上海市新泾社区2型糖尿病居民5年随访的前瞻性调查研究 2.血糖稳定的患者中糖尿病视网膜病变进展的危险因素研究

背景 在一些血糖控制良好的糖尿病患者中,仍然可观察到糖尿病视网膜病变(DR)的发生或发展.关于蒙古人种DR进展的危险因素目前尚不完全明确. 目的 了解血糖稳定控制的2型糖尿病患者中DR进展的5年发生率,探讨其危险因素. 方法 采用前瞻性研究设计.纳入2007-2012年上海市新泾社区中糖化血红蛋白(HbA1c)＜7.0％的2型糖尿病患者453例.其中2007年为基线调查阶段,2012年为终末调查阶段,每年对该人群进行检查,包括一般资料的收集、全身体格检查、实验室检查和眼科检查.采用Forward Logistic逐步回归和Cox逐步回归筛选分析DR进展的独立影响因素.采用Kaplan-Meier生存分析法比较不同HbA1c水平患者人群DR进展的发生率. 结果 453例血糖稳定控制的2型糖尿病人群中,5年后DR进展者146例,占32.23％.多元Logistic回归结果显示,基线调查时HbA1c是影响DR进展的独立影响因素[P＜0.01,优势比(OR)=2.84,95％可信区间(CI):2.11 ～3.82].Cox回归分析显示,基线调查时HbA1c≥5.2％人群中DR的发生率比HbA1c＜5.2％的人群升高了1.97倍[P＜0.01,相对危险度(RR)=1.97,95％ CI:1.32 ～2.93].结论 根据现有血糖稳定标准确诊的2型糖尿病人群中,DR进展的发生率仍然较高.建议在不发生低血糖等严重不良反应的前提下,尽量把血糖降到较低水平,从而降低DR进展的发生率.

A 5-year prospective study of type 2 diabetes patients in Shanghai Xinjing Community 2.The risk factors of diabetic retinopathy progression in type 2 diabetic residents with controlled blood glucose

Background Some diabetic patients with well controlled blood glucose still had diabetic retinopathy(DR).The risk factor of DR progression in Mongoloid was not clear.Objective This study was to assess the 5-year incidence and risk factors of DR progression in type 2 diabetic patients with controlled blood glucose.Methods A prospective study was performed under the informed consent of the patients.453 patients with glycosylated hemoglobin A1c (HbA1c)＜7.0％ in Shanghai xinjing Community from 2007 to 2012 were included in this study.The baseline survey started in 2007 and the final survey ended in 2012.The comprehensive examinations were carried out annually during the follow-up which including general information collection,systemic physical examination,laboratory examination and ophthalmological test.Forward Logistic regression and Cox regression were performed to analysis potential risk factors of DR progression.Kaplan-Meier survival analysis was performed to compare DR progress probability of patients with different HbA1 c level.This study was approved by Shanghai First People's Hospital Ethics Committee Results Among the 453 type 2 diabetic patients,146 developed or progressed DR during the follow-up.The 5-year DR progression rate was 32.23％.Logistic regression showed that baseline HbA1c level was the only independent risk factor of DR progression [P＜0.01,odds ratio (OR)=2.84,95％confidence interval (CI):2.11-3.82].Cox regression results showed that the incidence of DR progression in the baseline HbA1c≥5.2％ patients was 1.97 times higher than that in the baseline HbA1c＜5.2％ patients [P＜0.01,relative risk (RR)=1.97,95％ CI:1.32-2.93].Conclusions The progression rate of DR in type 2 diabetic patients with controlled blood glucose level is still high.In order to reduce DR progression in Chinese type 2 diabetic patients,the targeted HbA1c should be set to a lower level (under 5.2％) under the premise of absent severe side effects.