金华市50岁及以上2型糖尿病患者白内障患病状况及影响因素分析

Analysis on the prevalence of cataract and its influencing factors in type 2 diabetes patients aged 50 years and above in Jinhua City

目的了解金华市50岁及以上2型糖尿病患者白内障患病现状、分型及其影响因素,为2型糖尿病人群白内障疾病的防治工作提供依据。方法采用横断面研究及分层整群随机抽样方法,抽取金华市婺城区17个基本抽样单位2569名糖尿病患者作为研究对象。通过问卷调查的方式采集患者基本信息和糖尿病相关情况。由眼科医师和技师对患者进行眼底检查,并进行白内障的诊断。采用多因素logistic回归分析糖尿病人群罹患白内障的相关因素。结果本研究实际纳入2156例糖尿病患者(应答率83.92%),检出白内障患者391例(18.14%),其中核性307例(78.52%)、皮质性47例(12.02%)、后囊膜下5例(1.28%)、混合型32例(8.18%)。多因素logistic回归分析结果显示,相较于50~59岁的糖尿病患者,60~69岁和70岁及以上糖尿病患者白内障的发生风险增加,OR(95%CI)值分别为1.210(1.028~1.423)、1.419(1.151~1.751);相较于女性,男性糖尿病患者的白内障发生风险较高(OR=1.239,95%CI:1.036~1.481);相较于无高血压的患者,糖尿病合并高血压的患者白内障发生风险较高(OR=1.436,95%CI:1.102~1.871);相较于BMI正常患者,偏瘦、超重和肥胖的糖尿病患者白内障发生风险较高,OR(95%CI)值分别为1.466(1.084~1.982)、1.362(1.126~1.647)、1.345(1.053~1.718);相较于5年以下糖尿病病程的人群,5~9年、10年及以上糖尿病病程的人群白内障发生风险较高,OR(95%CI)值分别为1.848(1.475~2.315)、2.130(1.200~3.783);相较于空腹血糖水平<6.1 mmol/L,空腹血糖水平为6.1~7.9 mmol/L、≥8.0 mmol/L糖尿病患者白内障的发生风险较高,OR(95%CI)值分别为1.829(1.075~3.111)、2.171(1.124~4.194)。结论50岁及以上2型糖尿病人群白内障患病率高于非糖尿病人群。本研究提示对长病程、高龄以及合并高血压的糖尿病患者应重点关注。加强白内障定期筛查,加强血糖和血压控制对减少白内障发生具有重要意义。

Objective To investigate the prevalence and classification of cataract and their influencing factors in type 2 diabetes patients aged 50 years and above in Jinhua City,and to provide a basis for prevention and treatment of cataract among people with type 2 diabetes.Methods A cross-sectional study and stratified cluster random sampling method were used in this analysis.2,569 diabetes patients were selected from 17 basic sampling units in Wucheng District of Jinhua City to serve as the study subjects,and their general information and diabetes related information were collected through a questionnaire survey.Fundus examinations were made by ophthalmologists and technicians,and cataract diagnosis was performed.Multivariate logistic regression analysis was conducted to identify the factors related to cataract in the diabetes patients.Results A total of 2,156 diabetes patients were actually enrolled into the study(with a response rate of 83.92%).A total of 391(18.14%)cataract patients were detected,including 307 cases of nuclear cataract(78.52%),47 cases of cortical cataract(12.02%),5 cases of posterior subcapsular cataract(1.28%),and 32 cases of mixed cataract(8.18%).The results of multivariate logistic regression analysis displayed that diabetes patients aged 60-69 years and 70 years and above had an increased risk of developing cataract(OR=1.210,95%CI:1.028-1.423;OR=1.419,95%CI:1.151-1.751)compared with ones aged 50-59 years.Male diabetes patients were at a higher risk of having cataract compared with female ones(OR=1.239,95%CI:1.036-1.481).Diabetes patients with hypertension had a higher risk of having cataract compared with ones without hypertension(OR=1.436,95%CI:1.102-1.871).Diabetes patients with underweight,overweight and obesity had a higher risk of suffering from cataract(OR=1.466,95%CI:1.084-1.982;OR=1.362,95%CI:1.126-1.647;OR=1.345,95%CI:1.053-1.718)compared with ones with normal BMI.Diabetes patients having the course of disease with 5-9 years and 10 years and above ran a higher risk of getting cataract(OR=1.848,95%CI:1.475-2.315;OR=2.130,95%CI:1.200-3.783)compared with ones having the course of disease less than 5 years.Diabetes patients with fasting blood glucose levels of 6.1-7.9 mmol/L and≥8 mmol/L ran a higher risk of getting cataract(OR=1.829,95%CI:1.075-3.111;OR=2.171,95%CI:1.124-4.194)compared with ones with fasting blood glucose level<6.1 mmol/L.Conclusion The prevalence rate of cataract was higher in diabetes patients aged 50 years and above than in non diabetes population.The results suggest that special attention should be paid to diabetes patients with long disease course,advanced age and hypertension.It is of great significance for reducing the occurrence of cataract to strengthen the regular screening of cataract and enhance the control of blood sugar and blood pressure.