45岁以上糖尿病患者中糖尿病视网膜病变的患病率调查及相关危险因素分析

Survey of diabetic retinopathy of the diabetic population over 45 years old

背景 糖尿病视网膜病变（DR）是糖尿病的眼部并发症及主要的致盲性眼病之一,了解与DR发病相关的危险因素对其防治有重要意义. 目的 调查健康体检人群45岁以上糖尿病患者中DR的患病率及其相关影响因素. 方法 采用横断面研究设计.收集2010年6月至2011年3月山西医科大学附属第一医院参加体检的7300人的资料,45岁以上者共5012人行双眼免扩瞳眼底照相,其中确诊为糖尿病的患者574例,按本研究纳入标准纳入480例进行问卷调查,计算糖尿病及DR的患病率,对糖尿病患者中不同影响因素与DR的关系进行分析. 结果 糖尿病患者眼底照片清晰者480例（480/574）,占83.6％,其中DR 95例（95/480）,占19.8％;45～55岁组DR患者占14.3％,＞55 ～ 65岁组占19.4％,＞65 ～75岁组占23.7％,＞75岁占21.5％,不同年龄组DR的患病率差异无统计学意义（x2=3.824,P=0.281）.糖尿病病程≤5年、＞5 ～ 10年、＞10 ～ 15年、＞15 ～ 20年、＞20年DR的患病率分别为11.8％ 、13.2％ 、15.4％、27.0％、62.5％,差异有统计学意义（x2=57.518,P=0.000）;体质量指数（BMI）＜18.5、18.5 ～22.9、23.0～24.9、≥25.0的患者中DR的患病率分别为16.7％、23.3％、16.8％、19.7％,各组间总体比较差异无统计学意义（x2=2.099,P=0.718）;问卷调查结果显示,听说过DR的患者比例为86％,口服降血糖药者、口服降血糖药联合注射胰岛素者、单纯注射胰岛素者DR的患病率分别为18.8％、19.8％、25.9％,不同治疗方式间DR的患病率差异无统计学意义（x2=1.477,P=0.478）.患者的性别、糖尿病病程、空腹血糖浓度、糖尿病家族史、是否检查眼底均为DR患病的相关因素（P=0.025、0.000、0.001、0.003、0.039）.结论 DR的患病率与患者对糖尿病转归的知晓程度、患者的治疗方式等有一定的关联,糖尿病患者的性别、糖尿病病程、糖尿病家族史、空腹血糖浓度及是否检查眼底是DR的危险因素.

Background Diabetiretinopathy（DR） ione of the leading causeof blindness.To understand the risk factorof Dpathogenesiiimportanfothe prevention and treatmenof DR.Objective The purpose of thistudy wato survey the prevalence and relevanfactorof Damong diabetipatientaged ove45 yearold.Methodcross-sectional study wadesigned.physical examination waperformed on 7300 subjectfrom July,2010 to March,2011 athe FirsHospital of Shanxi Medical University,and 5012 of them received non-mydriatidigital funduphotography.Type 2 diabetimellituwadetermined in 574 subjects,and 480 casethaconformed to the criteriof the currenstudy were recruited.questionnaire survey wacarried ouin the 480 patients,and the prevalence of diabeteand Dwacalculated fothe analysiof the causative factorof DR.ResultGradable funduphotographwere available in 480 subjects,and 98 of them presented with Dcomplication aprevalence rate of 19.8%.The morbidity rateof Dwere 14.3%,19.4%,23.7% and 21.5% in the 45-55 yeargroup,〉55-65 yeargroup,〉65-75 yeargroup and 〉75 yeargroup,respectively,withousignificandifference among them （x2 =3.824,P=0.281）.The incidence rateof Dwere 11.8%,13.2%,15.4%,27.0% and 62.5% in patientwith disease courseof lesthan 5 years,5-10 years,〉 10-15 years,〉 15-20 yearand ove20 years,respectively,with significandifference among differendisease duration（x2 =57.518,P =0.000）.No significandifference waseen in the prevalence of Damong groupwith body weighindiceof 〈18.5,18.5-22.9,23.0-24.9 and ≥25.0 （16.7%,23.3%,16.8%,19.7%） （x2 =2.099,P =0.718） and differentreatmenmethod,such aoral antidiabetidrugs,insulin injection ocombination treatmen（18.8%,25.9%,19.8%,respectively） （x2 =1.477,P=0.478）.The questionnaire survey showed close relevancy between gender,disease duration,fasting glucose concentration,family history of diabetes,and whethefunduexamination waperformed （P =0.025,0.000,0.001,0.003,0.039）.ConclusionThe prevalence rate of Dwaassociated with the awarenesfodiabeteand treatmenmodes.Gender,disease duration,family history of diabetes,fasting glucose concentration and submission to eye examination are the independenrisk factorof DR.