摘要目的 观察2型糖尿病(DM)患者DM视网膜病变(DR)程度及黄斑区视网膜厚度与肾小球滤过率(GFR)之间的关系.方法 2型DM住院患者161例161只眼纳入研究.其中,男性95例95只眼,女性66例66只眼;平均年龄(62.2± 11.0)岁;平均DM病程(14.8±7.9)年.无DR(NO-DR组)、轻度非增生型DR(NPDR,轻度NPDR组)、中度NPDR(中度NPDR组)、重度NPDR分别为91、24、24、13只眼,增生型DR(PDR)9只眼.统计时,重度NPDR与PDR合并为重度DR组.所有患者均行直接检眼镜、眼底彩色照相、频域光相干断层扫描(SD-OCT)、空腹血糖、糖化血红蛋白、肾功能检查.99mTcDTPA肾动态显像法评估GFR.结合直接检眼镜及眼底彩色照相评估DR程度.SD-OCT测量黄斑中心凹直径1 mm区域视网膜平均厚度(CSF)、黄斑部视网膜容积和视网膜平均厚度(MRT).采用Spearman等级相关和Pearson相关分析GFR与DR分期、黄斑区视网膜厚度的相关性.Logistic回归分析GFR对DR发生的风险比.结果 NO-DR组、轻度NPDR组、中度NPDR组、重度DR组患者GFR逐渐降低,差异有统计学意义(F=12.32,P＜0.001).Pearson相关分析结果显示,GFR与CSF呈负相关(r=-0.202,P=0.010);与MRT无明显相关(r=-0.087,P=0.272).Spearman等级相关性分析结果显示,GFR与DR程度呈负相关(r=-0.325,P＜0.001).肾功能正常、轻度异常、不全者DR患病率比较,差异有统计学意义(x2=12.32,P=0.002).Logistic回归分析结果显示,GFR降低是DR的危险因素[95％可信区间=1.71～4.32,比值比=2.72,P＜0.001].结论 2型DM患者GFR与DR程度、CSF呈负相关;GFR降低是DR的危险因素.

abstractsObjective To investigate the relationship between glomerular filtration rate (GFR) and diabetic retinopathy (DR) and macular thickness in patients with type 2 diabetes mellitus (T2DM).Methods A total of 161 T2DM inpatients were enrolled in this study.There were 95 males (95 eyes) and 66 females (66 eyes),with an average age of (62.2±11.0) years.The average duration of diabetes was (14.8±7.9) years.The patients were grouped according to the degree of DR.Among them,91 patients were no DR,24 patients were mild non-proliferative DR (NPDR),24 patients were moderate NPDR,13 patients were severe NPDR and 9 eyes were proliferative DR (PDR).Severe NPDR and PDR were combine into severe DR group for statistical analysis.All patients underwent direct ophthalmoscope,fundus colorized photography,spectral domain optical coherence tomography (SD-OCT),fasting blood-glucose,glycated hemoglobin and renal function examinations.GFR was evaluated by 99 mTcDTPA.DR degree was evaluated by direct ophthalmoscope and fundus colorized photography.Central subfield (CSF),central macular volume and mean retinal thickness (MRT) were measure by SD-OCT.The correlation between GFR and DR staging and macular retinal thickness were analyzed by Spearman correlation analysis and Pearson correlation analysis.Logistic regression analysis was used to analyze the correlation between GFR and presence of DR.Results GFR was gradually decreased in patients with no DR,mild NPDR,moderate NPDR and severe DR (F=12.32,P＜0.001).Pearson correlation analysis demonstrated that GFR was negatively correlated to CSF (r=-0.202,P=0.010);but no correlation with MRT (r=-0.087,P=0.272).Spearman correlation analysis demonstrated that GFR was negatively correlated to DR staging (r=-0.325,P ＜ 0.001).The difference of DR prevalence rate in normal,slight abnormal renal function and renal insufficiency patients was significant (x2=12.32,P=0.002).Logistic regression analysis demonstrated that lower levels of GFR was significantly associated with presence of DR (95％ confidence interval=1.71-4.32,odds ratio=2.72,P＜0.001).Conclusion In T2DM patients,GFR is negatively correlated to DR staging and CSF.Lower GFR is independent risk factors for DR.