2型糖尿病视网膜病变影响因素的巢式病例对照研究

陈佳贤; 万亚男; 苏健; 朱政; 潘恩春; 沈冲; 文进博; 王凯; 于浩; 覃玉; 崔岚; 周金意; 武鸣

doi:10.16462/j.cnki.zhjbkz.2022.03.005

2型糖尿病视网膜病变影响因素的巢式病例对照研究

doi: 10.16462/j.cnki.zhjbkz.2022.03.005

陈佳贤¹,
万亚男²,
苏健²,
朱政²,
潘恩春³,
沈冲¹,
文进博³,
王凯⁴,
于浩⁵,
覃玉²,
崔岚²,
周金意²,
武鸣^{1, 2, ,}

1.
211166 南京，南京医科大学公共卫生学院流行病与卫生统计学系
2.
210009 南京，江苏省疾病预防控制中心慢性非传染性疾病防制所
3.
223001 淮安，淮安市疾病预防控制中心慢病科
4.
223200 淮安，淮安市淮安区疾病预防控制中心
5.
223300 淮安，淮安市清江浦区疾病预防控制中心

基金项目:

江苏省卫生厅医学领军人才项目 K201105

江苏省第五期“333工程”科研项目 BRA2020090

江苏省卫生健康委2020年度医学科研项目 M2020085

详细信息

通讯作者:
武鸣，E-mail: jswuming@vip.sina.com

中图分类号: R181.3
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出版历程
- 收稿日期: 2021-06-30
- 修回日期: 2021-10-07
- 网络出版日期: 2022-03-17
- 刊出日期: 2022-03-10

An analysis of influencing factors of diabetic retinopathy among type 2 diabetic patients: a nested case-control study

1.
Department of Epidemiology and Biostatistics, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China
2.
Department of Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
3.
Department of Chronic Disease Prevention and Control, Huai'an City Center for Disease Control and Prevention, Huai'an 223001, China
4.
Huai'an District Center for Disease Control and Prevention, Huai'an 223200
5.
Qingjiangpu District Center for Disease Control and Prevention, Huai'an 223300, China

Funds:

Jiangsu Provincial Leading Talents and Innovation Team Program K201105

Jiangsu Provincial Fifth "333 Project" BRA2020090

Jiangsu Provincial Health Commission 2020 Medical Research Project M2020085

More Information

Corresponding author: Wu Ming, E-mail: jswuming@vip.sina.com

摘要

摘要: 目的探讨2型糖尿病患者中糖尿病视网膜病变(diabetic retinopathy, DR)的影响因素。方法以2013-2014年“社区糖尿病综合干预及应用项目”淮安市35岁以上2型糖尿病人群队列为基础，对其开展问卷调查、身体测量，实验室检测，并将随访期间发生DR的1 544人作为病例组，按照性别，年龄(±4岁)随机抽取对照进行1∶1匹配，建立对照组(1 544人)。采用巢式病例对照研究方法，对糖化血红蛋白、糖尿病病程、SBP等DR的影响因素进行Logistic回归分析，计算OR及其95% CI。此外，使用多分类Logistic回归分析模型分析轻中度DR和重度DR的影响因素。结果病例组平均年龄为(58.09±8.55)岁，对照组平均年龄为(58.15±8.50)岁，中位随访时间为6年。单因素Logistic回归分析显示胰岛素使用(OR=2.26, 95% CI: 1.75~2.92)，高TG(OR=1.06, 95% CI: 1.02~1.11)，腰臀比增加(0.1为变化量)(OR=1.28, 95% CI: 1.15~1.43)，高糖化血红蛋白(OR=1.65, 95% CI: 1.57~1.73)，SBP高(OR=1.01, 95% CI: 1.00~1.01)，糖尿病病程长[5-10年vs. < 5年(OR=1.69, 95% CI: 1.42~2.01), ≥10年vs. < 5年(OR=2.38, 95% CI: 1.94~2.91)]是DR发生的危险因素。结论胰岛素使用、TG、腰臀比、糖化血红蛋白、SBP和糖尿病病程是2型糖尿病患者发生DR的影响因素。应加强2型糖尿病病人的DR筛查力度。
- 2型糖尿病 /
- 糖尿病视网膜病变 /
- 巢式病例对照研究 /
- 危险因素
Abstract: Objective To investigate the influencing factors of diabetic retinopathy (DR) in type 2 diabetic patients. Methods This nested case-control study was based on a prospective cohort study: Comprehensive Research on the Prevention and Control of the Diabetes, including type 2 diabetic patients over 35 years old at communities in Huai'an City in 2013-2014. Standardized questionnaires, anthropometric measurement and biochemical blood tests were used to collect baseline information. For this study, 1 544 patients diagnosed with DR during follow-up were recruited as cases, controls were randomly selected and were 1∶1 matched with case by age (±4 years) and sex. The relationship between DR and glycated hemoglobin, diabetes duration, systolic blood pressure and other influencing factors were analyzed using Logistic regression model. In addition, multinominal Logistic regression was performed to analyze the influencing factors of mild-moderate and severe DR. Results The mean age of cases and controls was (58.09±8.55) and (58.15±8.50) years, respectively, and the median of follow-up was 6 years. Logistic regression model found that insulin use (OR=2.26, 95% CI: 1.75-2.92), triglyceride (OR=1.06, 95% CI: 1.02-1.11), waist-hip ratio (per 0.1-unit increase) (OR=1.28, 95% CI: 1.15-1.43), glycated hemoglobin (OR=1.65, 95% CI: 1.57-1.73), systolic blood pressure (OR 1.01 (95% CI: 1.00-1.01), diabetes duration [5-10 y vs. < 5 y, OR =1.69 (95% CI: 1.42-2.01); ≥10 y vs. < 5 y, OR=2.38, (95% CI: 1.94-2.91)] were associated with the risk of DR. Conclusions Insulin use, triglyceride, waist-hip ratio, glycated hemoglobin, systolic blood pressure and diabetes duration are the influencing factors of DR among type 2 diabetic patients. It is important to strengthen screening for DR among type 2 diabetic patients.
- Type 2 diabetes mellitus /
- Diabetic retinopathy /
- Nested case-control study /
- Risk factors

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表 1 参与者基线特征

Table 1. Baseline characteristics of the participants

变量	对照(n= 1 544)	病例(n= 1 544)	t/χ²值	P值
男性[n (%)]	545(35.3)	551(35.7)	0.035 ^b	0.851
降压药使用(%)	618(40.0)	543(35.2)	7.558 ^b	0.006 ^c
降脂药使用(%)	134(8.7)	113(7.3)	1.760 ^b	0.184
文化程度小学及以上(%)	552(36.1)	448(29.2)	16.047 ^b	< 0.001 ^c
吸烟(%)	319(20.7)	368(23.8)	4.313 ^b	0.038 ^c
胰岛素使用(%)	95(6.2)	199(12.9)	39.882 ^b	< 0.001 ^c
年龄(岁)	58.15±8.50	58.09±8.55	0.177 ^a	0.859
BMI(kg/m²)	26.10±3.43	26.10±3.48	0.253 ^a	0.800
腰臀比	0.89±0.07	0.90±0.07	-4.427 ^a	< 0.001 ^c
糖化血红蛋白(%)	7.12±1.52	8.65±2.08	23.300 ^a	< 0.001 ^c
TC/HDL-C	3.84±1.15	3.91±1.17	-1.775^a	0.076
SBP(mm Hg)	143.49±19.93	145.37±20.56	-2.580 ^a	0.010 ^c
DBP(mm Hg)	83.00±10.46	83.11±11.02	-0.285 ^a	0.776
糖尿病病程(年)			88.436 ^b	< 0.001 ^c
< 5	1 033(66.9)	788(51.0)
5~ < 10	325(21.0)	419(27.1)
≥10	186(12.0)	337(21.8)
TG(mg/dl)	1.95±1.59	2.12±1.82	-2.843 ^a	0.004 ^c
注：^at检验；^bχ²检验; ^c差异有统计学意义。

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表 2 糖尿病视网膜病变影响因素的Logistic回归分析

Table 2. Logistic regression analysis of the influencing factors of diabetic retinopathy

影响因素	单因素分析			多因素分析
影响因素	β值	OR (95% CI)	P值	β值	OR (95% CI)	P值
年龄(岁)	-0.001	1.00 (0.99~1.01)	0.859	0.001	1.00 (0.99~1.01)	0.776
性别(男/女)	0.017	1.02 (0.88~1.18)	0.821	0.047	1.05 (0.89~1.24)	0.572
胰岛素(使用/不使用)	0.814	2.26 (1.75~2.92)	< 0.001 ^a	0.322	1.38 (1.04~1.84)	0.028 ^a
TG(mmol/L)	0.062	1.06 (1.02~1.11)	0.005 ^a	0.068	1.07 (1.01~1.14)	0.031 ^a
BMI(kg/m²)	-0.003	1.00 (0.98~1.02)	0.800	-0.016	0.98 (0.96~1.01)	0.228
腰臀比(0.1个变化量)	0.245	1.28 (1.15~1.43)	< 0.001 ^a	0.21	1.23 (1.08~1.41)	0.002 ^a
糖化血红蛋白(%)	0.498	1.65 (1.57~1.73)	< 0.001 ^a	0.47	1.60 (1.52~1.69)	< 0.001 ^a
SBP(mm Hg)	0.005	1.01 (1.00~1.01)	0.010 ^a	0.006	1.01 (1.00~1.01)	0.002 ^a
糖尿病病程(年)
< 5	参照	参照	―		参照	―
5~ < 10	0.525	1.69 (1.42~2.01)	< 0.001 ^a	0.207	1.23 (1.01~1.49)	0.036 ^a
≥10	0.865	2.38 (1.94~2.91)	< 0.001 ^a	0.354	1.42 (1.13~1.80)	0.003 ^a
降脂药(使用/不使用)	-0.185	0.83 (0.64~1.08)	0.164	-0.218	0.80 (0.60~1.07)	0.142
TC/HDL-C	0.055	1.06 (0.99~1.12)	0.076	-0.098	0.91 (0.82~0.99)	0.043 ^a
注：^a差异有统计学意义。

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表 3 糖尿病视网膜病变严重程度的多分类Logistic回归分析结果

Table 3. Multinominal Logistic regression analysis of the severity of diabetic retinopathy

影响因素	轻-中度DR (n= 1 238)		重度DR (n=306)
影响因素	OR (95% CI)	P值	OR (95% CI)	P值
年龄(岁)	1.00 (0.99~1.01)	0.786	1.02 (0.99~1.03)	0.057
性别(男/女)	1.11 (0.94~1.32)	0.214	0.77 (0.58~1.03)	0.079
胰岛素(使用/不使用)	1.31 (0.97~1.76)	0.075	1.70 (1.13~2.56)	0.011 ^a
TG(mmol/L)	1.07 (1.01~1.14)	0.032 ^a	1.06 (0.69~1.17)	0.249
BMI(kg/m²)	0.99 (0.96~1.02)	0.406	0.96 (0.92~1.01)	0.103
腰臀比(0.1个变化量)	1.22 (1.06~1.40)	0.006 ^a	1.33 (1.06~1.66)	0.014 ^a
糖化血红蛋白(%)	1.56 (1.48~1.64)	< 0.001 ^a	1.81 (1.68~1.94)	< 0.001 ^a
SBP(mm Hg)	1.01 (1.00~1.02)	0.001 ^a	1.00 (0.99~1.01)	0.677
糖尿病病程(年)
< 5	参照	―	参照	―
5~ < 10	1.16 (0.95~1.42)	0.151	1.65 (1.20~2.26)	0.002 ^a
≥10	1.35 (1.06~1.72)	0.014 ^a	1.83 (1.27~2.62)	0.001 ^a
降脂药(使用/不使用)	0.82 (0.60~1.10)	0.186	0.75 (0.45~1.27)	0.290
TC/HDL-C	0.90 (0.81~0.99)	0.029 ^a	0.96 (0.82~1.13)	0.628
注：^a差异有统计学意义。

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变量	对照(n= 1 544)	病例(n= 1 544)	t/χ²值	P值
男性[n (%)]	545(35.3)	551(35.7)	0.035 ^b	0.851
降压药使用(%)	618(40.0)	543(35.2)	7.558 ^b	0.006 ^c
降脂药使用(%)	134(8.7)	113(7.3)	1.760 ^b	0.184
文化程度小学及以上(%)	552(36.1)	448(29.2)	16.047 ^b	< 0.001 ^c
吸烟(%)	319(20.7)	368(23.8)	4.313 ^b	0.038 ^c
胰岛素使用(%)	95(6.2)	199(12.9)	39.882 ^b	< 0.001 ^c
年龄(岁)	58.15±8.50	58.09±8.55	0.177 ^a	0.859
BMI(kg/m²)	26.10±3.43	26.10±3.48	0.253 ^a	0.800
腰臀比	0.89±0.07	0.90±0.07	-4.427 ^a	< 0.001 ^c
糖化血红蛋白(%)	7.12±1.52	8.65±2.08	23.300 ^a	< 0.001 ^c
TC/HDL-C	3.84±1.15	3.91±1.17	-1.775^a	0.076
SBP(mm Hg)	143.49±19.93	145.37±20.56	-2.580 ^a	0.010 ^c
DBP(mm Hg)	83.00±10.46	83.11±11.02	-0.285 ^a	0.776
糖尿病病程(年)			88.436 ^b	< 0.001 ^c
< 5	1 033(66.9)	788(51.0)
5~ < 10	325(21.0)	419(27.1)
≥10	186(12.0)	337(21.8)
TG(mg/dl)	1.95±1.59	2.12±1.82	-2.843 ^a	0.004 ^c
注：^at检验；^bχ²检验; ^c差异有统计学意义。

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2型糖尿病视网膜病变影响因素的巢式病例对照研究

doi: 10.16462/j.cnki.zhjbkz.2022.03.005

通讯作者:
武鸣，E-mail: jswuming@vip.sina.com

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An analysis of influencing factors of diabetic retinopathy among type 2 diabetic patients: a nested case-control study

Corresponding author: Wu Ming, E-mail: jswuming@vip.sina.com

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2型糖尿病视网膜病变影响因素的巢式病例对照研究

doi: 10.16462/j.cnki.zhjbkz.2022.03.005

通讯作者: 武鸣，E-mail: jswuming@vip.sina.com

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出版历程

An analysis of influencing factors of diabetic retinopathy among type 2 diabetic patients: a nested case-control study

Corresponding author: Wu Ming, E-mail: jswuming@vip.sina.com

计量

出版历程

目录

通讯作者:
武鸣，E-mail: jswuming@vip.sina.com