糖尿病视网膜病变眼底进展因素的队列研究

A cohort study on the progress of ocular fundus in patients with diabetic retinopathy

目的探讨影响糖尿病视网膜病变（diabetic retinopathy,DR）进展的相关因素。方法 2008年1月—2009年1月采用队列研究方法对行慢病管理的2型糖尿病（type 2 diabetes mellitus,T2DM）患者324例进行追踪随访,每年行眼底荧光素血管造影（fundus fluorescein angiography,FFA）、Hb A1c、血脂、尿白蛋白排泄率（urinary albumin excretion rate,UAER）等检测。采用Kaplan-Meier法计算进展率,Cox比例风险回归筛选影响DR发生进展的相关因素,P〈0.05为差异有统计学意义。结果 324例T2DM患者中,首次FFA确诊DR 85例,患病率为26.23%。1、2、3、4和5年累计眼底进展率分别为2.5%、5.9%、10.1%、17.8%和29.7%。多因素Cox比例风险分析显示,T2DM病程（OR=1.154,95%CI为1.075~1.238）、高血压史（OR=1.671,95%CI为1.092~2.556）、糖尿病肾病（diabetic nephropathy,DN）进展（OR=1.600,95%CI为1.045~2.451）、血糖控制（OR=2.146,95%CI为1.577~2.922）、TC控制（OR=1.395,95%CI为1.048~1.858）、TG控制（OR=1.345,95%CI为1.035~1.748）是影响DR进展的独立因素。结论 DM病程长、合并高血压、血糖、血脂控制不良将增加DR眼底进展的风险,了解DN进展情况有助于对DR发生发展的判断。

Objective To investigate the factors influencing on the progress of ocular fundus in patients with diabetic retinopathy （ DR ）.Methods The cohort study method was used,a total of 324 chronic disease managed peasants with type 2 diabetes mellitus （T2DM）was followed from January 2008 to Januany 2009.Fundus fluorescein angiography（FFA）,HbA 1 c,serum lipids,urinary albumin excretion rate （UAER） were measured once a year.The progress rates of DR were described with Kaplan-Meier method,and the risk factors associated with progress of DR were analyzed with Cox proportional hazard regression.P〈0.05 was considered statistically significant.Results The patients with DR first confirmed by FFA were 85 cases in 324 patients（26.23%）with T2DM.The cumulative progress rates of ocular fundus in 1,2,3,4 and 5 year were 2.5%,5.9%,10.1%,17.8% and 29.7%,respeetively.Muhivariate Cox proportional hazard regression analyses showed that T2DM course （OR=1.154, 95%CI：1.075-1.238）,the history of hypertension（OR=l.671,95%CI：1.092-2.556）,the progress of diabetic nephropathy（DN）（OR=l.600,95%Cl：1.045-2.451）,blood glucose controllment （0R=2.146,95% CI：1.577-2.922）,TC controllment （0R=1.395, 95% CI：1.048-1.858）, TG controllment （OR=1.345,95%Cl：1.035-1.748）were the independent progress factors of DR.Conclusion Longer courses of diabetes mellitus, complicated with hypertension,poor blood glucose and serum lipids controlled can elevate the progress of ocular fundus,to understand the progress of DN is helpful to judge the progress of diabetic retinopathy.