2型糖尿病患者星状玻璃体变性患病情况及影响因素

Presence and Risk Factors of Asteroid Hyalosis in Patients with Type 2 Diabetes

目的::在抚顺糖尿病视网膜病变队列研究中调查2型糖尿病患者中星状玻璃体变性(AH)的患病情况,并分析危险因素。方法::横断面调查研究。采用多阶段随机抽样方法于2012年7月至2013年5月在抚顺市将军街道社区招募年龄≥30岁且患有2型糖尿病的患者。以视盘为中心、黄斑为中心及黄斑颞侧、颞上、颞下、鼻侧共6方位进行双眼眼底照相,取质量较好的6张眼底照片。如在6张眼底照片中发现玻璃体内存在乳白色球状体则诊断为AH。根据纳入患者的年龄分为<50岁组,50~60岁组,60~70岁组,>70岁组。根据体质量指数(BMI)值,将患者分为BMI<20 kg/m 2组、20≤BMI<25 kg/m 2组、25≤BMI<30 kg/m 2组和BMI≥30 kg/m 2组。根据腰臀比(WHR)的四分位间距,将患者进一步分为WHR<0.93组、0.93≤WHR<0.97组、0.97≤WHR<1.01组、WHR≥1.01组。采用Fisher's精确检验、独立样本t检验对数据进行分析,并采用多因素Logistic回归分析对AH的危险因素进行分析。结果::共纳入具有清晰眼底照片且无玻璃体切割术史的患者1910例,其中20例患者存在AH,检出率为1.05%,95%置信区间(CI)为0.59%~1.50%,1例患者(5%)双眼均存在AH。多因素Logistic回归分析显示,高龄是AH的危险因素[比值比(OR)=1.71,95%CI:1.00~2.93,P=0.049]。随着WHR的增加,AH的检出率明显下降,从WHR<0.93组的2.24%下降到WHR≥1.01组的0.42%(χ^(2)=10.35,P=0.025)。0.97≤WHR<1.01组(OR=0.18,95%CI:0.04~0.84,P=0.029)和WHR≥1.01组(OR=0.19,95%CI:0.04~0.87,P=0.032)的患者与较低的AH检出率相关。AH检出率与其他因素无相关性(P>0.05)。结论::抚顺市2型糖尿病患者中AH的检出率为1.05%。高龄及较小的WHR是影响AH患病的危险因素。

Objective:To investigate the prevalence of asteroid hyalosis(AH)and its associated risk factors in population with type 2 diabetes according to the Fushun Diabetic Retinopathy Cohort Study(FS-DIRECT).Methods:In this cross sectional study,the study used a multistage random sampling method.Residents aged≥30 years and with type 2 diabetes in all of the communities of Jiangjun Street,Fushun City were recruited between July 2012 and May 2013.Six fields of color fundus photography with stereoscopic macula image of each subject were taken by certified photographers using a 45°non-mydriatic retinal camera after pupil dilation.Six fundus photographs with good quality were evaluated.AH was diagnosed as the presence of cream-white spherical bodies within the vitreous from 6 fields of fundus photographs.Patients were categorized into 4 groups,age<50 years,50≤age<60 years,60≤age<70 years,age≥70 years.Patients were further categorized into 4 groups based on the value of body mass index(BMI),BMI<20 kg/m2,20≤BMI<25 kg/m2,25≤BMI<30 kg/m2,and BMI≥30 kg/m2.Patients were further categorized into 4 groups by quartile range of waist-hip ratio(WHR),WHR<0.93,0.93≤WHR<0.97,0.97≤WHR<1.01,WHR≥1.01.Association between age,gender,WHR,et al and AH were analyzed.Fisher's exact test and independent sample t test were used to analyze the data,and multivariate Logistic regression analysis was used to analyze the risk factors of AH.Results:A total of 1910 patients with readable fundus photography and without a history of vitrectomy were included in this study.AH was found in 20 patients,prevalence 1.05%,95%confidence interval(CI)0.59%-1.50%,and was discovered bilaterally in 1 patient(5%).Multivariate logistic analysis showed that advanced age was significantly associated with the presence of AH(OR=1.71,95%CI:1.00-2.93,P=0.049).The prevalence of AH decreased significantly as the WHR increased,from 2.24%in the lowest quartile group,to 0.42%in highest quartile groups(χ^(2)=10.35,P=0.025).Patients in the third(OR=0.18,95%CI:0.04-0.84,P=0.029)and fourth(OR=0.19,95%CI:0.04-0.87,P=0.032)quartile of WHR were independently associated with a lower frequency of AH.No significant associations were found between AH and other characteristics(P>0.05).Conclusions:AH was detected in 1.05%of population with type 2 diabetes in Fushun city.Advanced age and a small WHR were found to be associated with the presence of AH.