[1]李涛,吴小利,刘兴德,等.糖尿病视网膜病变与外周血管和心血管病变的相关性研究[J].眼科新进展,2020,40(2):173-176.[doi:10.13389/j.cnki.rao.2020.0041]
　LI Tao,WU Xiaoli,LIU Xingde,et al.Correlation of diabetic retinopathy with peripheral vascular disease and cardiovascular disease[J].Recent Advances in Ophthalmology,2020,40(2):173-176.[doi:10.13389/j.cnki.rao.2020.0041]
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糖尿病视网膜病变与外周血管和心血管病变的相关性研究/HTML
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《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
40卷
期数:
2020年2期
页码:
173-176
栏目:
应用研究
出版日期:
2020-02-05

文章信息/Info

Title:
Correlation of diabetic retinopathy with peripheral vascular disease and cardiovascular disease
作者:
李涛; 吴小利; 刘兴德; 陶世冰; 王彬郦; 周燕; 唐娟
641300　四川省资阳市，资阳市第一人民医院
Author(s):
LI Tao; WU Xiaoli; LIU Xingde; TAO Shibing; WANG Binli; ZHOU Yan; TANG Juan
The First People’s Hospital of Ziyang，Ziyang 641300，Sichuan Province，China
关键词:
糖尿病视网膜病变; 外周血管疾病; 心血管疾病; 2型糖尿病; 危险因素
Keywords:
diabetic retinopathy; peripheral arterial disease; cardiovascular disease; type 2 diabetes; risk factor
分类号:
R774.1
DOI:
10.13389/j.cnki.rao.2020.0041
文献标志码:
A
摘要:
目的　探讨2型糖尿病患者发生糖尿病视网膜病变(diabetic retinopathy，DR)的危险因素，以及这些危险因素与外周血管疾病（peripheral arterial disease，PAD）和心血管疾病(cardiovascular disease，CVD)之间的关系。方法　将1243例2型糖尿病患者分为无糖尿病视网膜病变患者（Non-DR）组847例、非增生型DR(NPDR)组317例、增生型DR(PDR)组79例，收集年龄、性别、2型糖尿病病程、CVD、脑血管疾病、高血压病史、吸烟饮酒史、身体质量指数（body mass index，BMI）、收缩压（systolic blood pressure，SBP）、舒张压（diastolic pressure，DBP）等一般资料。测定所有患者空腹血糖(fasting blood sugar，FBG)、甘油三酯（triglycerides，TG）、总胆固醇（total cholesterol，TC）、高密度脂蛋白胆固醇（high-density lipoprotein cholesterol，HDL-C）、低密度脂蛋白胆固醇（low-density lipoprotein cholesterol，LDL-C）、糖化血红蛋白［hemoglobin (Hb)A1c，HbA1C］。采用无创性的血管筛检装置收集踝肱指数（ankle-brachial index，ABI）数值，且ABI<0.9或≥1.3被诊断为PAD。采用高分辨率B型超声筛查两侧颈部、股浅动脉、股动脉、腘动脉、胫前后动脉斑块。结果　与Non-DR组相比较，NPDR组和PDR组2型糖尿病病程更长，SBP、TC、LDL-C均更高。与NPDR组比较，PDR组TC、SBP、LDL-C均更高，且糖尿病病程更长，差异均有统计学意义(均为P<0.05)，但三组之间BMI、HbA1c、TG、HDL-C水平比较差异均无统计学意义（均为P>0.05）。Non-DR组、NPDR组、PDR组异常ABI发生率分别为7.20%、10.90%、13.89%，结果提示随着DR病变的加重，异常ABI发生率逐渐升高(P<0.05)。Non-DR组、NPDR组、PDR组外周动脉斑块发生率分别为68.00%、81.40%、87.20%，提示随着DR病变的加重，与Non-DR组比较，NPDR组和PDR组更容易患PAD(P<0.001)。将性别、年龄、糖尿病病程、冠心病、脑血管疾病、ABI、外周动脉斑块、SBP≥130 mmHg（1 kPa=7.5 mmHg）、HbA1c、TC、TG、HDL-C、LDL-C水平、吸烟史、饮酒史纳入多元线性回归分析，结果发现外周动脉斑块(r=2.15)、SBP≥130 mmHg(r=1.50)、高胆固醇血症(r=1.72)、高糖化血红蛋白(r=2.24)均是DR的危险因素（均为P<0.05）。结论　在2型糖尿病患者中，DR与PAD、CVD密切相关，而高胆固醇血症是DR、PAD和CVD的共同危险因素。在PDR患者中，PAD和CVD的患病率均明显高于NPDR，因此DR患者应及时进行ABI、超声检查和血脂检查，将有助于尽早识别和预防系统性血管疾病。
Abstract:
Objective　To explore risk factors of occurring diabetic retinopathy (DR) in patients with type 2 diabetes (T2D),and correlation of these risk factors with peripheral arterial disease (PAD) and cardiovascular disease (CVD).Methods　Totally 1243 T2D patients were classified as Non-DR (847 patients),non-proliferative DR (NPDR;317 patients) and proliferative DR (PDR;79 patients).General data were collected,including age,gender,course of T2D,CVD,cardiovascular disease,history of hypertension,history of alcohol drinking and smoking,body mass index (BMI),systolic blood pressure (SBP) and diastolic blood pressure (DBP),etc.Fasting blood glucose (FBG),triglycerides (TG),total cholesterol (TC),high-density lipoprotein cholesterol (HDL-C),low-density lipoprotein cholesterol (LDL-C),hemoglobin A1c (HbA1C) were detected in all patients.Ankle-branchial index (ABI) was measured with noninvasive vascular screening device.The patient with ABI<0.9 or ≥1.3 was diagnosed of PAD.High-resolution B ultrasound was used to detect plaques at both sides of neck,superficial femoral artery,femoral artery,popliteal artery,anterior and posterior tibial artery.Results　Compared with non-DR group,patients with NPDR and PDR had longer course of T2D,higher SBP,TC and LDL-C.Compared with NPDR group,patients with PDR had higher TC,SBP and LDC-C,and longer course of T2D (all P<0.05).No statistical difference was found in BMI,HbA1c,TG or HDL-C among three groups (all P>0.05).The incidences of abnormal ABI were 7.20%,10.90% and 13.89% in Non-DR,NPDR and PDR groups,respectively.With the aggravation of DR lesions,the incidence of abnormal ABI gradually increased (P<0.05).The incidences of peripheral arterial plaques were 68.00%,81.40% and 87.20% in Non-DR,NPDR and PDR groups,respectively.Compared with Non-DR group,patients with NPDR and PDR were more likely to have PAD with aggravation of DR lesions (P<0.001).Logistic regression analysis was taken to explore the correlation among sex,gender,course of T2D,coronary heart disease,cardiovascular diseases,ABI,peripheral arterial plaques,SBP≥130 mmHg (1 kPa=7.5 mmHg),HbA1c,TC,TG,HDL-C,LDL-C,smoking history and history of alcohol drinking.The results showed that peripheral arterial plaques (r=2.15),SBP≥130 mmHg (r=1.50),hypercholesteremia (r=1.72),high glycosylated hemoglobin (r=2.24) were risk factors of DR (all P<0.05).Conclusion　In patients with T2D,DR is closely related to PAD and CVD.Hypercholesterolemia is a common risk factor for DR,PAD and CVD.In patients with PDR,the prevalence of PAD and CVD is significantly higher than that of patients with NPDR.Therefore,we emphasize the recommendation of performing the ABI test,ultrasonography and lipid profile in DR patients in time,which will help to identify and prevent systemic vascular diseases as soon as possible.

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更新日期/Last Update: 2020-02-05