目的：分析影响糖尿病视网膜病变(DR)进展的相关因素。

方法：回顾性收集非增殖期糖尿病视网膜病变(NPDR)患者同时进行随访观察，将队列中由NPDR进展为增殖期糖尿病视网膜病变(PDR)的患者共77例作为队列中的疾病进展组，未进展为PDR的NPDR患者共115例作为队列中的观察组进行巢式病例对照研究，比较NPDR与PDR两组一般资料及实验室指标； 以一般资料及实验室指标作为自变量，PDR作为结局变量，对DR进展的影响因素进行回归分析； 最终对DR进展的影响因素进行诊断试验评价。

结果：PDR组较NPDR组年龄更小(P=0.001)、糖尿病病程更长(P=0.01)。实验室指标对比：PDR组中糖化血红蛋白(HbA1c)(P=0.001)、血尿素氮(BUN)(P=0.003)、血沉(ESR)(P<0.001)及同型半胱氨酸(HCY)(P=0.001)明显高于NPDR组，平均红细胞血红蛋白(MCH)(P=0.043)、平均红细胞血红蛋白浓度(MCHC)(P=0.002)明显低于NPDR组。影响DR进展的因素：HbA1c(OR=1.587，P<0.001)，BUN(OR=1.456，P=0.008)，MCH(OR=0.540，P=0.038)，ESR(OR=1.122，P=0.005)，HCY(OR=1.838，P=0.002)。采用ROC曲线分析确定DR进展影响因素的最佳诊断分界点：HbA1c为8.18%，BUN为5.46 mmol/L，ESR为8.93 mm/h，HCY为13.95 μmol/L。

结论：HbA1c、BUN、MCH、ESR、HCY是DR进展的影响因素，其中HbA1c、BUN、ESR、HCY是DR进展的危险因素，MCH是DR进展的保护因素。

METHODS: This study retrospectively collected the patients with nonproliferative diabetes retinopathy(NPDR)and followed up at the same time. A total of 77 patients in the cohort who progressed from NPDR to proliferative diabetes retinopathy(PDR)were taken as the disease progression group, while 115 NPDR patients who did not progress to PDR were selected as the observation group for a nested case-control study, comparing the general information and laboratory indicators of NPDR and PDR groups, taking general data and laboratory indicators as independent variables and PDR as outcome variables; Finally, diagnostic tests were conducted to evaluate the independent influencing factors of DR progression.

RESULTS: PDR group was younger than patients in the NPDR group(P=0.001), and the course of diabetes was longer(P=0.01); Glycated hemoglobin(HbA1c; P=0.001), blood urea nitrogen(BUN; P=0.003), erythrocyte sedimentation rate(ESR; P<0.001), and homocysteine(HCY; P=0.001)in the PDR group were significantly higher than those in the NPDR group, while mean red blood cell hemoglobin(MCH; P=0.043)and mean red blood cell hemoglobin concentration(MCHC; P=0.002)were significantly lower than those in the NPDR group. The independent influencing factors for screening DR progression include HbA1c(OR=1.587, P<0.001), BUN(OR=1.456, P=0.008), MCH(OR=0.540, P=0.038), ESR(OR=1.122, P=0.005), and HCY(OR=1.838, P=0.002). ROC curve was analyzed to determine the optimal diagnostic cut-off point for the influencing factors of DR progression: HbA1c: 8.18%; BUN: 5.46 mmol/L; ESR: 8.93 mm/h; HCY: 13.95 μmol/L.

CONCLUSION: Research has shown that HbA1c, BUN, MCH, ESR, and HCY are independent risk factors for DR progression. Among them, HbA1c, BUN, ESR, and HCY are independent risk factors for DR progression, while MCH is an independent protective factor for DR progression.