Clinical Analysis Between NLR、uACR、Homa-islet And Early Type 2 Diabetic Retinopathy

BackgroundThe number of diabetic patients in the world is increasing year by year.At present,the number of diabetic patients in China accounts for about one fourth of the world,ranking first in the world.Diabetic retinopathy is one of the common microvascular complication of diabetes,which is the main cause of vision loss in working age population.Early DR has no clinical symptoms and is often ignored.Most patients are in the late stage of DR when they see a doctor.At this time,the damage of retina is often difficult to reverse.At present,DR is mainly screened by fundus photography,However,its wide application is limited by high cost,complex practical procedures and poor patient compliance,some DR patients can not get timely diagnosis,which delays the treatment of the disease,increases the difficulty of clinical follow-up treatment,and negatively affects the prognosis of patients.Therefore,we should evaluate the risk factors of DR in early stage of diabetic patients,to seek reliable and safety indicators for screening early DR in clinical work,which has a high impact on DR early diagnosis and treatment can effectively prevent the occurrence of DR and delay the progress of DR.The purpose of this study is to investigate the correlation between neutrophil to lymphocyte ratio(NLR),urinary microalbumin /creatinine ratio(uACR)and Homa-islet and early DR and to analyze their diagnostic value for early DR.ObjectiveTo investigate the risk factors of early DR,evaluate the diagnostic value of NLR、uACR and Homa-islet in early DR,and explore their clinical significance.MethodA total of 216 patients with type 2 diabetes mellitus(T2DM)who are admitted to the Endocrinology Department of the Third Affiliated Hospital of Xinxiang Medical College between June 2019 and August 2020 are enrolled in the study.According to whether the patients have concurrent retinopathy or not,they are divided into a T2 DM group with early retinopathy as the DR group and a T2 DM group without retinopathy as the T2 DM group.Clinical data including patients’ gender,age,duration of T2 DM,neutrophil count,lymphocyte count,fasting glucose,fasting C-peptide,and uACR are collected.NLR and Homa-islet are calculated,to analyze the risk factors of early DR,and to evaluate the diagnostic value of NLR,uACR,Homa-islet for early DR.Result1.There is no significant difference in gender,course of disease,diastolic blood pressure and cystatin C between the two groups(P > 0.05);NLR,uACR,systolic blood pressure,neutrophil count and fasting blood glucose in DR group are significantly higher than those in T2 DM group,while fasting C-peptide,lymphocyte count and Homa-islet in DR group are significantly lower than those in T2 DM group(P < 0.05).2.Binary logistic regression analysis show that systolic blood pressure,NLR,uACR are independent risk factors for DR,Homa-islet is a protective factor of DR(P < 0.05).3.ROC curve analysis results show that: When NLR > 1.85,uACR > 20.965ug/mg,Homa-islet < 230.51,DR is easy to occur,the area under curve(AUC)of NLR,uACR and Homa-islet combined detection in the diagnosis of DR is 0.820,which is significantly higher than the AUC of three independent diagnosis of DR,and the other two jointly diagnose with DR.The AUC of the three combined detection diagnosis of DR is significantly different from that of the three alone diagnosis and two combined diagnosis of DR(P < 0.05).ConclusionNLR and uACR are risk factors of DR,Homa-islet is protective factor of DR;When NLR > 1.85,uACR > 20.965ug/mg,Homa-islet < 230.51,DR is easy to occur.The combined detection of the three indicators have better diagnostic value for early DR,and the diagnostic value of the combined detection of the three indicators is better than the single detection or the combined detection of the two indicators.