| BackgroundWith the continuous improvement of social and economic level,people’s lifestyle and eating habits have changed significantly,such as sedentary,less exercise,high oil and fat diet.This has led to an annual increase in the incidence of diabetes.At present,the number of diabetes patients in China has ranked first in the world.With the increase of the duration of diabetes,the related symptoms of chronic microvascular complications gradually appear,such as diabetic nephropathy,diabetic peripheral neuropathy,and diabetic retinopathy(DR).The most common of these is diabetic retinopathy.Without timely intervention,DR will lead to irreversible vision loss and blindness,threatening the life safety of patients.The American Diabetes Association recommends that patients with type 2 diabetes should have their first comprehensive eye examination within 5 years after the first diagnosis of diabetes or the onset of diabetes to achieve early detection,early intervention,and early treatment.However,the early symptoms of DR are not obvious,and Chinese diabetic patients lack correct understanding of DR.Early detection and timely treatment of DR can delay the development of the disease.Therefore,it is of great significance to find the risk factors of DR and find a simpler index to assess the risk of DR.At present,some studies have found that Vitamin D(VD)can reduce the expression of reactive oxygen species and vascular endothelial growth factor in retinal cells.It is an effective inhibitor of retinal neovascularization.However,a large number of studies on the relationship between VD and DR at home and abroad have not reached a unified conclusion in recent years.Therefore,it is worth to explore whether the decrease of serum VD level will increase the risk of DR and whether monitoring VD level will help to prevent DR early.ObjectiveTo explore the correlation between VD and DR.Find the related risk factors of DR,and construct a nomogram model of DR risk,so as to provide simple observation indicators for clinicians to predict the occurrence of DR.And carry out early intervention to delay the progress of DR.MethodsA total of 289 patients with Type 2 Diabetes Mellitus(T2DM)were hospitalized in Huai He Hospital of Henan University from November 2021 to October 2022 were selected for the study.According to the presence or absence of DR,the patients were divided into simple type 2 diabetes mellitus(NDR)group(n=126),non-proliferative diabetic retinopathy(NPDR)group(n=95),and proliferative diabetic retinopathy(PDR)group(n=68).The general data of all patients and indexes were collected,such as gender,age,height,weight,Body Mass Index(BMI),Glycosylated Hemoglobin(Hb A1c),High density lipoprotein cholesterol(HDL),Low density lipoprotein cholesterol(LDL),Triglyceride(TG),Total cholesterol(TC),Fasting blood-glucose(FBG),25-hydroxyvitamin D(25(OH)VD),Urine albumin-to-creatin(UACR),Systolic blood pressure(SBP),Diastolic blood pressure(DBP),Serum creatinine(Scr),and Blood uric acid(BUA).SPSS 27.0 software was used to analyze the clinical data of all patients.The differences among the three groups were compared.Observe the effect of VD on DR,screen out the independent risk factors of DR,and evaluate its ability to predict DR.At the same time,RStudio software was used to draw a possible nomogram for predicting DR according to the screened independent risk factors for DR to visually display the model.Results1.Prevalence of DR: A total of 289 T2 DM patients were included in this study.According to the results of fundus examination and the stage of diabetic retinopathy,they were divided into the NDR group126 cases(43.60%),NPDR group 95 cases(32.90%),and PDR group 68 cases(23.50%).The prevalence of DR in T2 DM patients was 56.40%.2.Comparison of clinical data: there were significant differences in age,course of disease,Hb A1 c,LDL,TG,TC,25(OH)VD,UACR,SBP,DBP and Scr among the NDR,NPDR and PDR groups(p < 0.05).The NDR,NPDR and PDR groups were compared in pairs,and the P value and corrected P value(p’ <0.05/3)were compared.It can be concluded that age,course of disease,Hb A1 c,25(OH)VD,UACR,SBP and Scr of NDR group and NPDR group were different,and the difference was statistically significant(p’ <0.017).There were significant differences in the course of disease,Hb A1 c,LDL,TG,TC,25(OH)VD,UACR,SBP,DBP and Scr between NDR group and PDR group(p’ < 0.017).There were significant differences in TG,25(OH)VD,UACR and DBP between NPDR group and PDR group(p’ < 0.017).3.Prediction of risk factors for DR: the course of disease,Hb A1 c,25(OH)VD,UACR and Scr were related to the risk and severity of DR(p < 0.05),25(OH)VD was a protective factor for DR,and the course of disease,Hb A1 c,UACR and Scr were independent risk factors for DR.ROC curve showed that the area under the curve(AUC)of 25(OH)VD,course of disease,Hb A1 c,UACR,Scr and the combined predictive value were 0.706,0.682,0.645,0.805,0.656,0.859,respectively.The corresponding sensitivities were55.80%,81.60%,68.10%,63.20%,42.30% and 77.30%,respectively.The specificity was 77.80%,47.60%,59.50%,85.70%,82.50% and 81.70%.4.Evaluation of the DR risk prediction model: the AUC area of the DR risk prediction model was0.857(95%CI: 0.814,0.900),and the discrimination of the model was good.The Bootstrap internal sampling method was used to repeat 1000 times,and the C-index of the model was 0.858,which showed that the prediction results of the model had high accuracy.The mean absolute error of the internal validation calibration curve was 0.026,indicating that the calibration of the model was good.When the threshold probability was in the range of 10.70%-13.80%,16.20%-94.60%,and greater than 96.90%,the net benefit of the nomogram model was good,and the model had good clinical application value.5.Correlation between VD and DR: There are differences in VD levels between men and women,with men having higher serum vitamin D levels than women.The longer the duration of diabetes,the lower the level of 25(OH)VD.The higher the DR stage,the higher the VD deficiency rate.The rate of VD deficiency in the PDR group was 86.80%,and there was a significant difference among the three groups(p< 0.05).6.The analysis of influencing factors for VD showed that 25(OH)VD was negatively correlated with Hb A1 c,LDL,TG,TC,UACR and SBP(p < 0.05).When other factors remained unchanged,for every 1%increase in Hb A1 c,25(OH)VD decreased by 0.366ng/ml.When TC increased by 1mmol/l,25(OH)VD decreased by 0.613 ng/ml.For every 1mg/g increase in UACR,25(OH)VD decreased by 0.038 ng/ml.Conclusion1.This study suggests that VD is associated with DR.2.The course of disease,Hb A1 c,25(OH)VD,UACR and Scr are related to the risk and severity of DR.VD is a protective factor for DR,and the course of disease,Hb A1 c,UACR and Scr are independent risk factors for DR.3.The longer the duration of diabetes,the lower the VD level.And the VD level is different between men and women.The increase of Hb A1 c,TC and UACR can reduce the level of VD,and then affect the occurrence of DR.4.The prediction model of DR risk in T2 DM patients constructed in this study has good predictive ability,calibration ability and clinical practicability,which can provide reference for clinical prevention and control of DR. |
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