医院就诊患者的糖尿病视网膜病变患病情况及相关因素分析

Prevalence and risk factors of diabetic retinopathy in hospital patients

目的了解到医院眼科就诊的糖尿病患者糖尿病视网膜病变（DR）的患病情况，并分析DR的相关因素。方法横断面研究。选择2012年10月至2013年6月在山东省烟台市牟平区中医医院眼科就诊的糖尿病患者，通过调查问卷获得患者的一般情况和病史，并进行相关实验室检查和眼部检查、眼底照相进行DR诊断及分级。采用多因素logistic回归分析DR的影响因素。结果就诊的糖尿病患者共676例，其中DR455例，在糖尿病患者中患病率67．31％。在DR患者中，轻度非增生性DR（NPDR）、中度NPDR、重度NPDR患者分别为211例（46．37％）、167例（36．70％）和57例（12．53％），增生性DR（PDR）20例（4．40％）。不同年龄组DR的患病率差异无统计学意义（x。=6．527，P：0．089），不同糖尿病病程DR的患病率差异有统计学意义（x2=39．401，P〈0．001），胰岛素使用者DR的患病率与不使用胰岛素者的患病率差异有统计学意义（x2=7．378，P=0．007）。单因素logistic回归分析结果显示，DR患病率与胰岛素使用、糖尿病病程、糖化血红蛋白（HbAlc）、尿微量白蛋白、三酰甘油、吸烟、肥胖及高血压有相关性（均P〈0．05）。多因素logistic回归结果显示，HbAlc（OR=1．131，95％CI：1．022～1．252，P=0．011）和糖尿病病程（OR=1．077，95％CI：1．046—1．108，P〈0．001）是DR发病的独立相关因素。结论到眼科就诊的糖尿病患者中DR患病率与糖尿病病程、HbA!C、肥胖、合并肾病、胰岛素使用、吸烟相关，糖尿病病程和HbAlc水平是DR的独立相关因素，糖尿病患者需定期做眼底检查。

Objective To analyze the prevalence and risk factors of diabetic retinopathy （DR） in ophthalmic patients. Methods A cross-sectional study was performed. Diabetic patients who were admitted to Department of Ophthalmology, Traditional Chinese Medicine Hospital of Muping between October 2012 and June 2013 were included. General information and medical history were obtained from each subject by questionaires. Laboratory and detailed ophthalmic examinations were performed during the study. DR was diagnosed and graded by mydriatic fundus photography. Prevalence of DR was calculated and logistic regression was used to analyze the relationship between DR and various factors. Results A total of 676 diabetic patients were included, and 455 of them presented with DR at a morbidity rate of 67. 31%. Among DR patients, the number of mild, moderate, severe non-proliferative diabetic retinopathy （NPDR） patients and proliferative diabetic retinopathy （PDR） patients were 211 （ 46. 37% ）, 167 （ 36. 70% ）, 57 （12. 53% ） and 20 （4.40%）, respectively. There was no significant difference in the prevalence of DR among different age groups （ X2 = 6. 527, P = 0. 089）. However, there was a significant difference between different disease duration groups （ X2 = 39. 401, P 〈 0. 001 ） , as well as between insulin therapy group and non-insulin therapy group （X2 = 7. 378, P = 0. 007 ） . The multivariate logistic regression analysis demonstrated the independent risk factors for DR occurrence were hemoglobin Alc （HbAlc） （ OR = 1. 131,95% CI：I. 022 - 1. 252, P = 0. 011 ） and duration of diabetes （ OR = 1. 077, 95% CI： 1. 046 - 1. 108, P 〈 0. 001 ）. Conclusions The prevalence of DR in ophthalmic patients was assoeiated with duration of diabetes, HbAle, obesity, smoke, nephropaty and insulin therapy. Increased HbAlc level and longer duration of diabetes were independent risk factors for DR in diabetic patients.