The Retrospective Study Of The Relationship Between Early Diabetic Kidney Disease And Retinopathy

Background: Diabetes kidney disease(DKD)is a manifestation of diabetic idiopathic systemic microangiopathy,is one of the common chronic complications of diabetes,and is also the most common single cause of end-stage renal disease in developed countries in Europe and the United States.Statistics as high as 44.5%,in China is about 25%.Diabetic retinopathy(DR)is also one of the important microangiopathy,which is one of the important causes of visual impairment and loss.Diabetic kidney disease and diabetic retinopathy have some of the same pathological basis.the 2018 ADA diabetic guidelines clearly point out that the existence of diabetic retinopathy is an important predictor of diabetic kidney disease.However,in the actual clinical work,we also found that a considerable number of patients with diabetic kidney disease are not complicated with retinopathy,and even the fundus examination of some patients with end-stage renal disease undergoing replacement therapy is normal.If the risk factors of retinopathy can be screened out in patients with early diabetic nephropathy,the incidence of diabetic retina can be reduced.Objective: The purpose of this study was to explore the risk factors of retinopathy in patients with early diabetic kidney disease and the difference of clinical indexes in patients with retinopathy in different stages,so as to prevent the risk factors of retinopathy.Delay its progress and treatment to provide reference.Methods: From June 2016 to December 2017,346 patients with type 2 diabetes mellitus complicated with early diabetic kidney disease who were hospitalized in the endocrinology department of our hospital were enrolled in the study.a total of 346 patients with complete clinical data,laboratory indicators and auxiliary examinations were included.There were 169 males and 177 females.According to the results of fundus examination,they were divided into two groups: non-diabetic retinopathy group(NDR group)and diabetic retinopathy group(DR group);DR group was further divided into background retinopathy group(BDR group)and proliferative retinopathy group(PDR group).The differences of clinical general data,biochemical indexes and complications among them;To analyze the risk factors of early diabetic kidney disease complicated with retinopathy.Results: 1.NDR compared with DR,There were significant differences in age,course of diabetes,diastolic blood pressure,low density lipoprotein,total cholesterol,high density lipoprotein,glycosylated hemoglobin,uric acid,urinary Microalbumin,thyrotropin and hypersensitive C-reactive protein(P<0.05);There was no significant difference in systolic blood pressure and triglyceride level(P>0.05);There were significant differences in coronary heart disease,carotid atherosclerosis and diabetic peripheral neuropathy between the two groups(P<0.05).2.BDR compared with PDR,There were significant differences in the course of diabetes,diastolic blood pressure,low density lipoprotein,total cholesterol,urinary Microalbumin and serum uric acid(P<0.05);Age,systolic blood pressure,high density lipoprotein,glycosylated hemoglobin,triglyceride,thyrotropin.There was no significant difference in thyrotropin and hypersensitive C-reactive protein levels(P>0.05).There was a significant difference in diabetic peripheral diabetic kidney disease between the two groups(P<0.05);but there was no significant difference in the occurrence of coronary heart disease and carotid atherosclerosis between the two groups(P>0.05).3.Multivariate regression analysis showed that the risk factors of early diabetic nephropathy complicated with retinopathy were the course of diabetes,diastolic blood pressure,low density lipoprotein,total cholesterol,glycosylated hemoglobin,uric acid and thyrotropin.It was complicated with coronary heart disease and carotid atherosclerosis,and the protective factor was high density lipoprotein.Conclusion: The occurrence of early diabetic kidney disease complicated with retinopathy is involved in many factors,and various factors affect each other.The comparison of different stages of retinopathy showed that there were significant differences in the course of disease,diastolic blood pressure level,lipid metabolism disorder,urinary Microalbumin,uric acid level and so on.Therefore,it is of great significance to control blood pressure,improve metabolic disorders and other measures to delay the occurrence and development of retinopathy in early diabetic patients.