Bulum Tomislav, Tomić Martina, Duvnjak Lea
Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, Zagreb, Croatia; Medical School, University of Zagreb, Zagreb, Croatia.
Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, Zagreb, Croatia.
Arch Med Res. 2017 Jul;48(5):467-471. doi: 10.1016/j.arcmed.2017.10.003. Epub 2017 Oct 28.
Results from studies investigating relationship between serum lipids and risk of development and progression of diabetic retinopathy (DR) in patients with type 1 diabetes (T1DM) are not consistent. The objective of this study was to explore the relationship between serum lipids and risk of development and progression of nonproliferative diabetic retinopathy (NPDR) in T1DM with normal renal function and with no therapeutic intervention that might influence on retinopathy and serum lipids status.
A total of 103 T1DM with normal renal function (urinary albumin excretion rate <30 mg/24 h, estimated glomerular filtration rate (eGFR) >60 mL min1.73m), and before any interventions with lipid-lowering therapy, ACE inhibitors or angiotensin II receptor blockers were included in this study and followed for 41 months. Photodocumented retinopathy status was made according to the EURODIAB protocol.
Patients who developed NPDR or progressed to proliferative retinopathy were older (44 vs. 33 years, p <0.001), had longer duration of diabetes (21.1 vs. 13.3 years, p <0.001), and higher serum total cholesterol level (5.1 vs. 4.5 mM/L, p = 0.02) compared to patients without retinopathy. In a backward stepwise Cox's multiple regression analysis serum total cholesterol was significantly associated with risk of development or progression of NPDR in our subjects (p = 0.04), with odds ratios of 1.27-1.91.
These data suggest that serum total cholesterol levels are associated with risk of development and progression of NPDR in T1DM and normal renal function. The study was conducted in patients with no therapeutic interventions.
关于1型糖尿病（T1DM）患者血清脂质与糖尿病视网膜病变（DR）发生及进展风险之间关系的研究结果并不一致。本研究的目的是探讨在肾功能正常、无可能影响视网膜病变和血清脂质状态的治疗干预的T1DM患者中，血清脂质与非增殖性糖尿病视网膜病变（NPDR）发生及进展风险之间的关系。
本研究纳入了103例肾功能正常（尿白蛋白排泄率<30mg/24小时，估计肾小球滤过率（eGFR）>60mL/min/1.73m²）且未接受任何降脂治疗、ACE抑制剂或血管紧张素II受体阻滞剂干预的T1DM患者，并随访41个月。根据EURODIAB方案记录视网膜病变状态。
与无视网膜病变的患者相比，发生NPDR或进展为增殖性视网膜病变的患者年龄更大（44岁对33岁，p<0.001），糖尿病病程更长（21.1年对13.3年，p<0.001），血清总胆固醇水平更高（5.1mM/L对4.5mM/L，p=0.02）。在向后逐步Cox多元回归分析中，血清总胆固醇与我们研究对象中NPDR的发生或进展风险显著相关（p=0.04），比值比为1.27至1.91。
这些数据表明，血清总胆固醇水平与肾功能正常的T1DM患者中NPDR的发生及进展风险相关。该研究是在未进行治疗干预的患者中进行的。
