2型糖尿病视网膜病变随访研究

目的探讨糖尿病视网膜病变(DR)发生发展的危险因素。方法2003年3月至2004年12月间在北京同仁医院内分泌科住院,眼底照相诊断为无DR(NDR)或轻中度非增殖性糖尿病视网膜病变(m-NPDR)的2型糖尿病患者,2年后对随访到的164人复查眼底照相,分析影响DR发生发展的危险因素。结果2006年随访患者的DR发生率为21.2%(22/104),轻中度糖尿病视网膜病变的进展率为36.7%(22/60)。回归分析显示,病程、糖化血红蛋白、总胆固醇(TC)及白蛋白尿是DR发生的独立危险因素;病程、体质量指数(BM I)及血脂异常是m-NPDR进展的独立危险因素。结论DR的发生发展受众多因素的影响,不能仅单纯控制血糖,需加强DR各种危险因素的控制,定期随访及时治疗,预防失明的发生。

Follow-up Study of Diabetic Retinopathy in Type 2 Diabetes Mellitus

Objective To investigate the incidence and progression of diabetic retinopathy in type 2 diabetes,and to analyze the risk factors associated with incidence and progression of diabetic retinopathy.Methods One hundred and sixty-four patients,diagnosed as type 2 diabetes mellitus(84 males,80 females;mean age: 58.84±9.12 years,age of onset: 50.65±9.31 years,diabetes duration: 8.21±6.73 years) from the endocrinology unit of Beijing Tongren Hospital from March 2003 to December 2004 were recruited in this study.All the patients had underwent one-field,non-mydriatic,digital photography,and had diagnosed as no diabetic retinopathy and mild or moderate nonproliferative diabetic retinopathy according to international clinical diabetic retinopathy disease severity scales in 2002.During follow-up in September 2006 to December 2006 the same method was used.According to the baseline degree of diabetic retinopathy,we divided the subjects into two groups: no diabetic retinopathy,mild or moderate nonproliferative diabetic retinopathy.The baseline age,diabetes duration,arterial blood pressure,body mass index,waist to hip ratio,fasting blood glucose,HbA1c,lipid profile were evaluated.Results After 2 years,DR developed in 22 of 104(21.2%) patients unaffected at baseline,progression of mild or moderate nonproliferative diabetic retinopathy in 22 of 60(36.7%).Logistic regression analysis showed that the duration,glycosylated hemoglobin,total cholesterol and urine albumin were independent risk factors of incidence of diabetic retinopathy;duration,body mass index and dyslipdemia were independent risk factors of progression of mild or moderate nonproliferative diabetic retinopathy in type 2 diabetes.Conclusion DR is a multifactorial microvascular complication of type 2 diabetes,which,apart from hyperglycemia,is influenced by blood pressure,lipid concentrations,urine albumin,and other factors.It is necessary to control the risk factors,with regular follow-up and in time treatment for preventing visual loss.