Study On Ocular Fundus Changes And Influencing Factors In Patients With Type 2 Diabetic Kidney Disease

Objective:To analyze the changes of ocular fundus and renal function in patients with type2 diabetes mellitus,and to further explore the correlation between diabetic retinopathy（DR）and diabetic kidney disease（DKD）,two major diabetic microvascular complications,and other influencing factors,regarding the improvement the vigilance of the occurrence and development of diabetic nephropathy.Methods:A total of 174 patients with type 2 diabetes medicated in our hospital from January 2020 to December 2020 were selected as the research subjects.The patient case data were collected and divided into three groups:normal albuminuria,microalbuminuria and massive albuminuria group according to the albumin-to-creatinine ratio（ACR）of random urine samples.The general indexes,laboratory indexes and the progression of fundus lesions of the three groups were compared.Univariate ANOVA analysis of variance,Kruskal-Wallis H rank sum test,×listχ2 test,Spearman correlation analysis,and dual Logistics regression analysis were used to determine the risk factors affecting the severity of diabetic nephropathy and diabetic retinopathy,and then the correlation between diabetic nephropathy and diabetic retinopathy was inferred.Receiver operating characteristic（ROC）curve was used to determine the diagnostic value of the variables.Results:1.Comparison of the general clinical data of the three groups showed that the gender distribution and duration of diabetes were not identical,and the differences were statistically significant（P<0.01）.Compared with the normal albuminuria group,the male patients in the microalbuminuria group and the large albuminuria group were more common and the disease course was relatively longer.There was no significant difference in age distribution and body mass index among the three groups（P>0.05）.2.The levels of creatinine,urea,cystatin C,retinol binding protein,α₁-microglobulin,lipoprotein（A）and NLR in micro and large albuminuria groups were significantly increased,and the glomerular filtration rate was significantly decreased significantly compare with normal albuminuria group（P<0.01）.There was no significant differences among the groups in triglyceride,total cholesterol,high density lipoprotein,low density lipoprotein,apolipoprotein A1,apolipoprotein B,mean platelet volume and platelet distribution width（P>0.05）.3.Spearman bivariate correlation analysis showed that ACR was positively correlated with creatinine,urea,cystatin C,retinol binding protein,α₁-microglobulin,lipoprotein（A）,and NLR,and negatively correlated with glomerular filtration rate,withα₁-microglobulin having the highest correlation（r=0.741,P<0.001）.The degree of ocular fundus change was positively correlated with the course of disease,creatinine,urea,cystatin C,retinol binding protein,α₁-microglobulin,lipoprotein（A）,NLR and ACR,and negatively correlated with the glomerular filtration rate,among which ACR had the highest correlation（r=0.451,P<0.001）.4.The ACR was set as the dependent variable and the influencing factors after preliminary screening was set as independent variables,multi-factor binary Logistics regression analysis was conducted and confounding factors were adjusted.The results showed that males were more prone to diabetic nephropathy than females,with an odds ratio of 4.496;Patients with severe fundus lesions were prone to diabetic nephropathy,the odds ratio was 2.222.The higher the urea andα₁-microglobulin indexes were,along with that the higher probability of diabetic nephropathy.The probability of diabetic nephropathy was 1.276-fold and 1.142-fold with the increase of urea andα₁-microglobulin by 1 unit,respectively,and the differences were statistically significant（P<0.05）.5.ROC analysis was performed based on ACR was abnormal as the state variable.The area under the fundus ROC curve（AUC）was 0.760,the AUC of urea was 0.868,and the AUC ofα₁-microglobulin was 0.905（P<0.05）.Whenα₁-microglobulin≥37.1mg/L,the sensitivity was 75.3%,the specificity was 93.3%,and the approximate index was 0.686.Conclusion:1.There is a certain correlation between diabetic nephropathy and diabetic retinopathy.When the fundus exudate occurs in T2DM patients,the changes of DKD and renal function should be vigilant.2.Urea,fundus changes andα₁-microglobulin were all independent risk factors for DKD,among whichα₁-microglobulin had the highest predictive value.Whenα₁-microglobulin increased to the critical value of 37.1mg/L,it may be used as an early warning value for the occurrence of diabetic nephropathy.3.Diabetic male patients have a longer course of disease and are more likely to develop DKD;ACR was positively correlated with the value of creatinine,urea,cystatin C,retinol-binding protein,α₁-microglobulin,lipoprotein（A）,and NLR,but negatively correlated with glomerular filtration rate,andα₁-microglobulin had the greatest correlation.The degree of ocular fundus change was positively correlated with the course of disease,creatinine,urea,cystatin C,retinol-binding protein,α₁-microglobulin,lipoprotein（A）,NLR and ACR,and negatively correlated with glomerular filtration rate,among which ACR had the highest correlation.