【摘要】：目的探討糖化血紅蛋白(HbA1c)與糖尿病視網(wǎng)膜病變(DR)的關系及其診斷閾值。設計以社區(qū)人群為基礎的橫斷面研究。研究對象北京社區(qū)糖尿病研究中2642例20~80歲已確診的2型糖尿病患者,其中2007例(76.0%)受試者(1199例女性)參與研究,平均年齡(64.1±9.0)歲。方法全體參與醫(yī)師經(jīng)過專門培訓,按照統(tǒng)一要求調查并填寫調查表,同時對患者進行體格檢查及相關的實驗室檢查,HbA1c用美國伯樂公司高壓液相儀測定,并對所有患者用45°免散瞳彩色眼底照相機留取后極部眼底照片一張。DR的嚴重程度參照Airlie House分級法。采用ROC曲線分析HbA1c診斷DR的最佳閾值。主要指標HbA1c在DR中的診斷閾值(敏感性、特異性、AUC)。結果本人群中DR患病率為(24.7±1.0)%(95%CI,22.8~26.6)。在二元邏輯回歸分析中,DR的出現(xiàn)與較高的HbA1c濃度(OR=1.23;95%CI,1.14~1.33)有關,隨著HbA1c增高,DR患病率呈上升趨勢。當HbA1c≥6.5%時,診斷DR的ROC曲線下面積最大(59.2%),且敏感性(75.1%)和特異性(43.4%)高。在二元邏輯回歸分析中,DR還與其他方面有關:較輕的年齡(OR=0.97;95%CI,0.95~0.98)、較長的糖尿病病程(OR=1.10;95%CI,1.08~1.12)、較高的收縮壓(OR=1.01;95%CI,1.01~1.02)、較低的體重指數(shù)(OR=0.95;95%CI,0.92~0.98)和升高的血尿素氮濃度(OR=1.01;95%CI,1.00~1.01)。結論當糖化血紅蛋白≥6.5%時與糖尿病視網(wǎng)膜病變顯著相關,提示糖化血紅蛋白為6.5%或許可以作為篩查糖尿病視網(wǎng)膜病變的閾值。
[Abstract]:Objective to investigate the relationship between glycosylated hemoglobin (HbA1c) and diabetic retinopathy (DR) and its diagnostic threshold. Design a cross-sectional study based on community population. Participants 2642 patients with type 2 diabetes between 20 and 80 years of age were enrolled in the Beijing community diabetes study. 2007 (76.0%) subjects (1199 women) participated in the study, with an average age of (64.1 鹵9.0) years. Methods all the doctors involved were trained, investigated according to the unified requirements and filled out the questionnaire. At the same time, the patients were examined by physical examination and related laboratory examination. The HbA1c was measured by the high pressure liquid chromatography (HPLC) instrument of Burle Company, USA. A photograph of the posterior polar fundus was taken from all patients with 45 擄pupil free color fundus camera. The severity of DR was compared with the Airlie House classification method. ROC curve was used to analyze the optimal threshold of DR diagnosis by HbA1c. Main outcome measures: diagnostic threshold (sensitivity, specificity, AUC).) of HbA1c in DR Results the prevalence rate of DR in this population was (24.7 鹵1.0)% (95 CI 22.8c26.6). In binary logistic regression analysis, the occurrence of DR was related to higher HbA1c concentration (OR=1.23;95%CI,1.14~1.33), and the prevalence of DR increased with the increase of HbA1c. When HbA1c 鈮，

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