自主神经功能障碍与 2 型糖尿病患者糖尿病视网膜病变风险的相关性。
Association of sudomotor dysfunction with risk of diabetic retinopathy in patients with type 2 diabetes.
机构信息
Postgraduate Training Basement of Jinzhou Medical University, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, 200233, China.
出版信息
Endocrine. 2024 Jun;84(3):951-957. doi: 10.1007/s12020-023-03682-3. Epub 2024 Jan 10.
PURPOSE
Sudomotor dysfunction is considered as one of the earliest manifestations of diabetic peripheral neuropathy. We aimed to investigate the association between sudomotor dysfunction non-invasively detected by the SUDOSCAN device and diabetic retinopathy (DR) in patients with type 2 diabetes.
METHODS
A total of 2010 patients admitted to a tertiary hospital located in Shanghai were included from March 2020 to September 2023. Sudomotor function was assessed by the SUDOSCAN device, and sudomotor dysfunction was defined as feet electrochemical skin conductance (FESC) <60 μs. Fundus radiography was used for DR assessment, which was graded according to the severity, specifically: (1) non-DR; (2) mild nonproliferative DR (NPDR); (3) moderate NPDR/vision-threatening DR (VTDR).
RESULTS
Among the enrolled 2010 patients, 525 patients had sudomotor dysfunction; 648 were diagnosed with DR, which was equivalent to 32.2% of all patients. Patients with sudomotor dysfunction had a significantly higher prevalence of DR, compared to those with normal sudomotor function (40.8% vs. 29.2%, P < 0.05). After controlling for confounding factors including HbA1c, sudomotor dysfunction was significantly associated with any DR (odd ratio [OR] = 1.57, 95% CI 1.26-1.96). When FESC was considered as a continuous variable, the multivariable-adjusted OR of DR was 1.29 (95% CI 1.17-1.42) for per 1-SD decrease in FESC. Furthermore, multinomial logistic regression revealed significant associations between sudomotor dysfunction and all stages of DR (mild NPDR: OR = 1.40, 95% CI 1.11-1.78; moderate NPDR/VTDR: OR = 2.35, 95% CI 1.60-3.46).
CONCLUSIONS
Sudomotor dysfunction was significantly associated with DR in patients with type 2 diabetes.
目的
自主神经功能障碍被认为是糖尿病周围神经病变的最早表现之一。我们旨在研究通过 SUDOSCAN 设备无创检测到的自主神经功能障碍与 2 型糖尿病患者糖尿病视网膜病变（DR）之间的关系。
方法
2020 年 3 月至 2023 年 9 月，我们纳入了来自上海一家三级医院的 2010 名患者。通过 SUDOSCAN 设备评估自主神经功能，将足部电化学皮肤传导（FESC）<60μs 定义为自主神经功能障碍。眼底照相用于 DR 评估，根据严重程度分级：（1）非 DR；（2）轻度非增殖性 DR（NPDR）；（3）中度 NPDR/威胁视力的 DR（VTDR）。
结果
在纳入的 2010 名患者中，525 名患者存在自主神经功能障碍；648 名患者被诊断为 DR，相当于所有患者的 32.2%。与自主神经功能正常的患者相比，自主神经功能障碍患者的 DR 患病率显著更高（40.8%比 29.2%，P<0.05）。在校正包括 HbA1c 在内的混杂因素后，自主神经功能障碍与任何 DR 显著相关（比值比 [OR] = 1.57，95%CI 1.26-1.96）。当将 FESC 视为连续变量时，FESC 每降低 1-SD，DR 的多变量校正 OR 为 1.29（95%CI 1.17-1.42）。此外，多项逻辑回归显示自主神经功能障碍与 DR 的所有阶段均显著相关（轻度 NPDR：OR=1.40，95%CI 1.11-1.78；中度 NPDR/VTDR：OR=2.35，95%CI 1.60-3.46）。
结论
自主神经功能障碍与 2 型糖尿病患者的 DR 显著相关。
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