关键词: 糖尿病, 2型；晚期糖基化终末产物；无创筛查；糖尿病并发症

Abstract: Background　With the development of living conditions and economy，type 2 diabetes mellitus （T2DM） and T2DM-related chronic complications are increasing year by year.Studies show that advanced glycation end-products（AGEs） in skin are closely associated with diabetes-related vascular complications，but in China there is lack of use of AGEs in skin in large-scale community-based screening of T2DM.Objective　To analyze the value of AGEs in skin measured noninvasively in community-based screening of T2DM-related vascular complications.Methods　From 2 community health centers participating in the medical consortium led by the First Affiliated Hospital of Anhui Medical University after signing a agreement，369 individuals undergoing physical examination during August 2017 to May 2018 were recruited，including 44 with T2DM without complications （pure T2DM group），53 with T2DM and complications （T2DM with complications group），and 272 healthy controls（control group）.Levels of TG，TC，Cr，FBG，HbA1c and AGEs in skin were measured in all participants.Prevalence of lower extremity vascular lesion was determined by ankle brachial index.By the prevalence and severity of peripheral vascular lesion，T2DM patients were stratified into T2DM without peripheral vascular lesion，T2DM with mild and moderate peripheral vascular lesion subgroups.By A/C ratio，T2DM patients were stratified into T2DM without albuminuria，T2DM with microalbuminuria，and macroalbuminuria subgroups.By Neurologic Deficit Score （NDS），T2DM patients were stratified into T2DM with normal neurological function，mild，moderate and severe neurologic deficit subgroups.Results　There was significantly difference in skin AGEs among pure T2DM group，T2DM with complications group and control group （P<0.05）.Specifically，the control group had lower AGEs in skin compared with other two groups （P<0.05）.Compared with pure T2DM group，the level of AGEs in skin was higher in T2DM with complications group （P<0.05）.T2DM patients with complications had higher level of AGEs than those without of the same age group （P<0.05）.The level of skin AGEs increased with the number and severity of T2DM-related complications，such as peripheral vascular lesions，albuminuria，and peripheral neuropathy，and so on （P<0.05）.Multivariate Logistic regression analysis showed that age 〔OR=0.84，95%CI（0.73，0.97）〕 and AGEs in skin〔OR=1.35，95%CI（1.17，1.57）〕 were associated with T2DM with peripheral vascular lesions （P<0.05）.Gender 〔OR=0.14，95%CI（0.03，0.61）〕，FBG 〔OR=1.49，95%CI （1.10，2.02）〕 and AGEs in skin〔OR=1.09，95%CI （1.02，1.16）〕 were associated with T2DM with albuminuria （P<0.05）.Gender 〔OR=0.23，95%CI （0.06，0.86）〕 and HbA1c 〔OR=1.68，95%CI （1.04，2.71）〕 were associated with T2DM with peripheral neuropathy （P<0.05）.The AUC of AGEs in skin in identifying T2DM-related complications was 0.833〔95%CI（0.753，0.914）〕，the optimal cut-off point was 71.5 AU，the sensitivity of diagnosis was 71.7%，and the specificity was 86.4%.Conclusion　AGEs in skin may be used as a predictor of T2DM with peripheral vascular disease and kidney disease，and may be used as a reference for noninvasive measurement of T2DM-related complications in the community.However，the relationship between AGEs in skin and diabetic neuropathy needs to be studied and verified further.

Key words: Diabetes mellitus, type 2；Advanced glycation end products；Noninvasive screening；Diabetes complications