Clinical Study On The Influencing Factors And Predictive Model Of Diabetic Retinopathy

ObjectiveTo guide clinical prevention the occurrence and progress of DR.,we research diabetes predictors of risk factor of DR and progress from the past medical history and clinical measures in lab, physicochemical index, TCM syndromes, TCM syndrome elements of metabolic syndrome and diabetes,Methods1.Clinical study on the wisk factors for the occurrence of DR:In this study,183 cases were included.According to the fundus situation we divided all the cases into DR group and non DR group.The table was used to observe the clinical data, physical and chemical indexes and TCM syndrome of the patients who met the inclusion criteria. We compared the analysis of the occurrence of DR group and the DR group of the indicators and the characteristics of Chinese Medicine.2. Clinical study on the wisk factors and the model for the progress of DR:In this study,58 cases were followed. According to the fundus situation we divided all the cases into DR progess group and DR none-progess group.The table was used to observe the clinical data, physical and chemical indexes and TCM syndrome of the patients who met the inclusion criteria at begin and the termination. We compared the analysis of the DR progression group and the DR non progress group of the indicators and the characteristics of Chinese Medicine. We develop a fomula for the progress of DR.ResultsPart I:Research on the related factors on the occurrence of DR1.General information:There were 103 men and 80 women in non DR group with the average age was 58.67±11.30 years. There were 61 men and 51 women in DR group with the average age was 59.97±10.91 years.There was no difference in sex ratio and mean age between the non DR group and the DR group. The proportion of smoking and drinking in DR group was significantly higher than that in group non DR.2. Disease and family history:The history of cerebral infarction in DR group, the proportion of hypertension history group, fatty liver and history of dyslipidemia proportion were significantly lower than that of non DR group, and the significant difference was statistically significant (P< 0.05).DR proportion of coronary artery disease proportion, hyperuricemia proportion of history, history of hypoglycemia,the proportion of family history of father and mother proportion of family history, brothers and sisters and family history of Dr group compared with no significant difference.3. Clinical measurement index:The average systolic blood pressure in the DR group was higher than that in the non DR group, and the statistical analysis was significantly different (P < 0.05).Average diastolic blood pressure, body mass index, waist hip ratio of DR group compared with the non DR group, there was no significant difference in statistical analysis (P=0.064)4. Laboratory test index:24h-UPr, ACR, Scr, BUN, UA, HbAlc, K, P of Dr group are significant higher and RBC, TP, ALB of Dr group are significant lower than those of non DR group.The CCR, eGFR,TC, TG, HDL-C, LDL-C, HGB, blood Ca2+, in non-DR group have significantly different with those of DR group.5. Symptoms of traditional Chinese Medicine:The ten traditional Chinese medicine syndromes with highest frequency occurred in non-DR group were:lassitude, pharynx dry mouth and dry, sexual desire drops, waist and knee pain, teeth loose hair loss, body weight, dry mouth, dry eyes, forgetfulness, spontaneous perspiration sleepy The ten traditional Chinese medicine syndromes with highest frequency occurred in non-DR group were:Fatigue, less gas lazy words, loss of libido, pharynx dry, dry mouth, teeth loose hair loss, waist and knee pain, dim, the body sleepy, eye dryness, night urination. The incidence of less gas lazy words, yellow urination, body edema in DR group is significantly higher than that of non DR group. The incidence of spontaneous sweating, dizziness, Fanre, dyspnea and shortness of breath, forgetfulness, bitter taste and dry throat in DR group is significantly lower than that of non DR group.6. TCM Syndrome Elements.Symptoms in non DR group in the order of occurrence frequency were:Yin deficiency, Qi deficiency, damp heat, Yang deficiency, blood deficiency, blood stasis, phlegm, qi stagnation, heat.Symptoms in DR group in the order of occurrence frequency were:Qi deficiency, Yin deficiency, blood deficiency, Yang deficiency, damp heat, blood stasis, phlegm, qi stagnation,.Comparising the symptoms between the two groups in the DR (-) group and the DR(+) group, Yin deficiency, damp heat in the two groups is not all the same (P< 0.05) but Qi deficiency, blood deficiency, Yang deficiency, qi stagnation, blood stasis, heat between two group distribution had no significant difference (P> 0.05).Part II:the research on the related factors of DR development1.General information on baseline:There were 20 men and 23 women in non progess DR group with the average age was 63.28±7.48years. There were 10 men and 5 women in DR group with the average age was 59.97±10.91 years.The average age of progress group is significantly lower than that of non-progess group.There was no difference in the sex,smoking and alcohol consumption between the DR progress group and the DR non- progress group.2. Disease and family history on baseline:Compared with the non progress group, the history of hypertension in the development group was significantly higher, the difference was statistically significant. Compared with the non progress group, there was no significant difference in the progression of coronary heart disease, cerebral infarction, hyperlipidemia, fatty liver, hyperuricemia, hypoglycemia, family history, and the difference was not statistically significant.3. Clinical measurement index on baseline:Compared with the non progression group in systolic blood pressure and diastolic blood pressure had no significant difference, the difference was not statistically significant.The ratio of body mass index, waist to hip ratio in DR progress group was higher than that in the non DR progress group, and the statistical analysis was significantly different (P< 0.05).4. Laboratory test index:Compared with non progression group. In the control group 24 hours urine protein, urine micro protein/creatinine ratio, serum creatinine, blood urea nitrogen, creatinine clearance rate, glomerular filtration rate, blood glucose, glycosylated hemoglobin, blood phosphorus significantly increased with significant difference. Compared with non progression group, progressive group uric acid, total cholesterol, triglyceride, low density lipoprotein, high density lipoprotein, erythrocyte count, hemoglobin, serum potassium, calcium, serum total protein, albumin no significant difference, the difference is not statistically significant.5. Symptoms of traditional Chinese Medicine on baseline:The ten traditional Chinese medicine syndromes with highest frequency occurred in non-DR progress group were:fatigue, limb trapped heavy, loss of libido, pharynx dry mouth and dry, waist and knee pain, teeth loose hair loss, forgetful, dim, skin itching, sweating.The ten traditional Chinese medicine syndromes with highest frequency occurred in DR progress group were:fatigue, eye dryness, body trapped heavy, dizziness, tooth loose hair loss, dry mouth, skin itching, shape cold limbs, waist and knee pain, sexual loss. Compared with the non progression group, the progressive group baseline palpitations Zheng Zhong, insomnia and dreaminess, claw a wing symptoms of frequency distribution was significantly decreased, the difference has statistical significance.6. TCM Syndrome Elements on baseline:Symptoms in non-DR progeress group in the order of occurrence frequency were:qi deficiency, yin deficiency, blood deficiency, damp heat, blood stasis, qi stagnation, phlegm, heat, Yang Shen.Symptoms in non-DR progeress group in the order of occurrence frequency were:qi deficiency, yin deficiency, Yang deficiency, blood deficiency, damp heat, blood stasis, phlegm, heat, qi stagnation. Compared with the non progress group, the frequency distribution of deficiency of Yang deficiency in the development group was significantly higher, and the difference was statistically significant.Part III:the research on the related factors of DR development1. Multivariate analysis results:Body mass index, ACR, Scr, glycosylated hemoglobin were independently associated with DR progression.2. DR progress prediction equation:The area under the ROC curve was 0.974. Combined with clinical practice, with the maximum Youden index as the principle, the diagnostic value of DR progression probability was 0.30, the diagnostic sensitivity was 100%, and the specificity was 95.3%.Conclusion1.Risk factors of DR:smoking, drinking, accompanied with hypertension, associated with cerebral infarction, with fatty liver, a history of hypoglycemia,24h urinary protein quantitative increase, increased urinary albumin creatinine ratio, serum creatinine, blood urea nitrogen elevated, elevated serum uric acid, reduce glycated hemoglobin increased, red cell count, elevated serum potassium, serum phosphorus level increased, reduce serum total protein, serum albumin decreased, less gas lazy words, yellow urine, systemic edema. In group DR, spontaneous sweating, dizziness, Fanre, dyspnea and shortness of breath, forgetfulness, bitter taste and dry throat symptoms significantly reduced the frequency distribution.2. Risk factors for DR progression:With age, hypertension, body mass index increased, waist hip than increased,24 hours urine protein quantitative increase, urine micro protein to creatinine ratio height, serum creatinine, blood urea nitrogen increased, endogenous creatinine clearance rate increased, glomerular filtration rate increased, elevated blood glucose, glycated hemoglobin levels, elevated serum phosphate, Yang deficiency.3. Multivariate logistic regression analysis showed that body mass index, ACR, glycosylated hemoglobin were independently associated with DR progression. The small sample validation of the DR progress prediction equation was established with a sensitivity of 100% and a specificity of 95.3%. Validation sensitivity was 81.8%, specificity was 97.4% and accuracy was 94%.The model is reliable and desirable.