青岛开发区糖尿病性视网膜病变流行病学调查及相关因素

目的:分析青岛市开发区社区人群糖尿病性视网膜病变临床流行病学状况及其早期干预。方法:免费普查社区登记的确诊糖尿病患者600例,进行眼科检查,并对检查结果进行统计学分析,及对确诊为糖尿病性视网膜病变病例进行早期干预及治疗。结果:为600例糖尿病患者进行眼科检查,检出糖尿病性视网膜病变107例,患病率17.8%。并对这107例患者进行眼底荧光造影检查,其中确诊病例中有非增殖期病变者79例(73.8%),增殖期病变28例(26.2%)。对糖尿病病程、血糖控制情况、血压、血脂、糖尿病肾病的相关因素进行分析,在确诊的糖尿病视网膜病变患者中,糖尿病病程<10a者12例(11.2%),>10a者95例(88.8%);合并高血压者75例(70.1%);合并高血脂者66例(61.7%);合并糖尿病肾病者37例(34.5%)。结论:通过分析得出糖尿病病程长、空腹血糖高、合并高血压、高血脂、及糖尿病肾病者均属糖尿病视网膜病变发生的高危人群,高危糖尿患者群的密切监测及定期眼底检查是社区患者防治糖尿病视网膜病变的关键。     

关于加强患者遵守糖尿病视网膜病变筛选的意义和存在的问题

在中国,糖尿病视网膜病变已经成为主要的致盲疾病之一。大多数盲是可以避免的,因为及时的激光治疗在挽救视力时被证明是有效的。但是许多患者在早期没有症状,到出现症状时,对于有效的激光治疗为时已晚。所以做为糖尿病患者整体护理的一部分,对糖尿病患者仔细的和定期的眼部监测是非常有必要的。但是目前在中国对糖尿病视网膜病变的筛选还远远不够。作为将来糖尿病视网膜病变的干预基础,这篇文章分析了糖尿病视网膜病变筛查的重要性及执行问题。     

糖尿病视网膜病变的防治策略

糖尿病视网膜病变是我国正处于上升趋势的主要致盲性眼病。为了有效地控制其患病率的上升,近几年的防治策略主要强调对糖尿病视网膜病变的筛查和循证医学指导下的治疗。在社区和基层医院广泛开展早期糖尿病视网膜病变的筛查、定期随诊及治疗评估是降低糖尿病患者视觉残疾发生率的关键措施。新制定的糖尿病视网膜病变国际分类法有利于社区筛查工作者、内分泌科医师及眼科医师间在早期防治糖尿病视网膜病变方面的沟通和交流。目前,在糖尿病视网膜病变的光凝、手术治疗及全身系统治疗方面,已开展了多项临床多中心的随机对照研究,其结果对糖尿病视网膜病变的早期防治具有重要意义。相信坚持在循证医学指导下开展糖尿病视网膜病变的早期防治,一定会有效控制糖尿病引起的视觉残疾。 （中华眼科杂志．2008．44：6-8）     

糖尿病早期视网膜神经退行性病变

糖尿病视网膜病变是人类最主要的致盲原因之一．其发病机制目前尚不清楚。经典理论认为最基本的病理改变为微血管改变。但是近年来的临床和基础研究发现糖尿病患者和动物模型在视网膜特征性微血管发生改变以前已经出现了神经元的改变。现将糖尿病视网膜病变早期视网膜神经退行性病变的国内外研究进展综述如下。     

导升明治疗糖尿病性视网膜病变的概况

糖尿病性视网膜病变是重要的致盲性眼病之一，其早期诊断和及时治疗是防止糖尿病患者失明的重要措施。国内外学者临床实践和研究证明，导升明（羟苯磺酸钙，doxium,calcium dobesilute)对糖尿病性视网膜病变的微循环改变，在预防和治疗上提供了可能。本文从导升明对糖尿病性视网膜病变进程的影响，对眼部病变、视网膜功能和血液学变化、视网膜血液循环、血－视网膜屏障、血液粘度的影响等方面进行综述。     

糖尿病患者早期荧光眼底血管造影的意义——附67例临床报告

近年来，我国糖尿病的发病率有逐年上升的趋势，糖尿病导致的视网膜病变也是眼科临床的常见病之一。糖尿病视网膜病变已成为眼科患者视力损伤和失明的主要原因。因此，早期诊断糖尿病视网膜病变，以便适时进行干预性治疗，其意义尤显重要。最近我们观察了67例糖尿病的眼底检查情况，报告如下。     

视觉电生理检查在糖尿病视网膜病变前期诊断中的应用

糖尿病视网膜病变(DRP)是糖尿病常见的严重并发症之一，也是主要的致盲性眼病之一，如能在糖尿病视网膜病变发生之前，早期诊治，有效的控制血糖及改善视网膜的微循环，就可以减少DRP的发生或减慢其进程，笔者于2001年8月～2004年5月对58例(116只眼)未发生眼底病变的DM确诊患者进行OPs及PVEP检查，现报告如下：     

糖尿病视网膜病变发生发展的全身及眼局部相关因素

糖尿病性视网膜病变(diabetic retinopathy,DR)是最为常见的致盲性眼底病变之一,其发病机制不明。长期以来,早期对于糖尿病性视网膜病变的治疗只是单纯控制血糖,但这并不能完全阻止糖尿病性视网膜病变的进一步发展。因此,研究全身及眼局部相关因素的影响作用十分重要。近年来,国内外大量研究认为,许多全身及眼局部因素对糖尿病性视网膜病变发生发展起重要作用。本文综述此方面成果,为最终通过全身及眼局部的综合干预为早期防治糖尿病性视网膜病变提供思路。     

针刺加川芎嗪离子导入早期干预DR血管病变机制的研究

糖尿病视网膜病变（diabetic retinopathy，DR）是糖尿病（diabetes mellitus，DM）最为常见和严重的微血管并发症之一。近年来，随着DM患者人数的快速增长和寿命的延长，DR的发病率逐步增加，已成为人类最主要的致盲疾病之一，严重影响到糖尿病患者的生存质量。临床流行病学调查表明，DM发病5年后，DR发病率为25％，10年后增至60％，15年后可高达75％-80％。目前，国内外虽然对DR的发病机制、临床诊疗有了深入研究，视网膜激光凝固等中西医治疗方法也取得了一定疗效，     

增殖性糖尿病视网膜病变的手术时机

增殖性糖尿病视网膜病变（proliferative diabetic retinopathy,PDR）是糖尿病患者主要致盲原因,我院在三年中统计2型糖尿病患者428例,大约26．5％的糖尿病患者有不同程度的视网膜病变,其中5．5％为增殖期糖尿病视网膜病变。糖尿病视网膜病变的黄斑水肿、渗出占9．5％,早期的增殖性糖尿病视网膜病变应进行激光治疗,严重的增殖性糖尿病视网膜病变是玻璃体切割手术的常见适应证。     

促红细胞生成素/促红细胞生成素受体系统与糖尿病视网膜病变

糖尿病视网膜病变(diabetic retinopathy,DR)是世界性致盲眼病之一,其发病机制尚不完全清楚。促红细胞生成素(erythropoietin,EPO)是新发现的独立的潜在的糖尿病视网膜病变的血管源性因子。而EPO在DR发病中所起的作用,在不同研究中有不同的表现。本文就EPO/EPOR系统在DR中的表达与DR病变发病的关系研究以及EPO治疗DR的相关研究进展进行综述。     

The epidemiology of diabetic retinopathy

The paper presents a statistic study of the incidence of the diabetic retinopathy in patients who have been recently taken into evidence in the Antidiabetic Centre Timi?oara. These patients were diagnosed between 1994 and 1997. The incidence of the diabetic retinopathy in Romania is more significant than in other countries like USA, France, UK, Finland. The prevalence of the diabetic retinopathy is significant too being placed around the value of 0.02-0.03%. When diabetes mellitus was found, the incidence of nonproliferative diabetic retinopathy was placed around 8% while the incidence of proliferative diabetic retinopathy was placed around 1%. The diabetic retinopathy is more often diagnosed in patients insulin dependent. After 20 years of diabetes mellitus evolution, 80% of the insulin dependent patients and 60% of the noninsulin dependent patients present diabetic retinopathy with a more or less important impact on the visual function.     

Incidence of and risk factors for diabetic retinopathy in Isfahan,Iran

Background Evidence on the incidence of and risk factors for diabetic retinopathy is mainly derived from studies in developed countries. Locally derived evidence is required for planning a well-coordinated approach to this public health problem in developing countries. Objective The objectives of the present study were to estimate the incidence of and risk factors for the development of diabetic retinopathy using routinely collected data from a clinical information system at the Isfahan Endocrinology and Metabolism Research Center, Iran, for non-insulin-dependent (insulin-treated and non-insulin-treated) diabetes. Method During the mean (standard deviation (SD)) follow-up period of 5.1 (2.1) (range 1–9) years, 549 diabetic patients (161 male and 388 female) from the Isfahan Endocrinology and Metabolism Research Center outpatient clinics at Amin University Hospital, Iran, were examined. The mean (SD) age of the participants was 45.7 (9.3) years with a mean (SD) duration of diabetes of 6.9 (5.7) years at initial registration. Results Among the 549 patients free of retinopathy at initial registration with at least one follow-up visit between 1992 and 2001, the incidence of any retinopathy was 89.4 (95% confidence interval (CI): 79.0, 101.0) [96.1 (95% CI: 76.7, 118.0) in males and 86.6 (95% CI: 74.5, 99.9) in females] per 1000 person-years based on 2786 person-years of follow-up. The incidence rate of retinopathy was 60% greater among insulin-treated than non-insulin-treated non-insulin-dependent diabetes mellitus (NIDDM) clinic attenders. The incidence of any retinopathy was greater with older age, longer duration of diabetes, higher diastolic blood pressure and poor metabolic control. Using a Cox's Proportional Hazards Model for insulin-treated and non-insulin-treated NIDDM diabetes separately, poor metabolic control was a significant independent predictor of retinopathy for insulin-treated and non-insulin-treated NIDDM patients. When all variables were entered in the model, age, poor metabolic control and fasting blood glucose were significant predictors of retinopathy. In the insulin-treated group, fasting blood glucose was also a significant predictor of retinopathy. Systolic and diastolic blood pressure, gender, smoking, proteinuria, body mass index and creatinine had no significant independent association with retinopathy when other covariates were considered. Conclusion These data suggest that diabetic retinopathy in this population of Iranian non-insulin-dependent diabetic patients is common, being found in almost half of the patients after a mean 5-year follow-up. Poor metabolic control is the major risk factor.     

Clinical and legal issues in the management of patients with diabetes

Retinopathy is a likely complication of diabetes mellitus, and optometrists who manage patients with diabetes must be prepared to recognize the disease, educate the patient, communicate with the physician treating the disease, and follow up as appropriate to minimize the opportunity for undiagnosed complications. Liability most often results from failure to diagnose diabetic retinopathy, failure to monitor retinopathy adequately, and failure to refer or obtain consultation in a timely manner. Care for patients with diabetes should include appropriate record-keeping and documentation.     

Pharmacological treatment of diabetic retinopathy

Despite the better options of controlling diabetes mellitus and although the prognosis of diabetic retinopathy has markedly improved by laser treatment and vitreoretinal surgery, diabetic retinopathy still is the leading cause of blindness in working age people in industrialized countries. Little has changed in the last decades regarding the prognosis of ocular complications in diabetes mellitus. We therefore need better tools and new therapeutic approaches for the prevention and treatment of diabetic ocular complications. Newer therapeutic options are directed at the causative mechanisms of diabetic retinopathy. Experimental and clinical evidence suggests that pharmacological compounds like somatostatin analogues and protein kinase C (PKC) inhibitors may be effective in the treatment of diabetic retinopathy. Chronic overproduction of growth hormone and insulin-like growth factor 1 play an important role in the pathogenesis of diabetic retinopathy. In the treatment of diabetic retinopathy somatostatin receptors are the targets of somatostatin analogues like octreotide. Octreotide has shown to be a promising treatment of diabetic retinopathy and diabetic macular edema. One important pathomechanism in the development of diabetic retinopathy is the activation of PKC induced by high glucose due to an increased diacylglycerol level. The selective PKC-beta inhibitor ruboxistaurin mesylate enables a new therapeutical approach for the treatment of diabetic retinopathy. Ongoing prospective clinical trials investigate whether the treatment with the specific PKC-beta inhibitor can prevent the progression of diabetic retinopathy and diabetic macular edema.     

Diabetic retinopathy and insulin therapy in a rural diabetic population

The prevalence of diabetic retinopathy was lower in a rural diabetic population when compared to the prevalence of diabetic retinopathy in medical center clinic populations. Adult-onset (Type II) diabetics were at greater risk for developing diabetic retinopathy shortly after diagnosis than newly diagnosed cases of juvenile diabetes (Type I). The use of insulin positively correlated with the prevalence of diabetic retinopathy in this rural population.     

Prevalence and risk factors of diabetic retinopathy among noninsulin-dependent diabetic subjects.

In a population-based study in Taiwan, 11,478 subjects aged 40 years or older were screened for diabetes in one urban and five rural areas. Among the 715 subjects proven to have diabetes, 527 subjects underwent ophthalmoscopy. Diabetic retinopathy was present in 184 of the 527 subjects (35.0%), including background diabetic retinopathy in 157 subjects (30.0%), preproliferative diabetic retinopathy in 15 subjects (2.8%), and proliferative diabetic retinopathy in 12 subjects (2.2%). Diabetic retinopathy was correlated with the duration of diabetes and age at onset of diabetes, type of diabetes treatment, higher serum creatinine levels, and lower serum cholesterol levels. Several other factors, including gender, age, residential area, family income, educational level, control and family history of diabetes, body mass index, physical activity, exercise, cigarette smoking, stroke, ischemic heart disease, leg vessel disease, hypertension, and proteinuria, had no significant association with retinopathy. By multiple logistic regression analysis, duration of diabetes was the most important risk factor related to retinopathy. Diabetic subjects treated with insulin had a higher risk of developing retinopathy than those treated with dietary control (relative risk, 1.57; .05 < P < .10). The univariate analysis disclosed that proliferative diabetic retinopathy was related to older age at examination, older age at onset of diabetes, type of diabetes treatment, and presence of leg vessel disease. Insulin-treated diabetic subjects also had a higher risk of proliferative diabetic retinopathy than patients in whom diabetes was controlled by diet, with a relative risk of 2.51 (.05 < P < .10) in the multiple logistic regression analysis.     

Hospital based epidemiological study for diabetic retinopathy: study design and preliminary results

AIM: To describe the design and preliminary results of the hospital based epidemiological study for diabetic retinopathy(HBESDR), an ongoing epidemiological study to estimate the prevalence of diabetic retinopathy(DR) and to elucidate the clinical, anthropometric, biochemical and any other risk factors associated with diabetic retinopathy. METHODS: Totally 2000 diabetes will be recruited from the Diabetes eye clinic in the First Affiliated Hospital of China Medical University. All subjects underwent blood sugar estimation and Oral Glucose Tolerance Test to diagnose diabetes. All diabetes would undergo complete questionnaire, a comprehensive eye examination. Blood and urine would be collected for biochemical investigations. All fundus photographs for any DR will be graded. Participants who need treatment will be sent to the ophthalmic clinic and follow-up interval program for all subjects will be suggested. A computerized database is created for the records. RESULTS: To date, 1174 diabetes have been recruited, there were 350(29.81%) DR in all diabetes, most of them were with mild non-proliferative diabetic retinopathy (NPDR) (139, 39.71%); 71(20.29%) moderate NPDR, 66(18.86%) severe NPDR, 74(21.14%) proliferative diabetic retinopathy (PDR). Females, longer duration of diabetes, family history of diabetes and hypertension had a statistically significant increase in risk of any DR. CONCLUSION: The study is expected to provide an estimate of the overall prevalence of DR and the prevalence with different duration of diabetes and also a better understanding of the risk factors associated with DR.     

Hospital based epidemiological study for diabetic retinopathy:study design and preliminary results

AIM:To describe the design and preliminary results of the hospital based epidemiological study for diabetic retinopathy(HBESDR),an ongoing epidemiological study to estimate the prevalence of diabetic retinopathy(DR) and to elucidate the clinical,anthropometric,biochemical and any other risk factors associated with diabetic retinopathy.METHODS:Totally 2000 diabetes will be recruited from the Diabetes eye clinic in the First Affiliated Hospital of China Medical University.All subjects underwent blood sugar estimation and Oral Glucose Tolerance Test to diagnose diabetes.All diabetes would undergo complete questionnaire,a comprehensive eye examination.Blood and urine would be collected for biochemical investigations.All fundus photographs for any DR will be graded.Participants who need treatment will be sent to the ophthalmic clinic and follow-up interval program for all subjects will be suggested.A computerized database is created for the records.RESULTS:To date,1174 diabetes have been recruited,there were 350(29.81%) DR in all diabetes,most of them were with mild non-proliferative diabetic retinopathy(NPDR)(139,39.71%);71(20.29%) moderate NPDR,66(18.86%) severe NPDR,74(21.14%) proliferative diabetic retinopathy(PDR).Females,longer duration of diabetes,family history of diabetes and hypertension had a statistically significant increase in risk of any DR.CONCLUSION:The study is expected to provide an estimate of the overall prevalence of DR and the prevalence with different duration of diabetes and also a better understanding of the risk factors associated with DR.     

Longitudinal study examining the risk factors for proliferative retinopathy and maculopathy in type-I diabetes: The Royal College of Physicians of Edinburgh Diabetes Register Group

PURPOSE: The aim of this study was to determine whether there were any differences in the risk factors for developing proliferative diabetic retinopathy or maculopathy in patients with type-I diabetes. METHOD: In all, 1632 patients aged 35 years or younger at diagnosis and treated with insulin, attending six hospital diabetes clinics in Scotland and included on the Royal College of Physicians of Edingburgh Diabetes Register were followed up for a median of 4.0 (2.5-5.5 years: interquartile range). All patients were screened at least annually for diabetic retinopathy using direct ophthalmoscopy, and positive findings were confirmed using slit lamp by an ophthalmologist. RESULTS: Duration of diabetes and HbA1c were the important risk factors for developing proliferative retinopathy, while the duration of diabetes, systolic blood pressure, and HbA1c were the important factors of maculopathy. The adjusted relative incidence for proliferative retinopathy with a HbA1c in the highest quartile was 26.7, while for maculopathy it was only 2.29. Carstairs deprivation score was not associated with either retinal pathology. There was a plateau effect for systolic blood pressure of 140 mmHg and for duration of diabetes of 16 years for developing either maculopathy or proliferative retinopathy. CONCLUSION: Duration of diabetes is a strong predictor for maculopathy and proliferative disease, but is relatively more important for proliferative disease. Raised systolic blood pressure is relatively more important for predicting maculopathy, while raised HbA1c is relatively more important for developing proliferative retinopathy.