Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, Medical School, University of Zagreb, Zagreb, Croatia.
Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, Medical School, University of Zagreb, Zagreb, Croatia.
Diabetes Res Clin Pract. 2014 Dec;106(3):555-9. doi: 10.1016/j.diabres.2014.09.018. Epub 2014 Oct 22.
The aim of this study was to evaluate risk factors for development and progression of nonproliferative retinopathy (NPR) in normoalbuminuric patients with type 1 diabetes mellitus (T1DM).
A total of 223 T1DM with normal renal function and normoalbuminuria were included in this study and followed for 48 months. Photodocumented retinopathy status was made according to the EURODIAB protocol. Urinary albumin excretion rate (UAE) was measured from at least two 24-h urine samples. Possible risk factors for development or progression of NPR were examined in backward stepwise Cox's multiple regression analysis.
The majority of patients (70%) had no retinopathy while 67 (30%) had NPR at baseline. Patients with NPR were older, had longer duration of diabetes, higher systolic blood pressure, BMI, resting heart rate, UAE and lower estimated glomerular filtration rate (p ≤ 0.04 for all). After 48 months 24 patients (10.7%) developed NPR or progressed to proliferative retinopathy. Systolic blood pressure (HR 1.03, CI 1.01-1.05, p=0.02), UAE (HR 1.14, CI 1.07-1.21, p<0.001), and resting heart rate (HR 1.05, CI 1.01-1.09, p=0.006) were significantly associated with development or progression of NPR.
Our results suggest that retinopathy is present and may progress in T1DM even when coexisting renal disease is excluded. Normoalbuminuric T1DM requires close monitoring for the early detection of retinopathy, especially if they have a higher UAE, systolic blood pressure and resting heart rate.
本研究旨在评估无白蛋白尿的 1 型糖尿病（T1DM）患者非增殖性视网膜病变（NPR）发展和进展的危险因素。
本研究共纳入 223 例肾功能正常和无白蛋白尿的 T1DM 患者，随访 48 个月。根据 EURODIAB 方案进行光记录的视网膜病变状态。尿白蛋白排泄率（UAE）通过至少两次 24 小时尿液样本进行测量。使用向后逐步 Cox 多重回归分析检查 NPR 发展或进展的可能危险因素。
大多数患者（70%）没有视网膜病变，而 67 名（30%）患者基线时有 NPR。NPR 患者年龄较大，糖尿病病程较长，收缩压、BMI、静息心率、UAE 较高，估计肾小球滤过率（eGFR）较低（所有 p≤0.04）。48 个月后，24 名患者（10.7%）出现 NPR 或进展为增殖性视网膜病变。收缩压（HR 1.03，CI 1.01-1.05，p=0.02）、UAE（HR 1.14，CI 1.07-1.21，p<0.001）和静息心率（HR 1.05，CI 1.01-1.09，p=0.006）与 NPR 的发展或进展显著相关。
我们的结果表明，即使排除并存的肾脏疾病，T1DM 中也存在并可能进展的视网膜病变。无白蛋白尿的 T1DM 需要密切监测，以早期发现视网膜病变，特别是如果他们的 UAE、收缩压和静息心率较高。
