016~1.244; P=0.023)、胱抑素C(OR=2.466,5%CI 1.495~4.068; P<0.001)、眼底评分(OR=1.275,5%CI 1.088~1.494; P=0.003)、左室后壁厚度(OR=1.306,5%CI 1.051~1.622; P=0.016)和颈动脉粥样斑块形成(OR=1.578,5%CI 1.051~2.370; P=0.028)为危险因素。ROC曲线分析结果表明胱抑素C预测DR合并DN价值最高,AUC为0.677。结论 T2DM患者DR合并DN的患病率较高,其发生与多种因素相关,其中,胱抑素C预测DR合并DN价值最高。
英文摘要:
      Objective To analyze the risk factors of diabetic retinopathy (DR) complicated with diabetic nephropathy (DN) and their predictive values. Methods A total of 1969 cases with type 2 diabetes mellitus (T2DM) diagnosed in our department from May 2017 to May 2018 were recruited in this study. According to their clinical data, they were assigned into DR complicated with DN group (DR+DN, n=609), DR group (n=746) and without DR or DN group (non-DR+non-DN, n=614). Their blood glucose level, blood pressure and liver and renal functions were compared among the 3 groups. The risk factors for DR complicated with DN and their predictive values were analyzed. SPSS statistics 18.0 was used to perform the statistical analysis. Analysis of variance or Chi-square test was employed for different data types. Multivariate logistic regression analysis was used to analyze the risk factors for DR combined with DN. Receiver operating characteristic (ROC) curve analysis was applied to assess the predictive values for the obtained factors. Results Except the level of high-density lipoprotein cholesterol (HDL-C) and intima-media thickness (IMT) of left carotid artery, there were significant differences in other indices among the 3 groups (P<0.05). Logistic multivariate regression analysis showed that the protective factors for occurrence of DR complicated with DN was age (OR=0.966,5%CI 0.932-1.000; P=0.049), albumin (ALB, OR=0.872,5%CI 0.837-0.908; P<0.001) and statins (OR=0.400,5%CI 0.265-0.606; P<0.001), while, the risk factors were course of hypertension (OR=1.021,5%CI 1.005-1.037; P=0.011), systolic blood pressure(OR=1.018,5%CI 1.007-1.029; P=0.002), fasting blood glucose (OR=1.054,5%CI 1.002-1.108; P=0.040), triglycerides (OR=1.133,5%CI 1.021-1.256; P=0.019), low-density lipoprotein cholesterol (OR=1.355,5%CI 1.017-1.805; P=0.038), blood urea nitrogen (OR=1.124,5%CI 1.016-1.244; P=0.023), cystatin C (OR=2.466,5%CI 1.495-4.068; P<0.001), score of fundus oculi (OR=1.275,5%CI 1.088-1.494; P=0.003), thickness of left ventricular posterior wall (OR=1.306,5%CI 1.051-1.622;P=0.016) and carotid atherosclerotic plaque (OR=1.578,5%CI 1.051-2.370; P=0.028). ROC analysis revealed that cystatin C was the most significant predictor for occurrence of DR complicated with DN, with the area under ROC curve of 0.677. Conclusion In T2DM patients, the prevalence of DR complicated with DN is quite high, which is related to a variety of factors, and among them, cystatin C has the highest efficiency in the prediction.
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