| Objective: To investigate the prevalence of diabetic retinopathy(DR)and diabetic kidney disease(DKD)in patients with Type 2 diabetes mellitus(T2DM),and to study the correlation between them and their independent risk factors.Methods: A total of 781 T2 DM patients hospitalized in the Department of Endocrinology and Metabolism of our hospital from August 1,2020 to July 31,2021 were enrolled.General data of all patients were collected,including name,gender,age,duration of the disease,family history,smoking history,drinking history,history of hypertension,history of coronary heart disease,history of insulin use,etc.Systolic blood pressure(SBP),diastole blood pressure(DBP),fasting plasma glucose(FPG),fasting C-peptide(FCP),glycosylated hemoglobin A1c(Hb A1c),prothrombin time(PT),activated partial prothrombin time(APTT),fibrinogen(FIB),total cholesterol(TC),triglyceride(TG),high-density lipoprotein(HDL),low-density lipoprotein(LDL),serum creatinine(s Cr),uric acid(UA),cystatin C(Cys C),estimated glomerular filtration rate(e GFR),urinary microalbumin/creatinine ratio(UACR)and other laboratory data were detected in all patients.All patients underwent fundus examination or angiography.The included patients were divided into the non-diabetic retinopathy(NDR)group and the diabetic retinopathy(DR)group,and the non-diabetic kidney disease group and the diabetic kidney disease(DKD)group according to urinary microalbumin/creatinine ratio(UACR)and/or the decrease of e GFR.The differences among the above groups in various influencing factors were compared.The independent risk factors of DR and DKD were analyzed by binary logistic regression,and then grouped according to four scores for regression analysis,to draw the ROC curve for predicting the occurrence of DR and DKD.Finally,the DR group was further divided into mild,moderate and severe non-proliferative diabetic retinopathy(NPDR)group and proliferative diabetic retinopathy(PDR)group.According to e GFR stage and UACR grade,the corresponding risk of DKD progression was determined,which was divided into low risk group,medium risk group,high risk group and extremely high risk group.Correlation analysis was used to study the relationship between different stages of DR and renal indices and the risk of DKD progression.Results: 1.A total of 176 patients with DR were detected in 781 T2 DM patients,with a detection rate of 22.5%,including 111 cases(63.1%)with mild NPDR,47 cases(26.7%)with moderate NPDR,6 cases(3.4%)with severe NPDR,and 12 cases(6.8%)with PDR.A total of 197 DKD patients(25.2%)were detected,with a detection rate of 24.7%.Among them,150 cases(76.1%)were at moderate risk of DKD progression,36 cases(18.3%)were at high risk,and 11 cases(5.6%)were at very high risk.2.There were significant differences in hypertension history,insulin use history,age,duration of the disease,SBP,FCP,Hb A1 c,FIB,s Cr,Cys C,e GFR and UACR between NDR and DR groups(all P<0.05).Binary logistic regression analysis: the positive influencing factors of DR are age,duration of the disease,SBP,Hb A1 c,UACR(β>0,OR>1,P<0.05),and the negative influencing factors are FCP(β<0,OR<1,P<0.05).The risk of DR was increased with age of 49～,66～ years,duration of the disease of 2～,8～,14～ years,SBP of 143～mm Hg,Hb A1 c of 7.5～,9.126～ %,UACR of 29.50～ mg/g(β>0,OR>1,P<0.05).The OR value of DR risk decreased with the increase of FCP quartile(β<0,OR<1,P<0.05).ROC curve for predicting the occurrence of DR showed that age,SBP,FCP and Hb A1 c had lower value in predicting DR(0.5<AUC<0.7),and duration of the disease,UACR predicted a higher value of DR(AUC>0.7).3.There were statistically significant differences in history of hypertension,history of coronary heart disease,history of insulin use,age,duration of the disease,SBP,FPG,Hb A1 c,FIB,TG,HDL,s Cr,UA and Cys C between non-DKD and DKD groups(all P<0.05).Binary logistic regression analysis: The positive influencing factors of DKD were DUR,SBP,Hb A1 c,FIB,UA,s Cr,Cys C(β>0,OR>1,P<0.05).When duration of the disease was in8～,14～ years,SBP was in 143～ mm Hg,Hb A1 c was in 9.126～ %,FIB was in 2.73～,3.08～ g/L,UA was in367.0～ μmol/L,s Cr was in 71.50～ μmol/L,Cys C was in 0.87～,1.06～mg/L,the risk of DKD was increased gradually(β>0,OR>1,P<0.05).ROC curve for predicting the occurrence of DKD showed that duration of the disease,SBP,Hb A1 c,FIB,s Cr,UA and Cys C were all low in predicting DKD(0.5<AUC<0.7).4.Correlation analysis between DR and renal indexes: the severity of DR was positively correlated with s Cr,Cys C and UACR(r>0,P<0.05),but negatively correlated with e GFR(r<0,P<0.05).The severity of DR was positively correlated with the risk of DKD progression(r>0,P<0.05).Conclusions:1.In the Department of Endocrinology and Metabolism of the First Affiliated Hospital of Shihezi University,the detection rate of type 2 diabetes patients complicated with diabetic retinopathy was22.5%,and the detection rate of diabetic kidney disease was 25.2%.2.Age,duration of the disease,SBP,Hb A1 c and UACR were independent risk factors for diabetic retinopathy,while FCP was protective factor.Among them,duration of the disease and UACR had higher predictive value for diabetic retinopathy.3.Duration of the disease,SBP,Hb A1 c,FIB,UA,s Cr and Cys C were independent risk factors of diabetic kidney disease.4.The severity of diabetic retinopathy is related to the risk of diabetic kidney disease progression,positively correlated with s Cr,Cys C and UACR,and negatively correlated with e GFR.5.The prevalence,risk factors and correlation of diabetic retinopathy and diabetic nephropathy in patients with type 2 diabetes mellitus in Shihezi area have local characteristics,which is of great significance to carry out the management of diabetes and its complications with local characteristics. |
