Analysis Of Risk Factors Related To DR And DKD And Study On Prediction Model Of DR

Objective:Based on the pathogenic factors of diabetic retinopathy(DR)and diabetic kidney disease(DKD),this study explored the correlation between biochemical indexes and DR and DKD,and made a prediction model of DR.Methods:1.A total of 599 patients diagnosed with type 2 diabetes mellitus(T2DM)who received fundus examination in Shanxi Provincial People’s Hospital from June 2019 to June 2022 were selected as subjects.Among them,50 patients were diagnosed with DKD by renal puncture biopsy.We collected general information about the subjects,including gender,age,systolic blood pressure(SBP),diastolic blood pressure(DBP),body mass index(BMI),smoking status,etc.We collected clinical information about the subjects,including alanine aminotransferase(ALT),aspartate aminotransferase(AST),serum albumin(ALB),blood urea nitrogen(BUN),blood creatinine(SCr),glycated hemoglobin(Hb Alc),D-dimer,triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),total bilirubin(TBIL),direct bilirubin(DBIL),indirect bilirubin(IBIL),free thyroxine(FT4),free triiodothyronine(FT3),thyroid stimulating hormone(TSH),total triiodothyronine(TT3),total thyroxine(TT4),24-hour urinary protein,glomerular filtration rate(e GFR),urine albumin-to-creatinine ratio(UACR),duration of diabetes,Stage of diabetic retinopathy,etc.2.According to whether T2DM patients were associated with diabetic retinopathy,patients with DR were classified as observation group,423 cases;patients without DR were classified as control group,176 cases.According to the international clinical grading standard for diabetic retinopathy,the patients were divided into three groups:DR1 group is the non-DR group,DR2 group is the non-proliferative diabetic retinopathy(NPDR)group,DR3 group is the proliferative diabetic retinopathy(PDR)group.3.The patients with T2DM were divided into groups according to whether they underwent renal puncture biopsy or not.The patients who underwent renal puncture biopsy were divided into observation group(renal puncture group),with a total of 50cases;Patients who did not undergo renal puncture biopsy were included in the control group(the non-renal puncture group),with a total of 549 cases.4.The cases were divided into five groups based on the level of e GFR(the five stages of e GFR):e GFR1 phase(e GFR≥90 m L/min/1.73 m~2),e GFR2 phase(e GFR60-89 m L/min/1.73 m~2),e GFR3 phase(e GFR 30-59 m L/min/1.73 m~2),e GFR4 phase(e GFR 15-29 m L/min/1.73 m~2),e GFR5 phase(e GFR<15 m L/min/1.73 m~2).The cases were divided into three groups according to the level of albuminuria:UACR 1(UACR<30 mg/g),UACR 2(30 mg/g≤UACR≤300 mg/g),UACR 3(UACR>300 mg/g).5.Statistical software SPSS 26.0 was used to analyze the data,and the normal distribution of the data was tested by histogram test and skewness and kurtosis value test.Independent samples t-test is used to compare normal distribution data,using (?)±s;the Mann-Whitney u test is used to compare non-normal distribution data,expressed as M(1/4,3/4);X~2analysis is used to compare classification data,represented by the number and percentage(%).Spearman rank correlation coefficient was used to evaluate the correlation between DR staging,e GFR staging and UACR staging.The risk factors of DR and DKD were analyzed by Logistic regression.The predictive efficiency was determined by receiver operating characteristic(ROC)curve.In all statistical analyses,P<0.05 indicated statistically significant differences.Results:1.A total of 599 patients(365 men and 234 women)participated in the study.The average age of the participants was 56.77±12.88 years old.The mean course of diagnosed T2DM was 11.57±7.71 years.Among them,423 had manifestations of DR,79.4%(n=336)of NPDR and 20.6%(n=87)of PDR.There were 50 patients with kidney puncture,,45 of whom were combined with DR.77.8%(n=35)of the patients were NPDR and 22.2%(n=10)of the patients were PDR.2.DR staging was positively correlated with e GFR staging and UACR staging(P<0.05).DR staging had a stronger correlation with UACR staging(DR staging and e GFR staging r=0.239;DR staging and UACR staging r=0.333).With the increase of e GFR and UACR staging,the prevalence of DR also increased.3.Comparison of clinical features between DR group and non-DR group In the DR group,diabetes duration,SBP,BUN,SCr,24-hour urine protein,UACR,LDL-C,the percentage of people with diabetes duration>8 years,the percentage of people with hypertension,the percentage of people with Hb A1c≥7.9%,the percentage of people with UACR>300mg/g and the percentage of people with e GFR<60m L/min/1.73 m~2were all higher than those in the non-DR group(P<0.05),e GFR,ALB,ALT,AST,TBIL,DBIL and IBIL were all lower than those in the non-DR group(P<0.05).4.Logistic regression analysis showed that the risk of DR was related to diabetes duration,hypertension,BUN,SCr,24-hour urinary protein,UACR,e GFR,ALB,LDL-C,etc(P<0.01).Diabetes duration>8 years(β0.940;OR 2.559;95%CI 1.777-3.687;P<0.01),hypertension(β0.541;OR 1.718;95%CI 1.192-2.475;P<0.01),UACR>300mg/g(β1.496;OR 4.465;95%CI 2.990-6.667;P<0.01)and e GFR<60m L/min/1.73m~2(β0.898;OR 2.455;95%CI 1.637-3.680;P<0.01)were significantly higher than other indexes.5.The diabetes duration>8 years,hypertension,e GFR<60m L/min/1.73m~2,UACR>300mg/g were the risk factors for the prediction model,according to its regression coefficientβ,the scoring weight of each risk factor was calculated proportionally.The ratio ofβ-value of diabetes duration>8 years,hypertension,e GFR<60m L/min/1.73 m~2,UACR>300mg/g was about 2:1:2:3.Therefore,according to their proportions,they are assigned 2 points,1 points,2 points and 3 points respectively.The results showed that the area under ROC curve(AUC)was 0.712(95%CI 0.667-0.757;P<0.001).The results show that when the score is≥6,the positive predictive value is 87.5%,the sensitivity is 39.7%,and the specificity is 86.4%.6.Clinical characteristics and comparison between renal perforation group and non-renal perforation group In the renal perforation group,smoking,Hb A1c,the percentage of people with Hb A1c≥7.9%,SBP,DBP,the percentage of people with hypertension,24-hour urinary protein,UACR,the percentage of people with UACR>300mg/g and the percentage of people with e GFR<60m L/min/1.73 m~2,SCr,TC,TG and LDL-C were all higher than those in the non-renal perforation group(P<0.05),e GFR,ALB,TBIL,DBIL,IBIL and Hb were all lower than those non-renal perforation group(P<0.05).7.Logistic regression analysis showed that the increased risk of DKD was associated with the increase of SBP,DBP,TC,LDL-C,24-hour urinary protein and UACR,it was also associated with the decrease of Hb,ALB,TBIL,DBIL,IBIL and e GFR(P<0.05).Conclusion:1.The levels of diabetes duration,hypertension,BUN,SCr,24-hour urinary protein,UACR,e GFR,ALB,LDL-C,TBIL,DBIL,IBIL in patients with T2DM are related to the occurrence and development of DR.We should pay attention to the changes of the above indicators to prevent the occurrence of DR.2.The degree of DR is correlated with e GFR stage and UACR stage of the kidney,and the correlation with UACR stage is more significant.3.Diabetes duration>8 years,hypertension,UACR>300mg/g and e GFR<60m L/min/1.73 m~2are significantly associated with the occurrence and severity of DR.Therefore,it is strongly recommended that patients with DR Prediction model score≥6go to the ophthalmology department to improve relevant examination and timely professional treatment.4.The levels of SBP,DBP,TC,LDL-C,24-hour urinary protein,UACR,Hb and serum bilirubin are related to the occurrence and progression of DKD,and paying attention to the changes of these indicators is helpful for early screening of DKD.