糖尿病性视网膜病变早期诊断和预防的相关因素探讨

发布时间：2018-03-28 14:50

本文选题：糖尿病性视网膜病变　切入点：非增生性糖尿病性视网膜病变　出处：《广州医学院》2011年硕士论文

【摘要】：目的探讨分析糖尿病性视网膜病变早期诊断和预防的相关因素,为临床防治和诊断提供可靠依据。方法对2004至2010年在我院住院的2型糖尿病病人412例,进行病史资料采集,糖尿病性视网膜病变筛查并且分期,同时检测糖化血红蛋白、空腹及餐后1、2、3小时血糖、胰岛素及C肽,通过餐后及空腹变量值得出相应时段血糖、胰岛素及C肽波动值。应用spss方差分析、非参数检验、卡方检验、相关和回归分析等进行统计学分析。结果①412例2型糖尿病病例中,无糖尿病性视网膜病变205例,占49.76%,非增生性糖尿病性视网膜病变154例,占37.38%,增生性糖尿病性视网膜病变53例,占12.86%。②无糖尿病性视网膜病变组、非增生性糖尿病性视网膜病变组及增生性糖尿病性视网膜病变组3组间年龄、糖尿病病龄、体质指数、高血压级别、糖化血红蛋白(HbA1C)、餐后2、3小时血糖、餐后1、2、3小时血糖波动、空腹胰岛素、餐后1、2小时胰岛素、餐后1、2、3小时胰岛素波动、空腹C肽、餐后1、2、3小时C肽,餐后1、2、3小时C肽波动差异有统计学意义(P0.05)。空腹血糖、餐后1小时血糖及餐后3小时胰岛素在3组间无明显统计学差异(P0.05)。③糖尿病性视网膜病变及增生性糖尿病性视网膜病变的患病率随糖尿病病龄的延长明显增加。④对于空腹及餐后1、2、3小时血糖、胰岛素、C肽和其相应时段波动值与糖尿病性视网膜病变发生或者发生发展行spearman秩相关分析时,除空腹血糖、餐后1小时血糖及其波动,餐后3小时胰岛素外,其余P0.05。⑤多因素logistic回归分析显示餐后3小时血糖、空腹胰岛素与糖尿病性视网膜病变发生在统计学上相关(P0.05),其相对危险度估计值Exp(B)分别为1.190及1.064。⑥餐后2小时血糖和餐后3小时血糖与HbA1C的相关系数为0.335和0.344,而空腹血糖与HbA1C相关系数要低,为0.275。结论①餐后血糖和空腹胰岛素升高为DR发生的危险因素,临床治疗中对餐后血糖和空腹胰岛素的检测和控制有利于预防DR发生;②餐后胰岛素、空腹及餐后C肽的降低,可以预测糖尿病性视网膜病变发生情况,对早期诊断糖尿病性视网膜病变提供血液学方面的参考。③血糖波动增大、胰岛素及C肽餐后波动值减小也能反应糖尿病性视网膜病变发生的情况,故临床上应该予以重视。
[Abstract]:Objective to analyze the related factors of early diagnosis and prevention of diabetic retinopathy and to provide reliable basis for clinical prevention and treatment. Methods 412 patients with type 2 diabetes mellitus hospitalized in our hospital from 2004 to 2010 were collected the history data were collected, the diabetic retinopathy was screened and staged, the glycosylated hemoglobin (HbA1c), fasting blood glucose and blood glucose of 3 hours postprandial were measured. Insulin and C-peptide were measured by postprandial and fasting variables. Spss variance analysis, nonparametric test, chi-square test, correlation and regression analysis were used to analyze the fluctuation of blood glucose, insulin and C-peptide. Results among 1412 cases of type 2 diabetes, 205 cases (49.76%) were non-diabetic retinopathy, 154 cases (37.38%) were non-proliferative diabetic retinopathy, and 53 cases (12.86.2%) were proliferative diabetic retinopathy. Age, age, body mass index, hypertension grade, glycosylated hemoglobin (HbA1CU), blood glucose (2h), postprandial blood glucose (2h) and postprandial blood glucose (3h) fluctuated among the three groups in the non-proliferative diabetic retinopathy group and proliferative diabetic retinopathy group. Fasting insulin, postprandial insulin, postprandial insulin, postprandial insulin fluctuation, fasting C-peptide, postprandial C-peptide, postprandial 1g / 2g / 3h, postprandial 1 / 2 / 3h, fasting blood glucose (FBG) were significantly different. There was no significant difference in postprandial blood glucose and postprandial insulin between the three groups. The prevalence of diabetic retinopathy and proliferative diabetic retinopathy increased significantly with the prolongation of diabetic age. 3 hours of blood glucose on an empty stomach and 1 hour postprandial, Spearman rank correlation analysis was performed between insulin C peptide and its corresponding time fluctuation value, except fasting blood glucose, 1 hour postprandial blood glucose and their fluctuation, and insulin 3 hours after meal, respectively, with the exception of fasting blood glucose, 1 hour postprandial glucose and insulin. The other P0.05.5 multivariate logistic regression analysis showed 3 hours postprandial blood glucose. Fasting insulin was statistically associated with diabetic retinopathy (P 0.05), and the relative risk estimates were 1.190 and 1.064.6 postprandial blood glucose and 3 hours postprandial blood glucose, respectively. The correlation coefficients between fasting insulin and HbA1C were 0.335 and 0.344 respectively. The correlation coefficient between blood glucose and HbA1C was lower, Is 0.275. Conclusion 1 the increase of postprandial blood glucose and fasting insulin is the risk factor of Dr. The detection and control of postprandial blood glucose and fasting insulin in clinical treatment is helpful to prevent the decrease of postprandial insulin, fasting and postprandial C-peptide in Dr. It can predict the occurrence of diabetic retinopathy and provide hematological reference for the early diagnosis of diabetic retinopathy. The decrease of postprandial fluctuation value of insulin and C-peptide can also reflect the occurrence of diabetic retinopathy, so we should pay attention to it clinically.
【学位授予单位】：广州医学院
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R774.1

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