本文選題：2型糖尿病 + 糖尿病視網膜病變　； 參考：《河北醫(yī)科大學》2017年碩士論文

【摘要】：目的:近30年來我國糖尿病患病率顯著增加,糖尿病視網膜病變(Diabetic Retinopathy,DR)是2型糖尿病患者最常見的微血管并發(fā)癥之一,嚴重病變會導致患者失明[1]。血清胱抑素C(Cys C)是一種廣泛存在于各種組織的體液和有核細胞的低相對分子量、堿性非糖化蛋白質。有研究發(fā)現(xiàn)大鼠的玻璃體和隔層視網膜細胞都會表達Cys C。糖化血紅蛋白(Hb A1c)是反映患者平均血糖水平高低的敏感指標,是監(jiān)測糖尿病血糖控制情況的金標準,研究認為糖尿病視網膜病變和糖化血紅蛋白水平呈正相關。本研究主要分析了2型糖尿病患者視網膜病變的發(fā)生及嚴重程度與患者血清Cys C及Hb A1c水平的相關性,為2型糖尿病視網膜病變的預防和臨床診治提供客觀的評價指標。方法:1選取2015年01月至2016年12月就診于保定市第一中心醫(yī)院內分泌科的住院2型糖尿病患者650例進行回顧性病例對照研究。其中男性患者312例,包含DR患者為120例,其中非增殖期視網膜病變(NPDR)患者為75例,增殖期視網膜病變(PDR)患者為45例;女性患者338例,包含DR患者為143例,其中非增殖期視網膜病變(NPDR)患者為80例,增殖期視網膜病變(PDR)患者為63例。2從住院系統(tǒng)收集患者個人基本信息:包括年齡、性別、糖尿病病程、有無糖尿病家族史、身高、體重、吸煙史(定義為至少每日吸煙一支,持續(xù)一年以上)、收縮壓(SBP)、舒張壓(DBP);次日清晨空腹狀態(tài)下抽靜脈血測定空腹血糖(FBG)、糖化血紅蛋白(Hb A1c)、總膽固醇(TC)、甘油三酯(TG)、低密度脂蛋白膽固醇(LDL-C)、高密度脂蛋白膽固醇(HDL-C)、谷丙轉氨酶(ALT)、谷草轉氨酶(AST)、谷氨酰胺轉移酶(GGT)、尿素氮(BUN)、肌酐(SCr)、血尿酸(SUA)、胱抑素C(Cys C);記錄患者眼底是否出現(xiàn)微血管瘤、出血點、硬性滲出、新生血管增殖等病變情況,為視網膜病變臨床分期提供可靠的依據。分別比較非糖尿病視網膜病變組(NDR組)與糖尿病視網膜病變組(DR組)患者、非增殖期視網膜病變組(NPDR組)與增殖期視網膜病變組(PDR組)患者一般資料及實驗室檢查;對比不同胱抑素水平及糖化血紅蛋白水平2型糖尿病患者發(fā)生NDR與DR;NPDR與PDR的患病率;用二元logistic回歸分析2型糖尿病患者發(fā)生DR的相關危險因素。結果:1 2型糖尿病患者發(fā)生DR的患病率為40.46%。胱抑素正常組及胱抑素升高組NDR與DR患病率對比差異有統(tǒng)計學意義(X2=7.770,P=0.0053)。不同糖化血紅蛋白水平(糖化血紅蛋白7%,7%-8%,8%-9%,9%水平)對比,四組患者中NDR與DR患病率對比差異有統(tǒng)計學意義(X2=66.68,P0.001)。隨著Cys C水平升高DR組及NDR組患者例數明顯增加;隨著Hb A1c水平的升高,DR患病率明顯升高。2 Logistic回歸分析顯示:HDL是2型糖尿病患者發(fā)生DR的保護因素[OR值分別為0.134,(95%CI 0.089-0.233,P=0.008)];年齡、糖尿病家族史、吸煙史、SBP、DBP、TG、糖尿病病程、Hb A1c、Cys C均是2型糖尿病患者發(fā)生DR的危險因素;OR值分別為1.214,(95%CI1.152-1.320,P=0.021);1.521,(95%CI 1.433-1.624,P=0.012);1.210,(95%CI 1.104-1.264,P=0.044);1.301,(95%CI 1.275-1.421,P=0.034);1.284,(95%CI 1.204-1.328,P=0.036);1.498,(95%CI 1.420-1.562,P=0.010);1.364,(95%CI 1.258-1.425,P=0.034);2.310,(95%CI2.091-2.510,P=0.002);3.211,(95%CI 3.047-3.451,P=0.021)。結論:1 2型糖尿病患者合并視網膜病變的危險因素眾多,Hb A1c可以較為真實的反映患者血糖控制情況及DR的嚴重程度,是2型糖尿病患者發(fā)生DR的危險因素。2 Cys C可以作為反映2型糖尿病患者視網膜病變情況的內源性標志物,是DR發(fā)生的重要危險因素;早期監(jiān)測胱抑素C和Hb A1c能夠對視網膜病變的發(fā)生、發(fā)展起到良好的監(jiān)測作用,為視網膜病變的預防、治療提供可靠監(jiān)測指標。3 HDL是2型糖尿病患者發(fā)生DR的保護因素;年齡、糖尿病家族史、吸煙史、SBP、DBP、TG、糖尿病病程、Hb A1c、Cys C均是2型糖尿病患者發(fā)生DR的危險因素。
[Abstract]:Objective: the prevalence of diabetes in China has increased significantly in the last 30 years. Diabetic retinopathy (Diabetic Retinopathy, DR) is one of the most common microvascular complications in type 2 diabetic patients. Severe lesions will lead to the blindness of [1]. serum cystatin C (Cys C), a low relative fraction of the body fluids and nucleated cells widely distributed in various tissues. It is found that the Cys C. glycated hemoglobin (Hb A1c) is a sensitive indicator of the average blood glucose level of the patients, and is the gold standard for monitoring the control of diabetic blood glucose. This study mainly analyzed the correlation between the incidence and severity of retinopathy of type 2 diabetic patients with the level of serum Cys C and Hb A1c in patients with type 2 diabetic retinopathy, and provided an objective evaluation index for the prevention and clinical diagnosis and treatment of type 2 diabetic retinopathy. Method: 1 from 01 months to December 2016 2015 in the first middle of Baoding City A retrospective case control study was conducted in 650 patients with type 2 diabetes in the Department of endocrinology in the heart hospital, of which 312 cases were male and 120 were DR patients, including 75 cases of non proliferative retinopathy (NPDR), 45 cases of proliferative retinopathy (PDR), 338 cases of female patients, and 143 cases including DR patients, of which the non proliferation period was non proliferative. 80 patients with retinopathy (NPDR) and 63 patients with proliferative retinopathy (PDR) collected the basic information of the patients from the hospital system: age, sex, the course of diabetes, family history of diabetes, height, weight, smoking history (defined as at least one cigarette per day, more than one year), systolic pressure (SBP), diastolic pressure (DBP); diastolic pressure (DBP); (DBP); Fasting blood glucose (FBG), glycated hemoglobin (Hb A1c), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), glutamine transaminase (ALT), glutamine transaminase (AST), glutamine transferase (GGT), urea nitrogen (BUN), creatinine (SCr), and blood uric acid. A), Cystatin C (Cys C), recording the occurrence of microangioma, bleeding point, hard exudation, neovascular proliferation and other pathological changes in the patients' fundus, providing a reliable basis for the clinical stage of retinopathy. Compared with non diabetic retinopathy group (group NDR) and diabetic retinopathy group (DR group), non proliferative retinopathy group (N General data and laboratory examination in group PDR) and proliferating retinopathy group (group PDR); the incidence of NDR and DR in type 2 diabetic patients with different cystatin levels and glycosylated hemoglobin levels, the prevalence of NPDR and PDR, and the risk factors of DR in type 2 diabetic patients were analyzed by two element logistic regression. Results: type 12 diabetic patients The incidence of the incidence of DR was statistically significant (X2=7.770, P=0.0053) in the normal group of 40.46%. cystatin and the elevated cystatin group (X2=7.770, P=0.0053). The comparison of the levels of glycosylated hemoglobin (glycosylated hemoglobin 7%, 7%-8%, 8%-9%, and 9%) was statistically significant in the prevalence of NDR and DR in the four groups (X2=66.68, P0.001). With the increase of Cys C level, the number of patients in group DR and NDR increased significantly. With the increase of Hb A1c level, the incidence of DR prevalence was significantly higher than that of.2 Logistic regression analysis showed that HDL was the DR protective factor of type 2 diabetes mellitus (0.134). Course, Hb A1c, Cys C are all the risk factors for DR in type 2 diabetic patients; OR values are 1.214, 95%CI1.152-1.320, P=0.021, 1.521, 1.210, 1.301, 1.284, 1.498, 1.364, 1.25. 8-1.425, P=0.034); 2.310, (95%CI2.091-2.510, P=0.002); 3.211, (95%CI 3.047-3.451, P=0.021). Conclusion: there are many risk factors for retinopathy of type 12 diabetic patients. Hb A1c can reflect the patient's blood glucose control and the severity of DR. It is a risk factor for DR in type 2 diabetes patients. The endogenous markers reflecting the retinopathy of type 2 diabetic patients are an important risk factor for the occurrence of DR; early monitoring of cystatin C and Hb A1c can play a good monitoring role in the development of retinopathy, and provide a monitoring index for the prevention of retinopathy, and the monitoring index.3 HDL is the occurrence of DR in type 2 diabetic patients. Protective factors, age, family history of diabetes, smoking history, SBP, DBP, TG, duration of diabetes, Hb A1c, Cys C were all risk factors for DR in type 2 diabetic patients.

【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R587.2;R774.1

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