北京市昌平区自然人群糖尿病视网膜病变患病率调查及危险因素分析

A population-based prevalence survey and risk factor analysis of diabetic retinopathy in Beijing Changping District

目的了解北京市昌平区自然人群糖尿病视网膜病变(diabetic retinopathy,DR)患病率及相关危险因素。方法根据2010年"昌平区卫生与人群健康状况调查",采用从166万昌平区常住自然人群中随机抽样18岁～79岁的8 155例健康受试者,其中3 760例空腹血糖≥5.6 mmol/L者参加本研究,最终2 551例受试者完成体格检查和血液生化指标的测定,包括空腹血糖(fasting plasma glucose,FPG),OGTT-2h血糖(oral glucose tolerance test 2h plasma glucose,OGTT-2hPG)和糖化血红蛋白(hemoglobin A1c,HbA1c),以及眼底检查,所有人选进行散瞳45°彩色眼底照相,以评价DR分级。结果 2 551例受试者中,已知糖尿病患者280例,新诊断糖尿病患者334例,糖调节受损(impaired glucose regulation,IGR)者853例。糖尿病和IGR患者的DR患病率分别为9.9%和1.2%。新诊断糖尿病患者DR患病率(2.7%)明显低于已知糖尿病患者(18.6%)。在糖尿病患者中,DR的发生与糖尿病病程[OR=1.49(95%CI:1.38～1.62)]、空腹血糖[OR=1.32(95%CI:1.22～1.43)]、2 hPG[OR=1.18(95%CI:1.12～1.24)]、HbA1c[OR=1.66(95%CI:1.45～1.90)],以及收缩压水平[OR=1.16(95%CI:1.02～1.31)]显著相关。结论本研究人群糖尿病和糖尿病前期患者DR患病率明显低于西方国家。糖尿病患者DR发生的主要危险因素是糖尿病病程、高血糖和高血压。

Objective This study describes the prevalence and risk factors of diabetic retinopathy （DR） in a Chinese population in Beijing Changping district. Methods In a total of 8 155 Chinese between 18 - 79 years of age, who participated in the 2010 Health Examination Survey in Beijing representing a population of 1 600 000 citizens in the district, 3 760 subjects whose fasting plasma glucose （FPG） ~ 5.6 mmol/L were invited to the study and 2 551 subjects completed physical examination and laboratory measurements including FPG, oral glucose tolerance test （OGTF） -2h plasma glucose （2hPG） and hemoglobin Alc （HbAlc）. The grade of DR was assessed with two 45° color digital retinal images. Results Of the 2 551 persons, 280 with known diabetes, 334 with newly-diagnosed diabetes and 853 with impaired glucose regulation （IGR） were identified. The prevalence of DR in diabetes and IGR subjects was 9.9% and 1.2% , respectively. The prevalence of retinopathy was much lower in newly-diagnosed diabetes （2.7%） than in known diabeticsubjects （ 18.6% ）. In diabetic patients, independent risk factors for retinopathy were longer diabetes duration [ odds ratio （OR） 1.49 = （95% CI 1.38 ~ 1.62）, for every one year increase], FPG [ OR = 1.32 （95% CI 1.22 - 1.43）, per mmol/L], 2hPG [ OR = 1.18 （95% CI 1.12 - 1.24）, per mmol/L], HbAlc [ OR = 1.66 （95% CI 1.45 - 1.90）, per 1% ], and higher systolic blood pressure [ OR = 1.16 （95% CI 1.02 - 1.31 ）, per 10 mmHg（ 1 mmHg =0. 133 kPa） ]. Conclusion The prevalence of DR in patients with diabetes and pre-diabetes was much lower in this study than that reported in western countries. The major risk factors for retinopathy are longer duration of diabetes, hyperglycemia, and hypertension.