摘要
目的探讨应用胰岛素抵抗(IR)替代指标评估2型糖尿病视网膜病变(DR)的价值。方法回顾性收集2020年5月至2022年9月在新乡医学院第三附属医院纳入国家标准化代谢性疾病管理中心的630例T2DM患者的临床资料,按照眼底检查结果分为DR组、非增殖DR组(NPDR)和增殖期DR组(PDR)。采用多因素logistic回归分析影响DR和NPDR患病的因素,并分析不同IR替代指标[稳态模型评估的胰岛素抵抗指数(HOMA-IR)、甘油三酯葡萄糖指数(TyG)、甘油三酯/高密度脂蛋白胆固醇(TG/HDL-C)、内脏脂肪指数(VAI)、TyG-体重指数(TyG-BMI)]和DR、NPDR的相关性。采用受试者工作特征(ROC)曲线明确IR替代指数与DR和NPDR的诊断切点。结果多因素logistic回归分析显示:舒张压(DBP)每升高1 mmHg,胰岛素(INS)每增加1 mIU·L^(-1),糖化血红蛋白(HbA1c)每增加1%,血肌酐(sCr)每增加1 mmol·L^(-1),DR的患病风险分别增加1.054、1.115、1.209、1.013倍;HOMA-IR是DR和NPDR的危险因素。ROC曲线显示:HOMA-IR预测DR和NPDR的曲线下面积分别为0.775、0.769,具备良好的预测价值。结论DBP升高、INS升高、sCr升高、HbA1c升高均是DR、NPDR患病的危险因素,既往使用降脂药是DR、NPDR患病的保护因素。此外,既往使用降脂药、降压药、降糖药的T2DM患者,HOMA-IR对于DR、NPDR的预测价值优于TyG、TyG-BMI、TG/HDL-C等IR替代指标。
Objective To investigate the value of surrogate indexes of insulin resistance(IR)with the risk of diabetic retinopathy(DR)with type 2 diabetes mellitus(T2DM).Methods The clinical data of 630 T2DM patients who were included in the National Center for Standardized Metabolic Disease Management in the Third Affiliated Hospital of Xinxiang Medical University from May 2020 to September 2022 were retrospectively collected.According to the fundus examination results,they were divided into non-DR group,non-proliferative DR group(NPDR)and proliferative DR group(PDR).Multivariate logistic regression was used to analyze the factors affecting the prevalence of DR and NPDR,and the correlation between different IR surrogate indicators[homeostasis model assessment of insulin resistance(HOMA-IR),triglyceride glucose(TyG),TG/HDL-C,visceral adiposity index(VAI),TyG-body mass index(TyG-BMI)]and DR and NPDR was analyzed.The receiver operating characteristic(ROC)curve was used to clarify the diagnostic cutoff point between IR substitution index and DR and NPDR.Results Multivariate logistic regression analysis showed that the risk of DR increased 1.054,1.115,1.209,and 1.013 times for every 1 mmHg increase in diastolic pressure(DBP),1 mIU·L^(-1) increase in insulin(INS),1%increase in glycated hemoglobin,and 1 mmo·L^(-1) increase in serum creatinine(sCr),respectively.HOMA-IR was only a risk factor for DR and NPDR.ROC showed that the areas under the curve predicted by HOMA-IR for DR and NPDR are 0.775 and 0.769,respectively,with good prediction value.Conclusion Elevated DBP,INS,sCr,and HbA1c are all risk factors for DR and NPDR.Previous use of lipid-lowering drugs is a protective factor for DR and NPDR.In addition,for T2DM patients who have previously used lipid-lowering drugs,antihypertensive drugs,and hypoglycemic drugs,HOMA-IR has a better predictive value for DR and NPDR than alternative IR indicators such as TyG,TyG-BMI,TG/HDL-C.
作者
曹旭
杜玮
CAO Xu;DU Wei(Department of Endocrinology,the Third Affiliated Hospital of Xinxiang Medical University,Xinxiang 453003,China)
出处
《河南医学研究》
CAS
2023年第13期2316-2321,共6页
Henan Medical Research
作者简介
通信作者:杜玮,E-mail:duw621@126.com。
