山东省泰安市高新区徂徕镇社区2型糖尿病居民糖尿病视网膜病变流行病学调查

Epidemiological investigation of type 2 diabetic patients with diabetic retinopathy in Culai Town of Tai＇an City in Shandong Province

目的 了解泰安市高新区徂徕镇社区2型糖尿病（DM）居民中DM视网膜病变（DR）的患病情况及其相关因素。 方法 根据社区DM管理档案数据库，采用整群抽样方法随机抽取2型DM（T2DM）患者785例。进行问卷调查、常规全身检查及视力和免散瞳眼底数码照相检查。DR诊断及分型参照我国糖尿病视网膜病变临床诊疗指南（2014年）。单眼或双眼DR均入选为DR患者。双眼者以双眼中程度较重者作为该患者DR分级。按有、无DR进行分组。采用GraphPad Prism 6, SigmaPlot 12.5，SPSS 20.0及Excel软件进行数据分析；多因素logistic回归分析DR患病影响因素。 结果 785例中，实际受检者699例，受检率89.04%。699例中，检出DR者（DR组）63例122只眼，占DM患者的9.01%；无DR者（NDR组）636例1272只眼，占DM患者的90.99%。DR 122只眼中，Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ期为19、17、70、10、6只眼。DR组、NDR组患者之间平均年龄、DM病程、舒张压比较，差异均有统计学意义（t年龄=15 290，P=0.002；tDM病程=9075，P＜0.000；t舒张压=15 810，P=0.006）。DR组、NDR组患者有高血压病史者为23、394例，分别占36.51%、61.95%；两组间差异有统计学意义[χ^2=15.42，比值比（OR）=0.35，95%可信区间（CI）为 0.21～0.60，P＜0.001]。空腹血糖＞6.11 mmol/L者为57、500例，分别占90.48%、78.62%；两组间差异有统计学意义（OR=2.51，95%CI为1.06～5.95，P=0.031）。Logistic回归分析结果显示，年龄、空腹血糖、DM病程是DR的影响因素（OR=1.04、0.86、0.90，P=0.021、＜0.000、＜0.000）。 结论 泰安市高新区徂徕镇社区T2DM患者DR患病率为9.01%。年龄、DM病程、空腹血糖与DR发生相关；有高血压病史者可能较无高血压病史者DR患病风险低。

Objective To investigate the prevalence and related factors of diabetic retinopathy （DR） among residents with type 2 diabetes mellitus （T2DM） in Culai Town of Tai＇an City in Shandong Province. Methods According to the DM management file database for community, 785 patients with T2DM were randomly selected by cluster sampling method. The questionnaires, routine general examinations, visual and fundus-free fluoroscopy were performed on all the patients. DR diagnosis and classification was according to the guidelines for clinical diagnosis and treatment of DR in China （2014）. Both monocular and binocular DR were selected as DR patients, and the worse eye for binocular DR were treated as the DR classification of the patient. The patients were grouped by presence or absence of DR. GraphPad Prism 6, SigmaPlot 12.5, SPSS 20.0 and Excel were used to achieve data analysis. Also, SPSS 20.0 was used for multi-factor logistic regression analysis. Results A total of 699 patients （89.04%） were actually recorded. There were 122 eyes of 63 patients （9.01%） with DR （DR group）, 1272 eyes of 636 patients （90.99%） without DR （NDR group）. Among the 122 eyes of DR, there were 19 （15.57%）, 17 （13.93%）, 70 （57.38%）, 10 （8.20%）, 6 （4.92%） eyes in stage Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅴ, respectively. The differences of mean age （t=15 290, P=0.002）, DM duration （t=9075, P〈0.000） and diastolic blood pressure （t=15 810, P=0.006） between the two groups were statistically significant. There were 23 （36.51%） and 394 （61.95%） patients with hypertension history in the DR group and the NDR group, with the significant difference （ χ^2=15.42, OR=0.35, 95%CI 0.21-0.60）. There were 57 （90.48%） and 500 （78.62%） patients with fasting blood glucose larger than 6.11 mmol/L in the DR group and the NDR group, with the significant difference （OR=2.51, 95%CI 1.06-5.95, P=0.031）. Logistic regression analysis showed that the age, fasting blood glucose and DM duration were influencing factors for DR （OR=1.039, 0.864, 0.898; P=0.021, 〈0.000, 〈0.000）. Conclusion The prevalence of DR in patients with T2DM in Culai Town of Tai＇an City is 9.01%. Age, DM duration, fasting blood glucose are associated to DR. Those with a history of hypertension may have a lower risk of DR than those without a history of hypertension.