2型糖尿病患者视网膜神经纤维层厚度与膳食脂肪的相关性

Correlation between thickness of retinal nerve fiber layer and dietary fat in type 2 diabetes mellitus

摘要:

目的 探讨2型糖尿病(T2DM)患者视网膜神经纤维层(RNFL)厚度与膳食脂肪的相关性。方法 选取就诊于哈尔滨医科大学附属第一医院内分泌科的186例T2DM患者。收集入组患者的一般临床资料,包括年龄、性别、病程、既往史、吸烟饮酒史、入院血压、身高、体质量等,并计算体质量指数(BMI)等指标。记录糖化血红蛋白A1c、空腹C肽、血脂、肾功能等相关血化验结果,光学相干断层成像(OCT)测量RNFL厚度。入组人员填写半定量饮食频率问卷。采用SPSS 22.0软件进行统计学分析,Spearman秩相关分析各象限RNFL厚度与膳食脂肪量之间的相关关系；采用单元和多元线性回归分析双眼各象限RNFL厚度的独立影响因素。结果 (1)相关分析显示,畜禽肉及肉制品与视网膜上、下方RNFL厚度(上方:r=－0.192,P=0.009；下方:r=－0.286,P=0.000)显著负相关；软饮与眼睛上方及下方RNFL厚度(上方:r=－0.169,P=0.021；下方:r=－0.264,P=0.000)均显著负相关；血清甘油三酯与视网膜下方、鼻侧RNFL厚度(下方:r＝－0.210,P= 0.004；鼻侧:r=－0.150,P=0.041)均显著负相关；血清肌酐与视网膜上方及鼻侧RNFL厚度(上方:r=－0.159,P=0.032；鼻侧:r=－0.156,P=0.036)呈负相关；年龄也与眼睛上方及鼻侧RNFL厚度(上方:r=－0.169,P=0.021；鼻侧:r=－0.184,P=0.012)呈负相关关系。(2)单元线性回归分析表明,年龄、甘油三酯、血肌酐、畜禽肉及肉制品与T2DM患者RNFL厚度相关(P＜0.05)。在上述单元线性回归分析基础上,以T2DM患者各象限RNFL为因变量,以年龄、甘油三酯、血肌酐、禽畜肉及肉制品为自变量,行多元线性回归分析,结果显示甘油三酯(P=0.007)、禽畜肉及肉制品(P=0.021)是视网膜下方象限RNFL厚度的独立影响因素。年龄(P=0.013)、甘油三酯(P=0.044)为视网膜鼻侧象限RNFL厚度的独立影响因素。血肌酐(P=0.042)是眼睛颞侧象限RNFL厚度的独立影响因素。结论 畜禽肉及肉制品的摄入量与T2DM患者RNFL厚度密切相关,饮食干预对预防T2DM视网膜病变有一定临床意义。

Abstract:

Objective To investigate the correlation between the thickness of retinal nerve fiber layer (RNFL) and dietary fat in patients with type 2 diabetes mellitus (T2DM). Methods A total of 186 in-patients with T2DM admitted to our department were selected for the study. Their general clinical data were retrieved, including age, gender, disease course, previous history, smoking and drinking history, admission blood pressure, height, and body mass, and body mass index (BMI) was calculated. Blood test results such as glycosylated hemoglobin A1c, fasting C-peptide, blood lipid and kidney function were recorded, and RNFL thickness was measured by optical coherence tomography. A semi-quantitative dietary frequency questionnaire was conducted with each participant. SPSS statistics 22.0 was used for statistical analysis, and Spearman rank correlation analysis for correlation between RNFL thickness and dietary fat mass. The univariate and multivariate linear regression analysis were performed to explore the independent influencing factors of RNFL thickness in each quadrant of both eyes. Results (1) Livestock and poultry meat and meat products were significantly negatively correlated with the superior and inferior RNFL thickness (superior:r=-0.192, P=0.009; inferior:r=-0.286, P=0.000). Soft drinks were significantly negatively correlated with the superior and inferior RNFL thickness (superior:r=-0.169, P=0.021; inferior:r=-0.264, P=0.000). There was a significant negative correlation between serum triglycerides (TG) and the inferior, nasal RNFL thickness (inferior:r=-0.210, P=0.004; nasal:r=-0.150, P=0.041). Serum creatinine (SCr) was negatively correlated with the superior and nasal RNFL thickness (superior:r=-0.159, P=0.032; nasal:r=-0.156, P=0.036). Age was also negatively correlated with the superior, nasal RNFL thickness (superior:r=-0.169, P=0.021; nasal:r=-0.184, P=0.012). (2) Univariate linear regression analysis showed that age, TG, SCr, poultry meat and meat products were associated with RNFL in patients with T2DM (P＜0.05). On the basis of the above univariate linear regression, multivariate linear regression was performed with RNFL thickness in each quadrant of T2DM patients as the dependent variable and age, TG, SCr, poultry meat and meat products as the independent variables, which showed that TG (P=0.007), poultry meat, and meat products (P=0.021) as independent influencing factors for the inferior RNFL thickness; age (P=0.013) and TG (P=0.044) for RNFL thickness in the nasal quadrant; and SCr (P=0.042) for the RNFL thickness in the temporal quadrant of the eye. Conclusion The intake of livestock and poultry meat and meat products is closely related to the thickness of RNFL in the patients with T2DM, and dietary intervention has clinical significance for early prevention of T2DM retinopathy.