增生性糖尿病视网膜病变非血糖非病程相关致病危险因素分析

Non-glycemia and non-duration dependant risk factors of proliferative diabetic retinopathy

目的分析增生性糖尿病视网膜病变(PDR)非血糖非病程相关致病危险因素。设计比较性病例系列。研究对象连续收集2型糖尿病合并糖尿病视网膜病变(DR)患者191例,其中PDR患者103例,糖尿病病程≥10年的非增生性糖尿病视网膜病变(NPDR)患者88例;平均年龄(63.9±8.0)岁。方法所有患者均接受详细的病史采集,包括2型糖尿病病程、糖尿病家族史,以及糖尿病确诊后的吸烟史、饮酒史、高血压病史;测量身高、体重及空腹血糖;并进行视力、裂隙灯显微镜、间接检眼镜、荧光素眼底血管造影(FFA)等系统眼科检查。根据国际糖尿病视网膜病变严重程度分级标准对所有患者眼底进行分级诊断。采用Logistic回归分析PDR患病危险因素。主要指标性别构成比、年龄、糖尿病发病年龄、体重指数(BMI)、空腹血糖,高血压病史、吸烟史、饮酒史及糖尿病家族史及各危险因素的优势比(OR)值。结果 NPDR组平均糖尿病病程(15.6±4.9)年较PDR组(12.9±6.6)年长(P=0.002),两组患者平均空腹血糖分别为(7.6±2.1)mmol/L和(7.5±1.6)mmol/L(P=0.78);PDR患者中男性所占比例(53/103)较NPDR患者(30/88)高(P=0.016);PDR患者年龄和糖尿病发病年龄(55.6±9.0岁和42.9±8.4岁)均较NPDR组(63.9±8.0岁和48.3±8.1岁)小(P=0.000)。PDR组和NPDR组间BMI、高血压病史、吸烟史、饮酒史及DM家族史差异均无显著性意义。Logistic回归分析显示,矫正了血糖和病程等相关因素后,性别(男性,OR:2.048)和年龄(低龄,OR:1.126)与PDR患病有关。结论控制血糖及糖尿病病程对PDR发病的影响后,男性及低龄是PDR的致病危险因素。

Objective To analyse the non-glycemia and non-duration dependant risk factors for proliferative diabetic retinopathy（PDR）. Design Comparative case series. Participants 191 cases with type 2 diabetes were continuously enrolled. Among them, 103 patients were diagnosed as PDR and 88 NPDR patients with 10 years or longer duration, whose mean age was 63.9±8.0 yrs. Methods All patients accepted questionnaire, including duration and family history of diabetes, history of smoking and alcohol drinking, history of hypertension. The visual acuity, slit lamp microscopy exanmination, indirect ophthalmoscopy, fundus fluorescein angiography （FFA） and other systemic examination were performed as well. The height, weight and fasting blood glucose were measured. Diabetic retinopathy （DR） was diagnosed and classified according to the international grading standard of DR. Logistic regression analysis was used for the analysis of the risk factors of PDR. Main Outcome Measures Gender, age, onset age of diabetes, body mass index （BMI）, fasting blood glucose, family history of diabetes, and history of hypertension, smoking and drinking, and the odd ratios （OR） of the risk factors. Results （1） The mean diabetes duration of NPDR group was longer than that of PDR group （15.6 ± 4.9 yrs and 12. 9 ± 6.6 yrs, P=0.002）, while no significant difference was found between fasting blood glucose of the two groups （7.5 ± 2.1 mmol/L and 7.5 ± 1.6 mmol/L, P=0.780）. It was suggested that the sample matches the design to study non-glycemia and non-duration dependant risk factors of PDR. （2） Male was more common in PDR group than in NPDR group （P=-0.016）. The mean age and onset age of diabetes of PDR patients were younger than that of NPDR （55.6±9.0 yrs and 42.9±8.4 yrs for PDR, 63.9±8.0 yrs and 48.3±8.1yrs for NPDR, P=0.000）. The differences of history of smoking, drinking, and hypertension, diabetes family history, mean BMI, and fasting blood glucose between PDR group and NPDR group were not significant. In binary logistic regression analysis, presence of PDR were associated with gender （male, OR ： 2.048 ）and age （younger age, OR： 1.126）. Conclusion Male and younger age were non-glycemia and non-duration dependant risk factors of PDR in the patients with type 2 diabetes. （Ophthalmol CHN, 2011, 20： 207-210）