Department of Ophthalmology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Department of Public Health, and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Invest Ophthalmol Vis Sci. 2020 Dec 1;61(14):25. doi: 10.1167/iovs.61.14.25.
Whether the association between diabetic kidney disease (DKD) and diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM) is leveraged by anemia remains unclear. This study is to evaluate the joint effect of DKD and anemia on DR.
Data were collected from electronic medical records of 1389 patients with T2DM in the Yiwu Central Hospital of Zhejiang Province from 2018 to 2019. Based on retinal examination findings, patients were classified as without diabetic retinopathy (non-DR), non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR). Odds ratio (OR) from multinomial logistic regression models adjusting for potential risk factors of DR were used to evaluate associations of DKD, renal function measures, and anemia with risk of NPDR and PDR. Path analysis was performed to help understand the association of DKD and hemoglobin (Hb) with DR.
The study included 901 patients with non-DR, 367 patients with NPDR and 121 patients with PDR. Both high DKD risk and abnormal renal function measures were significantly associated with PDR. Anemia was associated with increased risk of NPDR (OR = 1.75, 95% confidence interval [CI] = 1.18-2.58) and PDR (OR = 3.71, 95% CI = 2.23-6.18). DKD severity and anemia had joint effect on NPDR (OR = 2.29, 95% CI = 1.32-3.96) and PDR (OR = 11.31, 95% CI = 5.95-21.51). These associations were supported by path analysis.
DKD severity, abnormal estimated glomerular filtration rate (eGFR), and urinary albumin/creatinine ratio (UACR) were associated with increased risk of DR in patients with T2DM, and anemia had joint effect on these associations. Improving Hb level may decrease the risk of DR in patients with T2DM.
在 2 型糖尿病（T2DM）患者中，糖尿病肾病（DKD）和糖尿病视网膜病变（DR）之间的关联是否受贫血影响尚不清楚。本研究旨在评估 DKD 和贫血对 DR 的联合影响。
本研究从 2018 年至 2019 年期间收集了浙江省义乌市中心医院 1389 例 T2DM 患者的电子病历数据。根据视网膜检查结果，患者分为无糖尿病视网膜病变（非 DR）、非增生性糖尿病视网膜病变（NPDR）和增生性糖尿病视网膜病变（PDR）。使用多变量逻辑回归模型调整 DR 的潜在危险因素后计算比值比（OR），以评估 DKD、肾功能指标和贫血与 NPDR 和 PDR 风险的相关性。路径分析用于帮助理解 DKD 和血红蛋白（Hb）与 DR 的关联。
本研究纳入了 901 例非 DR 患者、367 例 NPDR 患者和 121 例 PDR 患者。高 DKD 风险和异常肾功能指标均与 PDR 显著相关。贫血与 NPDR（OR=1.75，95%置信区间[CI]：1.18-2.58）和 PDR（OR=3.71，95%CI：2.23-6.18）风险增加相关。DKD 严重程度和贫血对 NPDR（OR=2.29，95%CI：1.32-3.96）和 PDR（OR=11.31，95%CI：5.95-21.51）均有联合作用。这些关联得到了路径分析的支持。
在 T2DM 患者中，DKD 严重程度、估计肾小球滤过率（eGFR）异常和尿白蛋白/肌酐比值（UACR）与 DR 风险增加相关，贫血对这些关联有联合作用。提高 Hb 水平可能会降低 T2DM 患者发生 DR 的风险。
