上海市新泾社区2型糖尿病居民5年随访的前瞻性调查研究 1．糖尿病视网膜病变和糖尿病黄斑水肿的发病率及危险因素

A 5-year prospective study of type 2 diabetes patients in Shanghai Xinjing Community 1. The incidence and risk factors of diabetic retinopathy and diabetic macular edema in Chinese type 2 diabetes residents

背景糖尿病视网膜病变（DR）和糖尿病性黄斑水肿（DME）是2型糖尿病常见的眼底并发症，目前国外关于2型糖尿病人群DR和DME发病率及危险因素的研究结果差异较大，可能与研究对象的种族不同有关，而中国的相关流行病学调查研究较少。目的了解中国2型糖尿病患者中DR和DME的5年发病率，探讨其危险因素。方法采用横断面研究方法，对2007--2012年上海市新泾社区中805例2型糖尿病患者的DR和DME的发病率进行流行病学调查，其中2007年为基线调查阶段，2012年为终末调查阶段，每年对该人群进行检查，包括一般资料的收集、全身体格检查、实验室检查和眼科检查，结合OCT和荧光素眼底血管造影（FFA）成像依据目前通用的国际临床分类方法对DR和DME进行分级。将DR和DME发病作为结局变量，分析2型糖尿病患者DR和DME5年发病的独立影响因素。结果基线调查时无DR的2型糖尿病患者322例，其中151例在终末调查时发生DR，5年累积发病率为46．89％。多元Logistic回归结果显示，高血糖[优势比（OR）=1．12，95％可信区间（CI）：1．01—1．24，P=0．03]和高血压（OR=1．80，95％CI：1．14～2．86，P=0．01）是DR发病的独立危险因素。基线调查时无DME的2型糖尿病患者629例，其中124例在5年后发生DME，5年累积发病率为19．71％。多元Logistic回归结果显示，高血糖是DME唯一的独立影响因素（OR=1．36，95％CI：1．24—1．49，P〈O．01）。结论高血糖和高血压在中国2型糖尿病患者DR和DME的发病中寿桎雷喜作用．中国2珏!l糖尿病寓者府严格榨制向糖和ffn乐7k平．

Background Diabetic retinopathy （DR） and diabetic macular edema （DME） are common complications of diabetes. Currently abroad study results of incidence and risk factors of DR and DME in type 2 diabetes population varied largely depending on the ethnical difference. However, relevant epidemiological study is rare in China. Objective This survey was to assess the 5-year incidence and risk factors of DR and DME in Chinese type 2 diabetic patients. Methods A prospective cross-sectional study was performed under the informed consent of the patients. An epidemiological survey for 5-year incidence and risk factors of DR and DME was organized and carried out in 805 type 2 diabetes patients in Shanghai Xinjing Community from 2007 to 2012,and 2007 scheduled asthe baseline survey and 2012 scheduled as final survey. The comprehensive examinations were carried out annually during the 5 years,including sociodemographic information, systemic examination and ophthalmological test. DR onset and DME onset grading were performed by OCT and fundus fluorescein angiography （FFA） images based on current international classification. Cumulative incidence of 5 years for DR and DME was determined as the outcome variables,and the associations between potential risk factors and the outcomes were analyzed. Results In the baseline time,non-DR were found in 322 type 2 diabetic patients,of which 151 participants developed DR during the follow-up duration ,with the 5-year cumulative incidence rate 46.89%. The independent risk factors for DR occurrence were hyperglycemia （ odds ratio [ OR ] = 1.12,95 % confidence interval [ CI] ： 1.01 - 1.24, P = 0.03 ） and hypertension （ OR = 1.80,95% CI： 1.14-2.86, PJ= O. 01 ）. In the baseline time, 629 type 2 diabetes patients were non-DME, of which 124 participants developed DME during the follow-up duration, with the 5-year cumulative incidence rate 19.71%. Hyperglycemia appeared to be the only independent risk factor of DR onset （ OR = 1.36,95% CI： 1.24- 1. 49,P〈0. 01 ）. Conclusions Hyperglycemia and hypertension play an important role in the pathogenesis and development of DR and DME in Chinese type 2 diabetic patients, and intensive glycemic control and hypertension control should be emphasized in diabetic patients.