Wu Yutong, Hong Zhuomin, Luo Xiangxia
Gansu Provincial Hospital of Traditional Chinese Medicine (TCM), Gansu University of Chinese Medicine, Lanzhou, Gansu, China.
Front Endocrinol (Lausanne). 2025 Sep 1;16:1473517. doi: 10.3389/fendo.2025.1473517. eCollection 2025.
Diabetic retinopathy (DR) and diabetic kidney disease (DKD) are two prevalent diabetic complications significantly influencing global health and quality of life. However, little is known about their relationship in patients with type 2 diabetes mellitus (T2DM).
This study aimed to investigate the relationship between DR and DKD through a prospective observational research study.
T2DM patients were recruited from November 2020 to November 2022. A total of 223 T2DM patients were finally enrolled. Additionally, 50 healthy examinees were included as the control group. Diagnostic and staging criteria for DR are based on previously established standards. DKD was assessed using serum levels of cystatin C (CysC), β2-microglobulin (β2-MG), and homocysteine (Hcy). Traditional Chinese medicine (TCM) syndrome differentiation standards were based on the TCM Diagnosis and Treatment Standards for diabetes Retinopathy issued by the diabetes Branch of the Chinese Society of Traditional Chinese Medicine in 2011. The outcomes of interest were measured at baseline.
This study included 223 T2DM patients aged from 32 to 78 years. According to DR staging, patients were further categorized into four T2DM subgroups, namely, T2DM without DR, T2DM with light or moderate non-proliferative DR (lmNPDR), T2DM with heavy non-proliferative DR (hNPDR), and T2DM with proliferative DR (PDR). Among the participants, 154 (154/223, 69.06%) were diagnosed with DR. As DR severity increased, the levels of three DKD indicators presented a significant upward trend compared to those in the control group, except for Hcy in the PDR subgroup. Spearman's correlation analysis revealed significant associations between each DKD indicator and the T2DM subgroups, with rs = 0.223, p = 0.001, for Hcy; rs = 0.452, p < 0.001, for CysC; and rs = 0.564, p < 0.001, for β2-MG. Three TCM syndrome types were identified in the 223 T2DM patients. For four T2DM subgroups, the proportion of qi-yin deficiency increased with decreasing DR severity, whereas the proportion of yin-yang deficiency increased with increasing DR severity. Three DKD indicators exhibited statistically significant differences between the deficiency of the liver and kidney or yin-yang deficiency and qi-yin deficiency, except for Hcy in yin-yang deficiency.
This study suggests a potential association between DR and DKD and provides evidence that the incidence of qi-yin deficiency and yin-yang deficiency exhibits opposite trends with respect to DR severity.
糖尿病视网膜病变（DR）和糖尿病肾病（DKD）是两种常见的糖尿病并发症，对全球健康和生活质量有重大影响。然而，对于2型糖尿病（T2DM）患者中它们之间的关系知之甚少。
本研究旨在通过前瞻性观察性研究探讨DR与DKD之间的关系。
2020年11月至2022年11月招募T2DM患者。最终共纳入223例T2DM患者。此外，纳入50名健康体检者作为对照组。DR的诊断和分期标准基于先前确立的标准。使用血清胱抑素C（CysC）、β2微球蛋白（β2-MG）和同型半胱氨酸（Hcy）水平评估DKD。中医证候辨证标准基于中华中医药学会糖尿病分会2011年发布的糖尿病视网膜病变中医诊疗标准。在基线时测量感兴趣的结局指标。
本研究纳入223例年龄在32至78岁之间的T2DM患者。根据DR分期，患者进一步分为四个T2DM亚组，即无DR的T2DM、轻度或中度非增殖性DR（lmNPDR）的T2DM、重度非增殖性DR（hNPDR）的T2DM和增殖性DR（PDR）的T2DM。在参与者中，154例（154/223，69.06%）被诊断为DR。随着DR严重程度增加，与对照组相比，三个DKD指标水平呈现显著上升趋势，但PDR亚组中的Hcy除外。Spearman相关性分析显示每个DKD指标与T2DM亚组之间存在显著关联，Hcy的rs = 0.223，p = 0.001；CysC的rs = 0.452，p < 0.001；β2-MG的rs = 0.564，p < 0.001。在223例T2DM患者中识别出三种中医证型。对于四个T2DM亚组，气阴两虚的比例随DR严重程度降低而增加，而阴阳两虚的比例随DR严重程度增加而增加。除阴阳两虚中的Hcy外，肝肾亏虚或阴阳两虚与气阴两虚之间的三个DKD指标存在统计学显著差异。
本研究提示DR与DKD之间可能存在关联，并提供证据表明气阴两虚和阴阳两虚的发生率相对于DR严重程度呈现相反趋势。
