中国广州接受胰岛素治疗的2型糖尿病患者中改良稳态模型评估/相关血清因子与糖尿病视网膜病变的关系
Relationship between modified homeostasis model assessment/correlative serum factors and diabetic retinopathy among type 2 diabetics with insulin therapy in Guangzhou, China.
作者信息
Hu Li, Li Dong-Hao
机构信息
Department of Ophthalmology, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China.
出版信息
Int J Ophthalmol. 2014 Jun 18;7(3):463-8. doi: 10.3980/j.issn.2222-3959.2014.03.14. eCollection 2014.
AIM
To explore the related risk factors for diabetic retinopathy (DR) in type 2 diabetes with insulin therapy.
METHODS
We studied the relationships among blood glucose, serum C-peptide, plasma insulin, beta-cell function and the development of DR. Beta-cell function was assessed by a modified homeostasis model assessment (modified HOMA) which was gained by using C-peptide to replace insulin in the homeostasis model assessment (HOMA) of beta-cell function. We also studied the relationships between modified HOMA index and serum C-peptide response to 100g tasteless steamed bread to determine the accuracy of modified HOMA.
RESULTS
Our study group consisted of 170 type 2 diabetic inpatients with DR (age: 58.35±13.87y, mean±SD) and 205 type 2 diabetic inpatients with no DR (NDR) (age: 65.52±11.59y). DR patients had higher age, longer diabetic duration, higher hypertension grade, higher postprandial plasma glucose, higher fluctuation level of plasma glucose, lower body mass index (BMI), lower postprandial serum insulin and C-peptide, lower fluctuation level of serum insulin and C-peptide (P<0.05). In our logistic regression model, duration of diabetes, hypertension grade, fasting plasma insulin and glycosylated hemoglobin (HbA1C) were significantly associated with the presence of DR after adjustment for confounding factors (P<0.05).
CONCLUSION
Our results suggested although modified HOMA showed significant correlation to the occurrence of DR on Spearman's rank-correlation analysis, logistic regression showed no significant association between these two variables after adjustment for relevant confounding factors (such as age, sex, duration of diabetes, BMI, hypertension grade, HbA1C, plasma insulin). Duration of diabetes, hypertension grade, fasting plasma insulin and HbA1C were independently associated with the development of DR in Chinese type 2 diabetics.
目的
探讨2型糖尿病胰岛素治疗患者糖尿病视网膜病变（DR）的相关危险因素。
方法
我们研究了血糖、血清C肽、血浆胰岛素、β细胞功能与DR发生发展之间的关系。β细胞功能采用改良的稳态模型评估（改良HOMA）进行评估，该方法是在β细胞功能的稳态模型评估（HOMA）中用C肽替代胰岛素获得的。我们还研究了改良HOMA指数与血清C肽对100g无味馒头的反应之间的关系，以确定改良HOMA的准确性。
结果
我们的研究组包括170例患有DR的2型糖尿病住院患者（年龄：58.35±13.87岁，均值±标准差）和205例无DR（NDR）的2型糖尿病住院患者（年龄：65.52±11.59岁）。DR患者年龄更大、糖尿病病程更长、高血压分级更高、餐后血糖更高、血糖波动水平更高、体重指数（BMI）更低、餐后血清胰岛素和C肽更低、血清胰岛素和C肽波动水平更低（P<0.05）。在我们的逻辑回归模型中，校正混杂因素后，糖尿病病程、高血压分级、空腹血浆胰岛素和糖化血红蛋白（HbA1C）与DR发生显著相关（P<0.05）。
结论
我们的结果表明，虽然在Spearman等级相关分析中改良HOMA与DR的发生有显著相关性，但校正相关混杂因素（如年龄、性别、糖尿病病程、BMI、高血压分级、HbA1C、血浆胰岛素）后，逻辑回归显示这两个变量之间无显著关联。糖尿病病程、高血压分级、空腹血浆胰岛素和HbA1C与中国2型糖尿病患者DR的发生独立相关。
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