增殖性糖尿病视网膜病变的危险因素分析

目的 探讨广东地区病程10年及以上的2型糖尿病(DM)患者发生增殖性糖尿病视网膜病变( PDR)的危险因素。方法 收集中山大学中山眼科中心和中山大学附属第一医院内分泌科就诊的144例病程10年及以上的2型DM患者，分为PDR组和非增殖性糖尿病视网膜病变(NPDR)组，进行病例对照研究。通过x2检验及多因素logistic回归分析人群特征、生活行为习惯、既往病史、糖尿病家族史、血压及糖化血红蛋白等因素中与发展成PDR相关的因素。结果 单因素分析提示，年龄轻(OR=0.25，P =0.000)、教育程度低（OR=2.42,P=0.013）、糖尿病肾病(OR=2.80,P=0.01)、糖尿病周围神经病变(DPN)(OR=2.56,P=0.008)、运动少(OR=2.55,P=0.006)、高血压(OR=2.31,P=0.014)及吸烟(OR=3.96，P =0.001)与PDR相关。多因素logistic回归分析显示年龄轻(OR=0.92,P=0.000)、教育程度低(OR=2.64，P =0.021)、DPN (OR=2.36,P=0.036)及吸烟(OR=3.27，P=0.013)与PDR相关。结论 年龄轻、教育程度低、吸烟及DPN是广东地区病程10年及以上的2型DM患者发生PDR的危险因素。眼科医生应加大对年龄轻、教育程度低、吸烟及有DPN病史的DM患者的随访密度，并教育患者重视生活习惯。

The analysis of risk factors of proliferative diabetic retinopathy

Objective To investigate the risk factors of proliferative diabetic retinopathy (PDR) in type 2 diabetes mellitus (DM) patients of 10 years or more duration in Guangdong province. Methods A total of 144 type 2 DM of 10 years or more duration from Zhongshan Ophthalmic Center and the Department of Endocrinology of the First Affiliated Hospital of Sun Yat-sen University were divided into PDR group and non-proliferative diabetic retinopathy (NPDR) group, and then investigated by case-control study. To analyze the factors associated with PDR from the factors of demographic characteristics, behavioral habits, past disease history, diabetes family history, blood pressure and glycated hemoglobin by X 2 test and multivariate logistic regression analysis. Results Univariate analysis showed that younger age (OR=0.25, P=0.000), lower educated (OR=2.42, P=0.013), diabetic nephropathy (OR=2.80, P=0.01), diabetic peripheral neuropathy (DPN) (OR=2.56, P=0.008), less exercise (OR=2.55, P=0.006), hypertension (OR=2.31, P=0.014) and smoking (OR=3.96, P=0.001) were associated with PDR. Multivariate logistic regression analysis showed younger age (OR=0.92, P=0.000), lower educated (OR=2.64, P=0.021), DPN (OR=2.36, P=0.036) and smoking (OR=3.27, P=0.013) were associated with PDR. Conclusions Young age, low education, smoking and DPN are the risk factors of PDR in type 2 DM patients of 10 years or more duration. Ophthalmologists should follow up DM patients of young age, less educated, smoking and DPN frequently and let patients pay more attention to lifestyle.