亚临床动脉粥样硬化与糖尿病视网膜病变的发生相关：一项前瞻性研究。

Subclinical atherosclerosis associates with diabetic retinopathy incidence: a prospective study.

机构信息

Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

出版信息

Acta Diabetol. 2022 Aug;59(8):1041-1052. doi: 10.1007/s00592-022-01897-w. Epub 2022 May 27.

DOI:10.1007/s00592-022-01897-w

PMID:35624320

Abstract

BACKGROUND

The prospective correlation between subclinical atherosclerosis and diabetic retinopathy (DR) incidence in Chinese patients with type 2 diabetes mellitus (T2DM) remains elusive.

METHODS

Prospective data were obtained from 2781 patients with diabetes, among whom 1,964 and 2,180 T2DM patients without any and referable DR at baseline, respectively, were included in the analysis. Multivariate analyses were performed using the Cox proportional hazards model.

RESULTS

Over a median follow-up of 22.2 months (interquartile range 12.7-27.7), 282 (14.36%) and 125 (5.73%) patients developed any and referable DR, respectively. After adjustment for confounders, each standard deviation (SD) increase in brachial-ankle pulse wave velocity (ba-PWV) was associated with 31% (95% confidence interval 1.15-1.50) and 38% (1.14-1.66) higher risks of incident any and referable DR, respectively. Compared with the lowest ba-PWV quartile, the highest ba-PWV quartile had 135% (1.48-3.72) and 293% (1.83-8.44) higher risks of developing any and referable DR, respectively. Per SD increase of pulse pressure (PP) was associated with 22% (1.09-1.38) and 22% (1.02-1.46) higher risks of incident any and referable DR, respectively. The restricted cubic spline models further indicated a significant linear association of baseline subclinical atherosclerosis with referable DR, and a nonlinear association with any DR. In addition, adding the ba-PWV to the prognostic model for DR incidence improved the C-statistic value, the integrated discrimination improvement value, and the net reclassification improvement value (all P < 0.05).

CONCLUSIONS

Baseline subclinical atherosclerosis was significantly associated with an increased risk of DR incidence, and elevated ba-PWV independently predicted incident DR in T2DM patients.

摘要

背景

亚临床动脉粥样硬化与中国 2 型糖尿病（T2DM）患者糖尿病视网膜病变（DR）发生率之间的前瞻性相关性仍难以捉摸。

方法

从 2781 名糖尿病患者中获得前瞻性数据，其中基线时无任何和可归因于 DR 的 T2DM 患者分别为 1964 名和 2180 名，纳入分析。使用 Cox 比例风险模型进行多变量分析。

结果

中位随访 22.2 个月（四分位间距 12.7-27.7）后，分别有 282 名（14.36%）和 125 名（5.73%）患者发生任何和可归因于 DR。调整混杂因素后，肱踝脉搏波速度（ba-PWV）每增加一个标准差（SD），发生任何和可归因于 DR 的风险分别增加 31%（95%置信区间 1.15-1.50）和 38%（1.14-1.66）。与 ba-PWV 最低四分位数相比，ba-PWV 最高四分位数发生任何和可归因于 DR 的风险分别增加 135%（1.48-3.72）和 293%（1.83-8.44）。每增加一个 SD 的脉压（PP）与发生任何和可归因于 DR 的风险分别增加 22%（1.09-1.38）和 22%（1.02-1.46）相关。受限立方样条模型进一步表明，基线亚临床动脉粥样硬化与可归因于 DR 的发生呈显著线性相关，与任何 DR 的发生呈非线性相关。此外，将 ba-PWV 添加到 DR 发生率的预测模型中可提高 C 统计值、综合判别改善值和净重新分类改善值（均 P<0.05）。