胰岛素治疗与2型糖尿病患者视网膜病变的关系
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摘要
目的:探讨胰岛素治疗与2型糖尿病视网膜病变的关系。方法:收集2016-06/2018-01于我院内分泌科住院的2型糖尿病患者415例830眼。根据不同降糖用药、眼底造影检查结果、胰岛素用量分别进行分组,收集各组患者一般资料,采集清晨空腹静脉血,测量空腹血糖、糖化血红蛋白(HbA1c)、空腹C肽等指标。分析不同用药和不同视网膜病变组间患者空腹血糖、HbA1c、空腹C肽的变化以及胰岛素用量和糖尿病视网膜病变的相关关系。结果:不同用药组间糖尿病视网膜病变程度不同,不同视网膜病变组间患者的胰岛素用量不同(P<0.05),2型糖尿病患者并发视网膜病变的胰岛素用量切点值为37.5U/d。胰岛素用量>37.5U/d组中2型糖尿病患者的视网膜病变较多,且胰岛素用量与2型糖尿病患者视网膜病变程度呈正相关。结论:不同降糖治疗对糖尿病视网膜病变的影响不同,使用胰岛素治疗与2型糖尿病性视网膜病变的发病及严重程度呈正相关。
·AIM: To explore the relationship between insulin treatment and diabetic retinopathy in patients with type 2 diabetes mellitus.·METHODS: We collected data from 415 patients with type 2 diabetes who were treated at the Yantai Yuhuangding Hospital endocrinology unit from 2016 to 2018. The patients were divided into 6 groups based on the therapies they received and were divided into 3 groups based on the results of fundus angiography. All patients' general information were collected. Then we gathered the morning fasting venous blood and measured the fasting blood glucose, glycosylated hemoglobin, C peptide and analyzed the differences in fasting blood glucose, HbA1 c and fasting c-peptide in patients with different drugs and retinopathy groups and the relationship between insulin dosage and the severity of DR.·RESULTS: There were differences in the proportion of diabetic retinopathy among different treatment groups, and the dosage of insulin was different among different DR groups. The cut point affect the occurrence of retinopathy of insulin is 35.7 U/d, 4.5 years.·CONCLUSION: The effect of different hypoglycemic regimens on diabetic retinopathy were different. Insulin treatment is positively correlated with the incidence and severity of type 2 diabetic retinopathy.
·AIM: To explore the relationship between insulin treatment and diabetic retinopathy in patients with type 2 diabetes mellitus.·METHODS: We collected data from 415 patients with type 2 diabetes who were treated at the Yantai Yuhuangding Hospital endocrinology unit from 2016 to 2018. The patients were divided into 6 groups based on the therapies they received and were divided into 3 groups based on the results of fundus angiography. All patients' general information were collected. Then we gathered the morning fasting venous blood and measured the fasting blood glucose, glycosylated hemoglobin, C peptide and analyzed the differences in fasting blood glucose, HbA1 c and fasting c-peptide in patients with different drugs and retinopathy groups and the relationship between insulin dosage and the severity of DR.·RESULTS: There were differences in the proportion of diabetic retinopathy among different treatment groups, and the dosage of insulin was different among different DR groups. The cut point affect the occurrence of retinopathy of insulin is 35.7 U/d, 4.5 years.·CONCLUSION: The effect of different hypoglycemic regimens on diabetic retinopathy were different. Insulin treatment is positively correlated with the incidence and severity of type 2 diabetic retinopathy.
引文
1 Yau JW, Rogers SL, Kawasaki R, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care 2012;35(3):556-564
2 Ptram DA, Jiang X, Varma R, et al. Factors Associated with Prevalent Diabetic Retinopathy in Chinese Americans: The Chinese American Eye Study. Ophthalmol Retina 2018;2(2):96-105
3中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版).中华糖尿病杂志 2014; 9(7):447-498
4惠延年,王琳.糖尿病视网膜病变和黄斑水肿的国际临床分类法.国际眼科杂志 2004;4(1):56-59
5 Kronenberg H(著),向红丁(译). 威廉姆斯内分泌学.北京:人民军医出版社 2011:1
6廖二元. 内分泌代谢病学.北京:人民卫生出版社 2012:5
7郑彦,过贵元.胰岛素在糖尿病视网膜病变中的研究进展.国际眼科杂志 2012;12(3):461-463
8宋鄂,王越晖,徐琪,等.高浓度胰岛素对兔视网膜Müller细胞表达血管内皮生长因子的影响.中华眼科杂志 2004;40(1):40-44
9 Kakizawa H, Itoh M, Itoh Y, et al. The relationship between glycemic control and plasma vascular endothelial growth factor and endothelin-1 concentration in diabetic patients. Metabolism 2004;53(5):550-555
10马萍萍,王玉粦,吴炎,等.胰岛素对糖尿病大鼠视网膜VEGF和Ang-2表达的影响.医学研究杂志 2010;39(1):61-63
11 Testa MA, Puklin JE, Sherwin RS. Clinical predictors of retinopathy and its progression in patients with type I diabetes during CSII or conventional insulin treatment. Diabetes 1985;34(Suppl3):61-68
2 Ptram DA, Jiang X, Varma R, et al. Factors Associated with Prevalent Diabetic Retinopathy in Chinese Americans: The Chinese American Eye Study. Ophthalmol Retina 2018;2(2):96-105
3中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版).中华糖尿病杂志 2014; 9(7):447-498
4惠延年,王琳.糖尿病视网膜病变和黄斑水肿的国际临床分类法.国际眼科杂志 2004;4(1):56-59
5 Kronenberg H(著),向红丁(译). 威廉姆斯内分泌学.北京:人民军医出版社 2011:1
6廖二元. 内分泌代谢病学.北京:人民卫生出版社 2012:5
7郑彦,过贵元.胰岛素在糖尿病视网膜病变中的研究进展.国际眼科杂志 2012;12(3):461-463
8宋鄂,王越晖,徐琪,等.高浓度胰岛素对兔视网膜Müller细胞表达血管内皮生长因子的影响.中华眼科杂志 2004;40(1):40-44
9 Kakizawa H, Itoh M, Itoh Y, et al. The relationship between glycemic control and plasma vascular endothelial growth factor and endothelin-1 concentration in diabetic patients. Metabolism 2004;53(5):550-555
10马萍萍,王玉粦,吴炎,等.胰岛素对糖尿病大鼠视网膜VEGF和Ang-2表达的影响.医学研究杂志 2010;39(1):61-63
11 Testa MA, Puklin JE, Sherwin RS. Clinical predictors of retinopathy and its progression in patients with type I diabetes during CSII or conventional insulin treatment. Diabetes 1985;34(Suppl3):61-68