糖尿病视网膜病变与糖尿病肾病关系的研究

摘要

Objective Currently mechanisms of diabetic nephropathy ( DN) and diabetic retinopathy ( DR) remains unclear, but the hypothesis that persistent hyperglycemia and its abnormal metabolites play a vital role has been controversial. It is necessary to analyze the relationship of type 2 diabetic retinopathy and diabetic nephropathy in the aspect of onset and development of them, and whether we can use fundus examination to predict the renal injury level. This study aimed to find the relationship of diabetic retinopathy and diabetic nephropathy. Methods Patients with non-diabetic retinopathy(NDR) or proliferative diabetic retinopathy (PDR) were enrolled. Based on 8-hour urinary albumin excretion rate( UAER), the patients were divided into 3 groups; group A; UAER <20 μg/min, group B; UAER≥ 20-199 μg/min; group C: UAER >200 μg/min. Group A had 169 patients, including 53 NDR patients, PDR 116 patients; group B had a total of 76 patients, including 37 patients with NDR, 39 with PDR; group C had a total of 66 patients, including 40 patients with NDR, 26 with PDR. The glomerular filtration rate was compared between the subgroups. Results Glomerular filtration rate( GFR) was calculated according to the currently recommended MDRD simplified formula; eGFR = 186 x (SCr) -1154 × ( Age) -0.203 × (0.742 women). We found that among the three groups, PDR subgroup eGFR was lower than those in NDR. Significant difference in eGFR was found in groups B and C in PDR sub-group compared with the NDR sub-group(P<0.01). Conclusion Proliferative diabetic retinopathy appears to predict the degree of renal injury, but urinary albumin excretion rate had poor correlation with renal injury. The cause may be poor specificity of microalbuminuria as a biomarker of DN in diagnosis.%目的 本研究探讨了2型糖尿病患者糖尿病肾脏病变( diabetic nephropathy,DN)与视网膜病变(diabetic retinopathy,DR)之间的相关性.方法 本研究的患者为无糖尿病视网膜病变(non-diabetic retinopathy,NDR)或增殖期视网膜病变(proliferative diabetic retinopathy,PDR)的2型糖尿病患者.根据8h尿微量白蛋白排泄率(urinary albumin excretion rate,UAER)将患者分为3组:A组:UAER ＜20μg/min,B组:UAER为20～200 μg/min；C组:UAER＞ 200 μg/min,A组病人共169人,其中NDR 53人,PDR 116人；B组病人共76人,其中NDR37人,PDR 39人；C组病人共66人,其中NDR 40人,PDR 26人.比较各亚组间肾小球滤过率差异.结果 根据目前推荐的MDRD简化公式:估算肾小球滤过率(estimated glomemlar filtration rate,eGFR)=186×(SCr)-1.154×(Age)-0.203×(0.742女性),计算出肾小球滤过率,进行3组中各亚组间对比发现,PDR亚组eGFR均较NDR亚组eGFR降低.其中B组和C组PDR亚组与NDR亚组eGFR比较差异有统计学意义(P＜0.05).结论 增殖期糖尿病视网膜病变的出现,能够预测肾功能损伤程度,但其与尿微量白蛋白排泄率相关性不大.原因与微量白蛋白尿作为DN诊断生物标志物的特异性较差有关.