Abstract: Background　Diabetic retinopathy（DR） caused serious damage to visual function in diabetic mellitus,but the pathogenesis of DR was still unknown.Objective　To analyse the level of 25 hydroxy vitamin D3〔25（OH）D3〕 and insulin-like growth factor（IGF-Ⅰ） in well-controlled type 2 diabetes（T2DM） and explore the association between them and DR.Methods　128 patients followed up for 3 years in the First Affiliated Hospital of Xinjiang Medical University and the Armed Police Hospital of Xinjiang from January 2012 to June 2015,with well-controlled T2DM,were retrospectively enrolled.According to International Clinical Classification Criteria for Diabetic Retinopathy（2002）,all patients were examined by fundus fluorescein angiography and divided into three groups:normal group（control group,74 cases ）,non proliferative retinopathy（NPDR,31 cases ）and proliferative retinopathy（PDR,23 cases）.General information 〔including gender,age,diabetes duration,abdomen circumference,body mass index（BMI）,systolic blood pressure（SBP）,diastolic blood pressure（DBP）〕 and laboratory indexes〔including growth hormone（GH）,IGF-Ⅰ,fasting plasma glucose（FPG）,fasting C peptide（FC-P）,2 h postprandial（2 hPG）,2 h postprandial blood glucose C peptide（2 hC-P）,25（OH） D3,low density lipoprotein cholesterol（LDL-C）,triglyceride（TG）,high-density lipoprotein cholesterol（HDL-C）,total cholesterol（TC） and microalbuminuria〕 in the three groups were collected and compared.The risk factors of DR in T2DM were evaluated using multi-factor Logistic regression analysis.Results　There were no significant differences in gender,age,abdomen circumference,BMI,SBP and DBP among three groups（P>0.05）.The duration of diabetes in control group and NPDR group was shorter than the PDR group（P<0.05）.There were no significant differences in level of FPG，2 hPG，TG，HDL-C and TC among three groups（P>0.05）.The level of GH，IGF-Ⅰ，LDL-C and microalbuminuria in PDR group was higher than NPDR and control group（P<0.05）.The level of FC-P，2 hC-P，25（OH）D3 in the PDR group was lower than the control group and the NPDR group（P<0.05）.The level of 25（OH）D3 in the NPDR was lower than the control group （P<0.05）.Multivariate Logistic regression analysis showed that,diabetes duration 〔OR=1.811,95%CI（1.270，2.632）〕，IGF-Ⅰ〔OR=1.211,95%CI（1.121，1.380）〕，FC-P〔OR=1.049,95%CI（1.012，1.098）〕，25（OH）D3〔OR=1.788,95%CI（1.072，2.102）〕 and microalbuminuria 〔OR=4.137,95%CI（1.455,11.211）〕 were independent risk factors for DR in T2DM patients（P<0.05）.Conclusion　In addition to the common risk factors,such as diabetes duration,SBP,LDL-C,FC-P and microalbuminuria,decreased serum 25（OH）D3 and increased serum IGF-Ⅰ are also associated with DR,which may be one of the mechanisms for the progress of DR in patients with T2DM.

Key words: Diabetic retinopathy, Diabetes mellitus,type 2, Calcifediol, Insulin-like growth factor Ⅰ

摘要： 背景　糖尿病视网膜病变（DR）严重危害糖尿病患者视功能，但其发病机制尚有许多不明之处。目的　检测并分析血糖控制达标的2型糖尿病（T2DM）患者25羟维生素D3〔25（OH）D3〕水平、胰岛素样生长因子Ⅰ（IGF-Ⅰ）水平，探讨其与DR的关系。方法　回顾性选取2012年1月—2015年6月新疆医科大学第一附属医院及武警新疆总队医院收治且随访3年临床资料齐全的T2DM患者128例，患者3年内血糖控制均达标，根据2002年《糖尿病视网膜病变新的国际临床分级标准》将患者分为眼底造影正常患者（对照组）74例、非增殖期糖尿病视网膜病变（NPDR）患者（NPDR组）31例、增殖期糖尿病视网膜病变（PDR）患者（PDR组）23例。收集并比较3组患者的一般资料〔包括性别、年龄、糖尿病病程、腹围、体质指数（BMI）、收缩压（SBP）、舒张压（DBP）〕及实验室检查指标〔包括生长激素（GH）、IGF-Ⅰ、空腹血糖（FPG）、空腹C肽（FC-P）、餐后2 h血糖（2 hPG）、餐后2 h C肽（2 hC-P）、25（OH）D3、低密度脂蛋白胆固醇（LDL-C）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、总胆固醇（TC）及尿微量清蛋白〕，并采用多因素Logistic回归分析T2DM患者发生DR的影响因素。结果　3组患者性别、年龄、腹围、BMI、SBP、DBP比较，差异均无统计学意义（P>0.05）；对照组和NPDR组患者糖尿病病程短于PDR组（P<0.05）。3组患者FPG、2 hPG、TG、HDL-C、TC水平比较，差异无统计学意义（P>0.05）；PDR组患者GH、IGF-Ⅰ、LDL-C、尿微量清蛋白水平均高于对照组和NPDR组患者，FC-P、2 hC-P、25（OH）D3水平均低于对照组和NPDR组患者（P<0.05）；NPDR组患者25（OH）D3水平低于对照组（P<0.05）。多因素Logistic回归分析结果显示，糖尿病病程〔OR=1.811,95%CI（1.270，2.632）〕、IGF-Ⅰ〔OR=1.211,95%CI（1.121，1.380）〕、FC-P〔OR=1.049,95%CI（1.012，1.098）〕、25（OH）D3〔OR=1.788,95%CI（1.072，2.102）〕和尿微量清蛋白〔OR=4.137,95%CI（1.455,11.211）〕是T2DM患者发生DR的独立影响因素（P<0.05）。结论　除糖尿病病程、SBP、LDL-C、FC-P及尿微量清蛋白等常见危险因素外，血清25（OH）D3水平偏低及血清IGF-Ⅰ水平偏高也与DR有关，这可能是T2DM患者DR进展的机制之一。

关键词: 糖尿病视网膜病变, 糖尿病, 2型, 骨化二醇, 胰岛素样生长因子Ⅰ