糖尿病患者视网膜病变程度与血糖波动的关系及其影响因素

doi:10.13281/j.cnki.issn.1004-4469.2025.02.008

眼科 ›› 2025, Vol. 34 ›› Issue (2): 137-141.doi: 10.13281/j.cnki.issn.1004-4469.2025.02.008

糖尿病患者视网膜病变程度与血糖波动的关系及其影响因素

张琳琪¹ 居悦俊¹ 陈可² 王冠怡¹ 孔颖宏¹

¹南通大学附属常熟医院内分泌科，江苏常熟 215500； ² 南通大学附属常熟医院眼科，江苏常熟 215500

收稿日期:2024-03-13 出版日期:2025-03-25 发布日期:2025-03-13
通讯作者: 孔颖宏，Email：kongyinghong@163.com

Relationship between severity of diabetic retinopathy and blood glucose fluctuations and its influencing factors

Zhang Linqi¹, Ju Yuejun¹, Chen Ke², Wang Guanyi¹, Kong Yinghong¹

¹ Department of Endocrinology, Affiliated Changshu Hospital of Nantong University, Changshu Jiangsu 215500, China; ² Department of Ophthalmology, Affiliated Changshu Hospital of Nantong University, Changshu Jiangsu 215500, China

Received:2024-03-13 Online:2025-03-25 Published:2025-03-13
Contact: Kong Yinghong, Email: kongyinghong@163.com

摘要/Abstract

摘要： 目的分析2型糖尿病（T2DM）患者视网膜病变（DR）程度与血糖波动的关系及其影响因素。设计回顾性病例系列。研究对象 采用方便抽样方法选取2021年2月至2023年4月常熟医院收治的168例T2DM患者。方法按是否有DR及其严重程度分为无DR组（NDR）88例、非增生性DR组（NPDR）59例和增生性DR组（PDR）21例。比较三组基本资料、实验室检查指标和14天动态血糖监测（CGM）结果，采用多因素Logistic回归分析DR病情进展的影响因素，绘制受试者工作特征曲线（ROC），评估血糖在目标范围内的时间（TIR）、平均血糖波动幅度（MAGE）对DR病情进展的预测效能。主要指标 TIR、平均血糖（MBG）、血糖水平标准差（SDBG）、MAGE。结果三组的年龄、糖尿病病程、空腹血糖（FPG）、糖化血红蛋白（HbA1c）水平比较，NDR组＜NPDR组＜PDR组（P均<0.05）。三组TIR值比较，NDR组（79.78%±14.03%）＞NPDR组（67.51%±12.75%）＞PDR组（50.17%±10.18%）（P均<0.05）。三组MBG比较，NDR组的（8.15±1.76）mmol/L＜NPDR组的（8.77±1.89）mmol/L＜PDR组的（9.79±2.16）mmol/L（P均<0.05）。三组SDBG比较，NDR组的（1.84±0.48）mmol/L＜NPDR组的（2.39±0.62）mmol/L＜PDR组的（2.68±0.75）mmol/L（P均<0.05）。三组的MAGE比较，NDR组的（4.33±1.04）mmol/L＜NPDR组的（5.48±1.34）mmol/L＜PDR组的（6.67±1.69）mmol/L（P均<0.05）。ROC曲线分析显示：TIR<60.22%、MAGE>6.17 mmol/L、HbA1c＞8.83%均能预测PDR（P均<0.05），曲线下面积分别为0.918、0.684、0.680，其中TIR的预测效能最高（Z=3.105，3.401；P=0.002，0.001），其敏感度为90.48%，特异度为82.31%；多因素Logistic回归分析显示：MAGE＞6.17 mmol/L，TIR＜60.22%均为PDR的独立危险因素（P均<0.05）。结论 T2DM患者DR病情严重程度与血糖波动密切相关，MAGE＞6.17 mmol/L，TIR＜60.22% 会增加NDR和NPDR发展为PDR的风险，且TIR、MAGE可作为PDR发生的预测指标。（眼科，2025，34： 137-141）

关键词: 2型糖尿病, 糖尿病视网膜病变

Abstract: Objective To analyze the relationship between severity of diabetic retinopathy (DR) and blood glucose fluctuations in patients with type 2 diabetes mellitus (T2DM) and its influencing factors. Design Retrospective case series. Participants Using convenience sampling method to select 168 T2DM patients admitted to Changshu Hospital from February 2021 to April 2023. Methods According to the severity of DR, the patients were divided into 88 cases in non-DR group (NDR), 59 cases in non-proliferative DR group (NPDR) and 21 cases in proliferative DR group (PDR). The basic data, laboratory indicators and 14-day continuous glucose monitoring (CGM) results were compared among the three groups. The influencing factors of progression of DR were explored by multivariate Logistic regression analysis, and receiver operating characteristic curve (ROC) was drawn. The predictive efficiency of time in range (TIR) and mean amplitude of glycemic excursions (MAGE) on predicting the progression of DR was assessed. Main Outcome Measures TIR, mean blood glucose (MBG), standard deviation of blood glucose level (SDBG), MAGE. Results Age, diabetes course, fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) levels were manifested as NDR group<NPDR group<PDR group (all P<0.05). The TIR value was expressed as NDR group (79.78%±14.03%)>NPDR group (67.51%±12.75%)>PDR group (50.17%±10.18%) (all P<0.05), while the MBG level revealed NDR group [(8.15±1.76) mmol/L]<NPDR group [(8.77±1.89) mmol/L]<PDR group [(9.79±2.16) mmol/L] (all P<0.05). The SDBG level showed NDR group [(1.84±0.48) mmol/L]<NPDR group [(2.39±0.62) mmol/L]<PDR group [(2.68±0.75) mmol/L] (all P<0.05). The MAGE level was considered as NDR group [(4.33±1.04) mmol/L]<NPDR group [(5.48±1.34) mmol/L]<PDR group [(6.67±1.69) mmol/L] (all P<0.05). ROC curve analysis found that TIR<60.22%, MAGE>6.17 mmol/L and HbA1c>8.83% could all predict PDR (all P<0.05), and the areas under the curves were 0.918, 0.684 and 0.680, and TIR had the highest prediction efficiency (Z=3.105, 3.401; P=0.002, 0.001), and its sensitivity and specificity were 90.48% and 82.31%. Multivariate Logistic regression analysis showed that MAGE>6.17 mmol/L and TIR<60.22% were independent risk factors for PDR (all P<0.05). Conclusion The severity of DR in T2DM patients is closely related to the fluctuations of blood glucose. MAGE>6.17 mmol/L and TIR<60.22% will increase the risk of NDR and NPDR developing into PDR, and TIR and MAGE can be used as predictive indicators of NDR and NPDR. (Ophthalmol CHN, 2025, 34: 137-141)

Key words: type 2 diabetes mellitus, diabetic retinopathy

张琳琪居悦俊陈可王冠怡孔颖宏. 糖尿病患者视网膜病变程度与血糖波动的关系及其影响因素[J]. 眼科, 2025, 34(2): 137-141.

Zhang Linqi, Ju Yuejun, Chen Ke, Wang Guanyi, Kong Yinghong. Relationship between severity of diabetic retinopathy and blood glucose fluctuations and its influencing factors[J]. Ophthalmology in China, 2025, 34(2): 137-141.

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糖尿病患者视网膜病变程度与血糖波动的关系及其影响因素

Relationship between severity of diabetic retinopathy and blood glucose fluctuations and its influencing factors

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