糖化血红蛋白变异指数与糖尿病视网膜病变的相关性研究
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摘要
目的探讨T2DM患者糖化血红蛋白变异指数(HGI)与DR发病风险的关系。方法收集506例T2DM患者的临床资料,根据HGI数值,采用三分位数法将患者分为低、中和高HGI组,比较组间健康状况差异并分析HGI与DR发生的相关性。结果各组性别、年龄、糖尿病病程、BMI、血压、血浆肝脏酶学、TG、HDL-C、Scr、肾小球滤过率(eGFR)和BUN比较,差异无统计学意义(P>0.05)。而HbA1c、FPG、SUA、TC、LDL-C组间比较,差异有统计学意义(P<0.05)。高HGI(H-HGI)组和中HGI(M-HGI)组发生DR的风险分别是低HGI(L-HGI)组的2.49和1.88倍(P<0.05)。Logistic回归分析显示,HGI是DR的独立危险因素[OR(95%CI)1.397(1.047,1.865),P<0.05],而eGFR是DR的保护因素[OR(95%CI)0.988(0.979,0.997),P<0.05]。结论 HGI有望成为预测T2DM患者发生DR风险的新指标。
Objective To investigate the relationship between glycated hemoglobin variability index(HGI)and risk of diabetic retinopathy(DR)in patients with type 2 diabetes(T2DM). Methods A total of 506 patients with T2DM were enrolled in this study.The clinical characteristics were collected.All the subjects were divided into three groups according to tertilesof HGI values:low HGI group,middle HGI group and high HGI group.The clinical characteristics were compared among the three groups,and the relationship between HGI levels and the prevalence of DR was analyzed. Results There was no significantly statistical difference in age,diabetes duration,WHR,BMI,BP,plasma liver enzymes,TG,HDL,LDL-C,Scr and BUN among the three groups(P>0.05).But there were significant differences in HbA_1c,FPG,SUA,TC,and LDL-C among the three groups(P<0.05).The prevalence risks of DR were2.49 and 1.88 in High HGI group and Middle HGI group respectively when compared with Low HGI group(P<0.05).Logistic regression analysis showed that HGI was an independent risk factorfor DR [OR(95% CI)1.397(1.047,1.865),P<0.05],while eGFR is a protective factor for DR [OR(95% CI)0.988(0.979,0.997),P <0.05]. Conclusion HGI may be used as a new predictor of DR in patients with T2DM.
Objective To investigate the relationship between glycated hemoglobin variability index(HGI)and risk of diabetic retinopathy(DR)in patients with type 2 diabetes(T2DM). Methods A total of 506 patients with T2DM were enrolled in this study.The clinical characteristics were collected.All the subjects were divided into three groups according to tertilesof HGI values:low HGI group,middle HGI group and high HGI group.The clinical characteristics were compared among the three groups,and the relationship between HGI levels and the prevalence of DR was analyzed. Results There was no significantly statistical difference in age,diabetes duration,WHR,BMI,BP,plasma liver enzymes,TG,HDL,LDL-C,Scr and BUN among the three groups(P>0.05).But there were significant differences in HbA_1c,FPG,SUA,TC,and LDL-C among the three groups(P<0.05).The prevalence risks of DR were2.49 and 1.88 in High HGI group and Middle HGI group respectively when compared with Low HGI group(P<0.05).Logistic regression analysis showed that HGI was an independent risk factorfor DR [OR(95% CI)1.397(1.047,1.865),P<0.05],while eGFR is a protective factor for DR [OR(95% CI)0.988(0.979,0.997),P <0.05]. Conclusion HGI may be used as a new predictor of DR in patients with T2DM.
引文
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[6]魏凤江,蔡春友,时文涛,等.2型糖尿病合并高尿酸血症与胰岛素抵抗、血脂及血压相关性的研究.中国糖尿病杂志,2013,21:97-99.
[7]万倩,张倩,钱毅,等.肾小球滤过率评估方程在2型糖尿病患者中的应用.中国糖尿病杂志,2014,22:799-803.
[8]Shichiri M,Kishikawa H,Ohkubo Y,et al.Long-term results of the Kumamoto Study on optimal diabetes control in type 2diabetic patients.Diabetes Care,2000,23Suppl 2:B21-B29.
[9]Stratton IM,Kohner EM,Aldington SJ,et al.UKPDS 50:risk factors for incidence and progression of retinopathy in Type II diabetes over 6years from diagnosis.Diabetologia,2001,44:156-163.
[10]Hempe JM,Liu S,Myers L,et al.The hemoglobin glycation index identifies subpopulations with harms or benefits from intensive treatment in the ACCORD trial.Diabetes Care,2015,38:1067-1074.
[11]Cho NH,Kim TH,Woo SJ,et al.Optimal HbA1c cutoff for detecting diabetic retinopathy.Acta Diabetol,2013,50:837-842.
[12]Ahn CH,Min SH,Lee DW,et al.Hemoglobin glycation index is associated with cardiovascular diseases in people with impaired glucose metabolism.J Clin Endocrinol Metab,2017,8:102:2905-2913.
[13]Marini MA,Fiorentino TV,Succurro E,et al.Association between hemoglobin glycation index with insulin resistance and carotid atherosclerosis in non-diabetic individuals.PLoS One,2017,12:e0175547.
[14]Penno G,Solini A,Bonora E,et al.HbA1c variability as an independent correlate of nephropathy,but not retinopathy,in patients with type 2diabetes:the Renal Insufficiency And Cardiovascular Events(RIACE)Italian multicenter study.Diabetes Care,2013,36:2301-2310.
[15]Mccarter RJ,Hempe JM,Gomez R,et al.Biological variation in HbA1c predicts risk of retinopathy and nephropathy in type 1diabetes.Diabetes Care,2004,27:1259-1264.
[16]吴京阳,刘磊,耿金,等.eGFR作为糖尿病视网膜病变预警因子的研究.眼科新进展,2014,34:740-744.
[2]Romero-Aroca P,Sagarra-Alamo R,Pareja-Rios A,et al.Importance of telemedicine in diabetes care:Relationships between family physicians and ophthalmologists.World J Diabetes,2015,6:1005-1008.
[3]Group TDCaCTR.The relationship of glycemic exposure(HbA1c)to the risk of development and progression of retinopathy in the diabetes control and complications trial.Diabetes,1995,44:968-983.
[4]Chatziralli I,Sergentanis TN,Crosby-Nwaobi R,et al.Model for risk-based screening of diabetic retinopathy in people with newly-diagnosed type 2diabetes mellitus.Invest Ophthalmol Vis Sci,2017,58:99-105.
[5]Genuth S,Lachin JM,Nathan DM.Biological variation in HbA1c predicts risk of retinopathy and nephropathy in type 1diabetes:response to McCarter et al.Diabetes Care,2005,28:234-235.
[6]魏凤江,蔡春友,时文涛,等.2型糖尿病合并高尿酸血症与胰岛素抵抗、血脂及血压相关性的研究.中国糖尿病杂志,2013,21:97-99.
[7]万倩,张倩,钱毅,等.肾小球滤过率评估方程在2型糖尿病患者中的应用.中国糖尿病杂志,2014,22:799-803.
[8]Shichiri M,Kishikawa H,Ohkubo Y,et al.Long-term results of the Kumamoto Study on optimal diabetes control in type 2diabetic patients.Diabetes Care,2000,23Suppl 2:B21-B29.
[9]Stratton IM,Kohner EM,Aldington SJ,et al.UKPDS 50:risk factors for incidence and progression of retinopathy in Type II diabetes over 6years from diagnosis.Diabetologia,2001,44:156-163.
[10]Hempe JM,Liu S,Myers L,et al.The hemoglobin glycation index identifies subpopulations with harms or benefits from intensive treatment in the ACCORD trial.Diabetes Care,2015,38:1067-1074.
[11]Cho NH,Kim TH,Woo SJ,et al.Optimal HbA1c cutoff for detecting diabetic retinopathy.Acta Diabetol,2013,50:837-842.
[12]Ahn CH,Min SH,Lee DW,et al.Hemoglobin glycation index is associated with cardiovascular diseases in people with impaired glucose metabolism.J Clin Endocrinol Metab,2017,8:102:2905-2913.
[13]Marini MA,Fiorentino TV,Succurro E,et al.Association between hemoglobin glycation index with insulin resistance and carotid atherosclerosis in non-diabetic individuals.PLoS One,2017,12:e0175547.
[14]Penno G,Solini A,Bonora E,et al.HbA1c variability as an independent correlate of nephropathy,but not retinopathy,in patients with type 2diabetes:the Renal Insufficiency And Cardiovascular Events(RIACE)Italian multicenter study.Diabetes Care,2013,36:2301-2310.
[15]Mccarter RJ,Hempe JM,Gomez R,et al.Biological variation in HbA1c predicts risk of retinopathy and nephropathy in type 1diabetes.Diabetes Care,2004,27:1259-1264.
[16]吴京阳,刘磊,耿金,等.eGFR作为糖尿病视网膜病变预警因子的研究.眼科新进展,2014,34:740-744.