2型糖尿病发生增生性糖尿病视网膜病变的危险因素

Risk factors of proliferative diabetic retinopathy in type 2 diabetes

目的 探讨 2型糖尿病发生增生性糖尿病视网膜病变 (proliferative diabetic retinopathy,PDR)的患病率和危险因素。 方法 对 1994～ 2 0 0 1年首次在我院糖尿病中心就诊的 2型糖尿病患者2 739例 ,进行眼并发症筛查中散瞳检查眼底和荧光素眼底血管造影 (fundus fluorescein angiography,FFA)确定为糖尿病性视网膜病变 (diabetic retinopathy,DR)患者的临床资料进行回顾性分析。同期检测患者的血压、空腹和餐后血糖 ,糖化血红蛋白 (Hb A1c)、血脂、肌酐和尿白蛋白含量。 结果 2型糖尿病DR总患病率为 2 7.8% (76 1/2 739) ,PDR的患病率为 4 .2 % (114 /2 739) ,占所有 DR患者的 15 %。PDR病变组的病程、空腹血糖、糖化血红蛋白、血压水平和尿白蛋白含量均高于对照组 (P<0 .0 1,糖化血红蛋白低于 0 .0 5 )。L ogistic多元回归分析显示 ,影响 PDR发病的危险因素是病程 (r=0 .15 ,P<0 .0 1)和尿白蛋白含量 (r=0 .0 8,P<0 .0 5 )。病程为 5年和 5年以上的患者 ,并发 PDR的危险因素是尿白蛋白含量和空腹血糖水平 (r=0 .13,P<0 .0 5 )。进一步分析表明病程为 5年以内、5～ 10年和大于 10年的患者 ,PDR的患病率分别为 2 .3%、5 .9%、12 .4 %。无蛋白尿、微量蛋白尿和显性蛋白尿组 PDR的患病率分别为 2 .1%、

Objective To explore the morbidity rate and risk factors of proliferative diabetic retinopathy (PDR) in type 2 diabetes. Methods The clinical data of patients, with PDR in 2739 consecutive cases of type 2 diabetes diagnosed in this hospital from 1994 to 2001 were analyed retospectively. The diagnosis of diabetic retinopathy (DR) was confirmed by ophthalmoscopy and fundus fluorescein angiography (FFA). Blood pressure, fasting and postprandial blood sugar, glycosylated haemoglobin(HbA1c), total serum cholesterol, triglyceride, creatinine, and albumin excretion rate were measured. Results The morbidity rate of type 2 DR was 27.8%(761/2739), and the morbidity rate of PDR was 4. 2%(114/2 739) occupying 15% of the patients with DR. The duration, fasting blood sugar, glycosylated haemoglobin, blood pressure and albumin excretion rate were much higher than those in the control ( P< 0.01, glycosylated haemoglobin P< 0.05). The independent risk factors of PDR were duration of the disease r =0.15, P< 0.01) and albumin excretion rate ( r =0.08, P< 0.05). The risk factors of PDR were albumin excretion rate and fasting blood sugar ( r =0.13, P< 0.05) in patients with longer duration(≥5 years). The morbidity rate of PDR was 2.3%, 5.9% and 12.4% in patients with duration less than 5 years, 5 to 10 years and over 10 years groups, respectively. The morbidity of PDR of the patients in normal albuminuria, microalbuminuria and overt albuminuria group was 2.1%、5.3% and 18. 8% respectively. Conclusions Type 2 diabetes accompanied with PDR is relative to the duration of the diabetes, albumin excretion rate, fasting blood sugar, blood pressure, and glycosylated haemoglobin, in which the duration of the disease, albuminuria and fasting blood sugar are the risk factors of occurance of PDR.