1 型糖尿病患者的血脂谱、视网膜病变和肾病之间的关联和相互作用：芬兰糖尿病研究。
Associations and interactions between lipid profiles, retinopathy and nephropathy in patients with type 1 diabetes: the FinnDiane Study.
机构信息
Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, Finland; Division of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
出版信息
J Intern Med. 2013 Nov;274(5):469-79. doi: 10.1111/joim.12111. Epub 2013 Aug 1.
OBJECTIVES
The aim of this study was to investigate the associations between lipid profiles and retinopathy in the large nationwide FinnDiane Study and to examine interactions and correlations between retinopathy, nephropathy and lipid variables.
DESIGN AND SUBJECTS
A total of 1465 patients with type 1 diabetes, available lipid profiles, ophthalmic records and fundus photographs were included in the study. The Early Treatment of Diabetic Retinopathy Study scale was used to assess the severity of retinopathy. In an independent cohort of 1100 patients, laser treatment was used to define severe diabetic retinopathy.
RESULTS
HDL cholesterol was associated with proliferative retinopathy (PDR), and triglycerides were associated with mild nonproliferative retinopathy (NPDR) independently of nephropathy and other conventional risk factors (P < 0.01). Significant interactions were seen between albumin excretion rate (AER), retinopathy status and lipid parameters (including triglycerides, non-HDL cholesterol and apolipoprotein B; P < 0.001). Highly different correlations between AER and lipid variables were observed in patients without retinopathy or with mild NPDR compared with patients with moderate to severe NPDR or PDR. Similar interactions and correlations were observed in an independent cohort stratified by laser treatment. In patients without retinopathy or with mild NPDR, AER was low despite HDL cholesterol in the lowest or triglycerides, total cholesterol or LDL cholesterol in the highest quartiles.
CONCLUSIONS
Nephropathy had a strong effect on the associations between lipid variables and retinopathy, whilst dyslipidaemia was associated with nephropathy only in the presence of retinopathy. This finding suggests the existence of shared pathogenic mechanisms between retinopathy and nephropathy which could be targeted to prevent complications in patients with metabolic risk factors.
目的
本研究旨在探讨脂质谱与芬兰糖尿病研究（FinnDiane Study）中视网膜病变之间的关联，并研究视网膜病变、肾病和脂质变量之间的相互作用和相关性。
设计和受试者
本研究共纳入 1465 例 1 型糖尿病患者，他们具有可用的脂质谱、眼科记录和眼底照片。采用早期糖尿病视网膜病变研究（ETDRS）量表评估视网膜病变的严重程度。在一个包含 1100 例患者的独立队列中，激光治疗用于定义严重的糖尿病视网膜病变。
结果
高密度脂蛋白胆固醇与增生性视网膜病变（PDR）相关，而甘油三酯与轻度非增生性视网膜病变（NPDR）相关，独立于肾病和其他常规危险因素（P<0.01）。在白蛋白排泄率（AER）、视网膜病变状态和脂质参数（包括甘油三酯、非高密度脂蛋白胆固醇和载脂蛋白 B）之间观察到显著的相互作用（P<0.001）。在没有视网膜病变或轻度 NPDR 的患者中，与中度至重度 NPDR 或 PDR 患者相比，AER 与脂质变量之间的相关性存在很大差异。在按激光治疗分层的独立队列中观察到类似的相互作用和相关性。在没有视网膜病变或轻度 NPDR 的患者中，尽管 HDL 胆固醇处于最低水平或甘油三酯、总胆固醇或 LDL 胆固醇处于最高四分位，AER 仍较低。
结论
肾病对脂质变量与视网膜病变之间的关联有很强的影响，而脂代谢异常仅在存在视网膜病变的情况下与肾病相关。这一发现表明，视网膜病变和肾病之间可能存在共同的致病机制，可以针对这些机制来预防代谢危险因素患者的并发症。
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