自体荧光测糖尿病微血管病变

　　日本学者的一项研究显示，皮肤自体荧光（AF）值可反应1型糖尿病患者既往较长一段时期内的血糖控制情况，或可作为糖尿病微血管并发症的一项生物标志物。研究于2013年4月11日在线发表于《糖尿病护理》杂志。

　　研究旨在评估日本1型糖尿病患者中皮肤自体荧光（AF）值与既往血糖控制之间的关系，及其与微血管并发症进展之间的相关性。研究纳入241例患者，110例对照组患者。应用AF监测仪评估晚期糖基化终末产物水平，对患者既往20年内的连续3个月HbA1c水平根据其医疗记录进行评估，计算HbA1c曲线下面积（AUC）。应用多变量回归分析检测糖尿病并发症进展与多变量的相关性。

　　结果显示，随着患者视网膜病变与肾脏病变的加重，皮肤AF值亦随之增加。既往15年内患者HbA1c AUC 值与皮肤AF值显著相关（既往5年R = 0.35；既往10年R=0.36；既往15年R = 0.55，p＜0.0001）。既往3年、5年、10年及15年患者HbA1c AUC 值与视网膜病变与肾脏病变严重程度显著相关。将HbA1c AUC从独立变量中移除后的多变量分析表明，只有皮肤AF值与肾脏疾病进展独立相关，患者基线年龄、糖尿病发病时的年龄、皮肤AF与视网膜病变独立相关。 

与糖尿病相关的拓展阅读：

• 孕中期空腹血糖适合筛查我国妊娠期糖尿病
• Diabetes Care：网络教程改善青少年糖尿病预后
• Diabetes Care：青少年肥胖者发生糖尿病风险高于成人
• Hypertension：无糖尿病患者ACEI与小剂量噻嗪利尿剂联用对胰岛素作用影响不大
• Nat Rev Cardiol：戒烟降低非糖尿病患者心血管疾病风险 更多信息请点击：有关糖尿病更多资讯

Skin Autofluorescence Reflects Integration of Past Long-Term Glycemic Control in Patients With Type 1 Diabetes
OBJECTIVE
The aim was to investigate the relationships between skin autofluorescence (AF) and the impact of past glycemic control and microvascular complications in Japanese patients with type 1 diabetes.
RESEARCH DESIGN AND METHODS
Two hundred forty-one patients and 110 controls were enrolled. Advanced glycation end product accumulation was measured with AF reader. Three monthly HbA1c levels during the past 20 years were determined from medical records, and the HbA1c area under the curve (AUC) was calculated. We performed multivariate regression analyses to examine the associations between the severity of diabetes complications and various variables.
RESULTS
Skin AF values increased with increasing the severity of retinopathy (P < 10−11, linear regression analysis) and nephropathy (P < 10−5 for chronic kidney disease stage; P < 10−5 for albuminuria-based stage). HbA1c AUC values over the past 15 years were significantly correlated with skin AF values (past 5 years: R = 0.35, P < 0.0001; past 10 years: R = 0.36, P < 0.0001; past 15 years: R = 0.55, P < 0.0001; past 20 years: R = 0.22, P = 0.13). HbA1c AUC values over the past 3, 5, 10, and 15 years were significantly associated with the severity of both nephropathy and retinopathy. Multivariate analyses in which HbA1c AUC value was removed from the independent variables indicated that only skin AF was independently associated with nephropathy, whereas age at registration, age at onset of diabetes, and skin AF were independently associated with retinopathy.
CONCLUSION
Skin AF reflects past long-term glycemic control and may serve as a surrogate marker for the development of microvascular complications in place of HbA1c AUC value.