关键词: 糖尿病, 2型；糖尿病视网膜病变；危险因素；预测模型；社区卫生中心

Abstract: Background　Diabetic retinopathy（DR） has a high incidence and is a leading cause of blindness in adults.Although it is difficult to perform fundus screening in a wide range of population in communities，the risk prediction model of DR can help general practitioners identify high risk population of DR at an early stage.Therefore，carrying out the research on the risk prediction model for DR is particularly important.Objective　To explore the risk factors of DR in type 2 diabetic outpatients in community settings，and use them to establish and verify a risk prediction model for DR，further improving the screening efficiency of DR.Methods　From June 2018 to June 2019，421 type 2 diabetic outpatients from Fangzhuang Community Health Service Center were invited and were divided into model group（336 cases） and verification group（85 cases） by a table of random numbers.Demographic information，blood pressure，fasting blood glucose（FBG），2-h postprandial blood glucose，glycosylated hemoglobin（HbA1c），serum creatinine，urea nitrogen，total cholesterol（TC），triacylglycerol（TG），low-density lipoprotein cholesterol（LDL-C），urine protein，and results of non-mydriatic fundus color photography（NMFCS） of the patients were collected.Univariate Logistic regression analysis was used to identify DR-related factors in model group，and the related factors obtained were discussed with multivariate Logistic regression analysis to explore the risk factors of DR based on which the DR risk prediction model was constructed，and the feasibility of this prediction model was evaluated in the verification group.Results　Altogether，87 patients were found with DR，including 69 in the model group and 18 in the verification group.Multivariate Logistic regression analysis showed that years of having T2DM（β=0.196，OR=1.217，P<0.001），systolic blood pressure（β=0.028，OR=1.028，P=0.038），FBG（β=0.409，OR=1.506，P=0.003），HbA1c（β=0.594，OR=1.811，P=0.001） and LDL-C （β=0.360，OR=1.434，P=0.038） were risk factors of DR in type 2 diabates patients.Therefore，the DR risk prediction model was Y=1/〔1+e-（0.196X1+0.028X2+0.409X3+0.594X4+0.360 x5-16.482）〕，Y refers to the probability of DR，X1 to years of having T2DM，X2 to systolic blood pressure，X3 to FBG，X4 to HbA1c，and X5 to LDL-C.The area under the ROC curve of DR in the model group was 0.884，and the cut-off point was 0.192.The area under the ROC curve was 0.803，the sensitivity was 72.2%，and the specificity was 79.1% in type 2 diabates patients occurred DR in verification group.Conclusion　Years of having T2DM，systolic blood pressure，FBG，HbA1c and LDL-C were significantly correlated with DR.DR risk prediction model has certain prediction value for DR.

Key words: Diabetes mellitus, type 2；Diabetic retinopathy；Risk factors；Prediction model；Community health centers