糖尿病视网膜病变发生发展的相关因素分析

Analysis on relative factors of the incidence and developm ent of diabetic retinopathy

目的:探讨影响糖尿病视网膜病变(diabetic retinopathy,DR)发生发展的相关因素。方法:用眼底镜和眼底血管荧光素造影对631例2型糖尿病(type 2 diabetes mellitus,T2DM)患者进行眼底检查,采集可能与DR发生发展的相关指标。结果:(1)检出DR患者205例,患病率32.5%(95%CI:28.82%～36.15%);其中非增生性糖尿病视网膜病(nonproliferative diabetic retinopathy,NPDR)134例占21.2%(95%CI:18.04%～24.44%);增生性糖尿病视网膜病(proliferative diabetic retinopathy,PDR)71例占11.3%(95%CI:8.78%～13.72%)。(2)单因素分析显示:无视网膜病(non-diabetic retinopathy,NDR)、轻、中、重度NPDR和PDR患者间在人均经济收入、居住环境、是否应用胰岛素治疗、合并糖尿病肾病(diabetic nephropathy,DN)、合并糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)、坚持锻炼、糖尿病(diabetes mellitus,DM)病程、空腹血糖(fasting plasma glucose,FPG)、餐后2h血糖(2 hours'postprandial plasma glucose,2hPG)、糖化血红蛋白(glycosylated hemoglobin A1C,HbA1c)、收缩压(systaltic blood pressure,SBP)、胆固醇(total cholesterol,TC)、尿蛋白排泄率(urinary albuminate excretion rate,UAER)、血清肌酐(serum cremine,SCr)、尿素氮(blood urea nitrogen,BUN)方面的暴露水平差异有统计学意义(P<0.05,P<0.01)。(3)多因素有序Logistic回归显示:DM病程长、HbA1c、UAER水平高,不坚持体力锻炼者DR发生发展的风险增加,无DN和DPN合并症者DR发生发展的可能性降低(P<0.05,P<0.01)。结论:T2DM患者有较高的DR患病率。DM病程长、HbA1c水平高,不坚持锻炼是DR发生及其严重程度的独立危险因素,是否合并DN和DPN及UAER的改变可作为DR发生发展的预示指标。

AIM ： To investigate the relative factors of the incidence and development of diabetic retinopathy （DR）. ~ METHODS： The retinopathy of the 631 patients with type 2 diabetes mellitus （T2DM） was examined by ophthalmoscopy and fundus fluorescein angiography （FFA）, and the relative factors which possibly associate with the incidence and development of DR were collected. ~ RESULTS： There were 205 patients with DR, the morbidity rate of DR was 32. 5% （95% CI： 28. 82% - 36.15%）, the nonproliferative diabetic retinopathy （NPDR） and proliferative diabetic retinopathy （PDR） were 134 cases occupying 21. 2% （95% CI： 18. 04% - 24.44%） and 71 cases occupying 11.3% （95% C/： 8.78%- 13. 72%） of the patients with DR, respectively. Univariate analysis showed that income, living environment, whether treatment by insulin, combined with diabetic nephropathy （DN）, combined with diabetic peripheral neuropathy （DPN）, hold on exercise, course of diabetes, fasting plasma glucose （FPG~）, 2 hours＇ postprandial plasma glucose （ 2hPG ）, glycosylated hemoglobin Alc （HbAlc）, systolic blood pressure （SBP）, total cholesterol （TC）, urinary albumin excretion rate （UAER）, serum creatinine （SCr）, and blood urea nitrogen （BUN） were significant different among the patients without DR, the patients with NPDR and thepatients with PDR （ P〈 0. 05 or P〈 0. 01 ）. Multivariate ordinal Logistic regression analysis showed that the incidence and development of DR increased in patients with longer course of diabetes, high HbAlc, high UAER and without exercise, and decreased in patients without DN and DPN （P〈0.05 or P〈0.01~. ~ CONCLUSION. There was a high morbidity rate of DR in patients with patients with type 2 diabetes. The longer course of diabetes, high HbAlc, and without exercise were the independent development factors of DR, whether combined with DN, combined with DPN and UAER were indices for the incidence and development of DR.