社区糖尿病视网膜病变及危险因素探讨

Prevalence and Risk Factors of Diabetic Retinopathy in Cuigezhuang Community of Beijing

目的了解北京崔各庄社区2型糖尿病（T2DM）患者合并糖尿病视网膜病变（DR）及其危险因素，为预防糖尿病引起失明提供依据。方法2008年8月〈三甲医院与多社区中心联合管理2型糖尿病项目〉，对崔各庄社区采用整群抽样的方法，遵循T2DM患者自愿参加的原则，本研究共纳入329例T2DM患者；医师经过专门培训，按统一要求调查并填写调查表，并对患者进行体格检查及相关的实验室检查。结果（1）329例T2DM患者中，合并DR者74例，患病率为22．49％[95％cI（17．98％，27．00％）]，其中非增殖性、增殖性视网膜病变分别占89．2％和10．8％；（2）T2DM患者经济收入增高，DR的患病率降低（P=0．031）；糖尿病程延长，DR的患病率增加（P〈0．01）；糖化血红蛋白（HbA1c）水平增高，DR的患病率增加（P〈0．01）。（3）调整多个因素问的影响，相对于经济收入〈1000元／月的患者，收入为1000～2000元／月、〉2000元／月的患者发生DR的风险分别为0．470[95％CI（0．240，0．920）]和0．281[95％CI（0．060，1．327）]；相对于糖尿病病程〈5年的患者，5～10年、〉10年的患者发生DR的风险分别为1．644[95％CI（0．764，3．536）]和3．246[95％CI（1．447，7．283）]；相对于HbA1c水平〈6．5％的患者，6．5％-7．5％、〉7．5％的患者发生DR的发生风险分别为1．490[95％CI（0．653，3．399）]和3．192[95％CI（1．562，6．526）]。结论经济收入、HbA1c水平、病程长短是影响糖尿病患者发生DR的独立危险因素。应提倡早诊断、早治疗及血糖控制达标，才能有效遏制DR的发生、发展，预防失明。

Objective To understand the prevalence and risk factors of diabetic retinopathy （DR） in patients with di- abetes mellitus （T2DM） in Cuigezhuang community and to provide reference for diabetic blindness prevention. Methods Cluster sampling method was applied and Cuigezhuang community was enrolled in the study of jointed management of type 2 diabetes by grade A class 3 hospitals and multiple community health centers （ Aug. 2008 ） . A total of 329 T2DM patients entered the study voluntarily and finished investigation forms under the guidance of specially trained physicians. Physical and laboratory examinations were also carried out on these subjects. Results Seventy - four out of the 329 cases were with diabetic retinopathy [ prevalence rate, 22. 49%, 95% CI （ 17. 98%, 27.00% ） ] ; non - proliferative and proliferative retinopathy accounted for 89. 2% and 10. 8% respectively. DR incidence rate decreased as the income grew （ P = 0. 031 ）, while increased with the increase of duration （P 〈 0. 01 ） and HbA1clevel （P 〈 0. 01 ） . With the influence among individual factors adjusted, compared with patients with in- comes less than 1 000 Yuart/month, those with incomes between 1 000 and 2 000 Yuan/month and more than 2 000 Yuan/month displayed risk ratios of 0. 470 [95% CI （0. 240, 0. 920） ] and 0. 281 [95% CI （0. 060, 1. 327） ], respectively; compared with patients with durations less than 5 years, those with durations between 5 and 10 years and with durations more than 10 yearsdisplayed risk ratios of 1. 644 [ 95% CI （0. 764, 3. 536） ] and 3. 246 [ 95% CI （ 1. 447, 7. 283 ） ; respectively; compared with patients with HbA1clevels under 6. 5% , those with HbA1c between 6. 5% and 7.5% and with HbA1c levels above 7.5% dis- playedrisk ratiosofl. 490 [95%CI （0.653, 3.399）], 3.192 [95%CI （1.562, 6.526）3 .Conclusion Income, HbA1c level, and length of duration are independent risk factors of DR. Early diagnosis, early treatment and blood glucose control are important to the prevention of DR pathogenesis, development, and blindness caused by DR.