目的：探讨1型糖尿病(T1DM)患者视网膜病变(DR)的危险因素。

方法：回顾性研究。选取2010-01/2020-10在南方医科大学附属南海医院就诊的204例T1DM患者，根据眼底表现将患者分为DR组(71例)和无DR组(133例)，其中DR组包括非增殖期糖尿病视网膜病变(NPDR)组(48例)和增殖期糖尿病视网膜病变(PDR)组(23例)。采集其临床资料并检测相关生化指标。通过单因素分析DR/PDR的相关因素，采用多因素Logistic回归分析DR/PDR的危险因素并绘制受试者工作特征曲线(ROC)。

结果：T1DM患者的发病年龄、病程、糖化血红蛋白(HbA1c)，合并高血压、高脂血症、糖尿病肾病(DN)、糖尿病周围神经病变(DPN)与DR有关(P<0.05)。病程、体质量指数(BMI)、收缩压(SBP)，合并高脂血症、DN、DPN与PDR有关。Logistic回归分析结果显示病程(OR=1.130，P<0.001)和HbA1c(OR=2.734，P<0.001)是发生DR的危险因素； 病程(OR=1.144，P=0.005)和合并DN(OR=6.500，P=0.001)是发生PDR的危险因素。ROC曲线分析结果显示，病程和HbA1c预测DR发生的曲线下面积(AUC)分别为0.720、0.727，截断值分别为15.1a，8.2%，敏感性分别为50.7%、76.1%，特异性分别为86.5%、59.4%。病程预测PDR发生的AUC为0.713，截断值为18.5a，敏感性为73.9%，特异性为60.4%。

结论：T1DM患者视网膜病变与糖尿病发病年龄较晚有关。糖尿病病程和高血糖是DR的主要影响因素。HbA1c与DR的发生相关，DN与PDR的发生相关。

METHODS: A total of 204 patients with T1DM in recent 10a were enrolled. The patients were divided into DR group(n=71)and non-DR group(n=133). The clinical information was collected and relevant biochemical indices were detected. Univariate and multivariate Logistic regression were used to assess the relationship between potential risk factors and DR/proliferative diabetic retinopathy(PDR). The value of risk factors in predicting DR/PDR was evaluated by drawing receiver operating characteristic curve(ROC).

RESULTS: The age of onset, longer duration of diabetes, HbA1c, hypertension, hyperlipidemia, diabetic nephropathy(DN), diabetic peripheral neuropathy(DPN)were related to DR(P<0.05)in patients with T1DM. Longer duration of diabetes, body mass index(BMI), systolic blood pressure(SBP), hyperlipidemia, DN, DPN were related to PDR. Logistic regression analysis indicated that longer duration of diabetes(OR=1.130, P<0.001)and HbA1c(OR=2.734, P<0.001)were risk factors of DR. Longer duration of diabetes(OR=1.144, P=0.005)and DN(OR=6.500, P=0.001)were risk factors of PDR. The results of ROC curve analysis showed that the area under the curve(AUC)of the disease course and HbA1c predicting the occurrence of DR were 0.720 and 0.727, respectively. The cutoff values were 15.1a and 8.2%, respectively. The sensitivity was 50.7% and 76.1%, and the specificity was 86.5% and 59.4%, respectively. The AUC for predicting PDR was 0.713, the best cutoff value was 18.5a, the sensitivity was 73.9%, and the specificity was 60.4%.

CONCLUSION: Retinopathy is associated with age of onset in patients with T1DM. Duration of disease and hyperglycemia are the major influencing factor for DR. HbA1c is associated with DR. DN is associated with PDR occurrence.