Correlation And Risk Factors Of Retinopathy And Nephropathy In Type 2 Diabetic Patients

Objective:Diabetic kidney disease(DKD)and Diabetic Retinopathy(DR)are common chronic microvascular complications of diabetes mellitus.The purpose of this study was to investigate the correlation between DKD and DR and to analyze the risk factors.Methods:1.Patients with type 2 diabetes treated in the Department of Nephrology of Kunming First People’s Hospital from March 2017 to December 2020 were included as the study subjects.General clinical data,such as age,gender,history of hypertension and duration of diabetes,were collected from all subjects.Test research object of fasting plasma glucose(FPG),glycosylated hemoglobin(HbAlc),blood urea nitrogen(BUN),serum creatinine(SCr),cholesterol(TC),triglycerides(TG),high-density lipoprotein(HDL-C),low density lipoprotein(LDL-C),alpha 1 microglobulin(al-MG),urinary microalbuminuria(MAU),urinary transferrin(UTf),urine immunoglobulin G(IgU),n-acetyl-beta-D-glycosidase enzymes(NAG),and other laboratory data,perfect the Retinal examination of the study subjects.2.According to the ratio of urinary microalbumin to urinary creatinine(UACR),they were divided into normal albuminuria group(NAU group):UACR<30mg/g,microalbuminuria group(MAU group):30mg/g≤UACR<300mg/g,and large albuminuria group(CAU group):UACR≥300mg/g.According to the staging criteria of DR,selected patients divided into Ⅰ-Ⅵ period,including Ⅰ-Ⅲ period for the group fertile diabetic retinopathy(BDR),Ⅳ-Ⅵ period for hyperplastic group diabetic retinopathy(PDR).3.Data in different groups were analyzed by SPSS25.0 statistical software.Measurement data were described in the form of mean±standard deviation or P50(P25-P75);Analysis of variance(ANOVA)or non-parametric test were used to compare the measurement data of multiple groups.The classification data were expressed as percentage,and χ2 test was used for comparison.The risk factors of DKD and DR were analyzed by multivariate Logistic regression.The relationship between UACR,Retinal stage and each index was analyzed by bivariate correlation.ROC curves of EGFR and urine microprotein were plotted.A P value less than 0.05 was considered statistically significant.Results:1.A total of 116 patients were included in this study,among whom 74 were males,accounting for 63.79%;42 cases were female,accounting for 36.21%;The age range ranged from 33 to 82 years,and the course of disease ranged from 0 to 29 years.DM patients with hypertension in 95 cases,accounting for 81.9%;21 patients without hypertension(18.1%);Among 116 DM patients,94 cases(81.03%)had DKD.92 cases of DR,accounting for 79.31%;There were 79 cases(68.10%)of DKD combined with DR disease,15 cases(12.93%)of DKD alone,13 cases(11.21%)of DR only,and 9 cases(7.76%)of DKD alone.2.Compared with NAU group and MAU group,age,SBP,BUN,Scr,ACR,U-MALB,β2-MG,Al-MG,UTF and UIgG in DKD group with different proteinuria levels were increased,and eGFR was decreased in CAU group,with statistical difference(P<0.05).Compared with NAU group,ACR of MAU group increased.HBALC,UA,TC and TG were increased in CAU group,and the differences were statistically significant(P<0.05).With the increase of ACR level,the proportion of DR lesions in three groups also increased,and the difference was statistically significant(P<0.05).The relationship between the occurrence of hypertension and HbA1c and DKD was statistically significant(P<0.05).HbAlc(OR=1.965)was a risk factor for DKD.The absence of hypertension(OR:0.263)was a protective factor for DKD.The duration of DM,SBP,DBP,fasting,HbAlc,TC,TG,LDL,SCR,U-Malb,β2-MG,al-MG,UTf,UIgG were significantly positively correlated with UACR(0<r≤1,P<0.05).eGFR was negatively correlated with ACR(r=-0.391,P<0.001)and UACR.There was no significant correlation between FPG,HDL,NAG and UACR(P>0.05).3.Compared with NDR group and BDR group,the duration,SBP,HBALC,SCR,UACR,U-Malb,β2-MG,al-MG,UTF and UIGG of DM in PDR group were increased,and EGFR was decreased,with statistical difference(P<0.05).Compared with NDR group,the duration of DM,HBAlc,BUN,Scr,UACR,U-Malb,UTf,UIgG and eGFR were increased in BDR group.The BUN and TC in PDR group were increased,and the difference was statistically significant(P<0.05).The course of DM,the occurrence of hypertension,and the relationship between HbAlc,FPG and DR were statistically significant(P<0.05).The course of DM(OR=1.125),HbAlc(OR=4.336)and FPG(OR=0.729)were the risk factors for DR.The absence of hypertension(OR:0.221)was a protective factor for the occurrence of DR.4.There was a significant positive correlation between BUN,Scr,ACR,U-Malb,β2-Mg,Al-Mg,UTF,UIgG and DR stage(0<r≤1,P<0.05).EGFR(r=-0.533,P<0.001)was negatively correlated with DR stage.There was no significant correlation between NAG and DR staging(P>0.05).Spearman correlation coefficient between DKD grouping and DR staging was 0.428,P<0.00;Kendall analysis correlation coefficient=0.391,P<0.001.The ROC curve calculated the sensitivity of eGFR,Al-Mg,U-Malb,UTF and UIGG respectively as follows:79.17%,45.65%,69.57%,71.74%,68.48%;The specificity was 69.57%,87.50%,83.33%,83.33%,87.50%;The areas under the curve(AUC)were:0.786,0.676,0.771,0.771,0.763;At the critical point,the sensitivity and specificity of the combined detection were 72.83%and 91.67%.The AUC of combined detection was 0.846.Conclusions:1.Hypertension and HbA1c are risk factors affecting the occurrence of DKD.The course of DM,hypertension and HbA1c are the risk factors affecting the occurrence of DR.Strict control of blood pressure,blood sugar and other treatments is of great significance to prevent the occurrence of DKD and DR.2.There was a significant correlation between the degree of DR lesions and renal indicators,and there was also a positive correlation between DKD and DR stage.With the aggravation of one of the lesions,the proportion of the other lesions increased significantly,and the severity of the lesions also became more serious.There is a good correlation between DKD and DR in the occurrence and progression of the disease.When one of the lesions occurs,the other lesions should be screened in time for early detection and treatment.3.The lesion degree of DKD and DR is positively correlated with urinary microalbumin,urinary immunoglobulin G,al microglobulin,β2 microglobulin,and urinary transferrin,and negatively correlated with glomerular filtration rate,which can be used as indicators for long-term monitoring and evaluation.In screening lesions,multiple indicators can be combined to evaluate the disease from multiple perspectives.4.eGFR,al-MG,U-Malb,UTf and UIgG alone and combined could predict the occurrence of DR.The sensitivity of eGFR was the best,and the AUC of combined detection was the highest,which reached 0.846.