摘要
背景糖尿病视网膜病变(DR)严重危害糖尿病患者视功能,但其发病机制尚有许多不明之处。目的检测并分析血糖控制达标的2型糖尿病(T2DM)患者25羟维生素D3[25(OH)D3]水平、胰岛素样生长因子Ⅰ(IGF-Ⅰ)水平,探讨其与DR的关系。方法回顾性选取2012年1月—2015年6月新疆医科大学第一附属医院及武警新疆总队医院收治且随访3年临床资料齐全的T2DM患者128例,患者3年内血糖控制均达标,根据2002年《糖尿病视网膜病变新的国际临床分级标准》将患者分为眼底造影正常患者(对照组)74例、非增殖期糖尿病视网膜病变(NPDR)患者(NPDR组)31例、增殖期糖尿病视网膜病变(PDR)患者(PDR组)23例。收集并比较3组患者的一般资料[包括性别、年龄、糖尿病病程、腹围、体质指数(BMI)、收缩压(SBP)、舒张压(DBP)]及实验室检查指标[包括生长激素(GH)、IGF-Ⅰ、空腹血糖(FPG)、空腹C肽(FC-P)、餐后2 h血糖(2 h PG)、餐后2 h C肽(2 h C-P)、25(OH)D3、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、总胆固醇(TC)及尿微量清蛋白],并采用多因素Logistic回归分析T2DM患者发生DR的影响因素。结果 3组患者性别、年龄、腹围、BMI、SBP、DBP比较,差异均无统计学意义(P>0.05);对照组和NPDR组患者糖尿病病程短于PDR组(P<0.05)。3组患者FPG、2 h PG、TG、HDL-C、TC水平比较,差异无统计学意义(P>0.05);PDR组患者GH、IGF-Ⅰ、LDL-C、尿微量清蛋白水平均高于对照组和NPDR组患者,FC-P、2 h C-P、25(OH)D3水平均低于对照组和NPDR组患者(P<0.05);NPDR组患者25(OH)D3水平低于对照组(P<0.05)。多因素Logistic回归分析结果显示,糖尿病病程[OR=1.811,95%CI(1.270,2.632)]、IGF-Ⅰ[OR=1.211,95%CI(1.121,1.380)]、FC-P[OR=1.049,95%CI(1.012,1.098)]、25(OH)D3[OR=1.788,95%CI(1.072,2.102)]和尿微量清蛋白[OR=4.137,95%CI(1.455,11.211)]是T2DM患者发生DR的独立影响因素(P<0.05)。结论除糖尿病病程、SBP、LDL-C、FC-P及尿微量清蛋白等常见危险因素外,血清25(OH)D3水平偏低及血清IGF-Ⅰ水平偏高也与DR有关,这可能是T2DM患者DR进展的机制之一。
Background Diabetic retinopathy （DR） caused serious damage to visual function in diabetic mellitus, but the pathogenesis of DR was still unknown. Objective To analyse the level of 25 hydroxy vitamin Dz [ 25 （OH） D33 and insulin -like growth factor （IGF- I ） in well -controlled type 2 diabetes （T2DM） and explore the association between them and DR. Methods 128 patients followed up for 3 years in the First Affiliated Hospital of Xinjiang Medical University and the Armed Police Hospital of Xinjiang from January 2012 to June 2015, with well - controlled T2DM, were retrospectively enrolled. According to International Clinical Classification Criteria for Diabetic Retinopathy （2002）, all patients were examined by fundus fluorescein angiography and divided into three groups ： normal group （ control group, 74 cases ） , non proliferative retinopathy （NPDR, 31 cases ） and proliferative retinopathy （PDR, 23 cases） . General information [ including gender, age, diabetes duration, abdomen circumference, body mass index （BMI）, systolic blood pressure （SBP）, diastolic blood pressure （DBP） ] and laboratory indexes [ including growth hormone （ GH）, IGF- I , fasting plasma glucose （ FPG）, fasting C peptide （FC-P） , 2 h postprandial （ 2 hPG）, 2 h postprandial blood glucose C peptide （ 2 hC-P）, 25 （OH） D3, low density lipoprotein cholesterol （LDL-C）, triglyceride （ TG）, high - density lipoprotein cholesterol （ HDL-C）, total cholesterol （.TG） and microalbuminuria in the three groups were collected and compared. The risk factors of DR in T2DM were evaluated using mu]ti- factor Logistic regression analysis. Results There were no significant differences in gender, age, abdomen circumference, BMI, SBP and DBP among three groups （ P 〉 0.05 ） . The duration of diabetes in control group and NPDR group was shorter than the PDR group （P 〈 0. 05 ） . There were no significant differences in level of FPG, 2 hPG, TG, HDL-C and TC among three groups （ P 〉 0. 05 ） . The level of GH, IGF- I , LDL-C and microalbuminuria in PDR group was higher than NPDR and control group （P 〈0. 05） . The level of FC-P, 2 hC-P, 25 （OH） D3 in the PDR group was lower than the control group and the NPDR group （P 〈0. 05） . The level of 25 （OH） D3 in the NPDR was lower than the control group （P〈0.05） . Multivariate Logistic regression analysis showed that, diabetes duration [ OR = 1.811, 95% CI （1.270, 2.632）3, IGF-[ [OR = 1.211, 95% CI （1.121, 1.380）3, FC-P [OR = 1.049, 95% CI （1.012, 1.098）3, 25 （OH） D3 [OR=1.788, 95%CI （1.072, 2.102）] and microalbuminuria [OR=4.137, 95%CI （1.455, 11.211）] were independent risk factors for DR in T2DM patients （P 〈 0. 05） . Conclusion In addition to the common risk factors, such as diabetes duration, SBP, LDL-C, FC-P and microalbuminuria, decreased serum 25 （OH） D3 and increased serum IGF-I are also associated with DR, which may be one of the mechanisms for the progress of DR in patients with T2DM.
出处
《中国全科医学》
CAS
CSCD
北大核心
2016年第33期4046-4050,共5页
Chinese General Practice
基金
新疆维吾尔自治区自然科学基金资助项目(2014211C058)
