上海市淞南社区糖尿病居民中糖尿病视网膜病变患病率及其影响因素调查分析

The prevalence and related factors of diabetic retinopathy in Shanghai Songnan community

目的调查分析上海市淞南社区糖尿病（DM）居民中糖尿病视网膜病变（DR）患病率及其影响因素。方法根据社区DM管理档案数据库，整群抽样法随机抽取DM患者1177例进行问卷调查、常规全身检查、视力及免散瞳眼底数码照相检查。剔除无效问卷，提供有效问卷并配合完成免散瞳眼底数码照相检查的1120例DM患者纳入最终统计分析。DR诊断及分型参照2002年国际DR分型标准；单眼或双眼发现DR者均作为1例纳入DR患病率统计；双眼DR以程度较重者进行DR分级。按有、无DR（NDR）分组进行统计分析。因增生型DR（PDR）患者较少，在进行两组间年龄、DM病程、空腹血糖、使用胰岛素比率比较时，将非增生型重度DR与PDR统一作为重度DR进行统计学分析。采用χ^2检验统计分析与患病率相关的影响因素；通过logistic回归分析，筛选DR的影响因素。结果1120例DM患者中，检出DR者264例（DR组），DR患病率为23．57％；NDR856例（NDR组），占76．43％。DR组与NDR组患者年龄、DM病程、收缩压、空腹血糖、使用胰岛素比率比较，差异有统计学意义（t=－2．647、2．688、2．204、2．291，χ^2=12．527；P=0．008、0．007、0．028、0．022、0．000）。DR组中，轻、中、重度非增生型DR和PDR患病率分别为17．05％、5．09％、1．16％、0．27％。轻、中、重度DR患者间，空腹血糖水平和使用胰岛素比率比较，差异有统计学意义（t=21．964，χ^2=14．996；P=0．000、0．001）。Logistic回归分析结果显示，年龄、DM病程、使用胰岛素是DR的影响因素（比值比=0．769、1．239、1．682，P=0．001、0．043、0．005）。结论上海淞南社区DM居民中DR患病率为23．57％；DR发生与年龄、DM病程、使用胰岛素有关。

Objective In order to provide guidance for early interference of diabetic retinopathy （DR） in patients with diabetes mellitus （DM）, we surveyed the prevalence and analysis the related factors of DR in Shanghai Songnan community. Methods Based on an established resident health database, an epidemiology study was performed on the residents with DM in Shanghai Songnan community. 1177 patients completed questionnaire survey, and received physical examination and laboratory tests. The diagnosis and grading of DR were established based on the ocular fundus images acquired by digital non-mydriasis fundus camera. Patients with incomplete questionnaires were excluded. Results There were 1120 DM patients with valid questionnaires. DR was found in 264 （23.57%） patients. The prevalence of mild, moderate, severe non- proliferative DR and proliferative DR was 17.05%, 5.09%, 1.16% and 0.27% respectively. There was significant differences in age, disease course, systolic blood pressure, insulin usage between the DR group and NDR group（t=--2.647, 2.688, 2.204, 2.291;χ^2 = 12. 527; P = 0. 008, 0.007, 0.028, 0.022, 0. 000）. There was significant differences in fasting blood-glucose and insulin usage between the mild, the moderate and the severe DR group（t=21. 964,χ^2 = 14. 996;P=0. 000, 0. 001）. Stepwise logistic analysis identified that age, DM course, and insulin usage were the related factors of DR （OR=0. 769, 1. 239, 1. 100, 1. 071, 1.682;P=0.001, 0.043, 0.176, 0.097, 0.005）. Conclusion The age, DM course, and insulin usage were the related factors of DR. The high prevalence of DR indicated the importance of the management of diabetic patients.