Differential diameter responses in macular and peripheral retinal arterioles may contribute to the regional distribution of diabetic retinopathy lesions

Background  

Diabetic retinopathy is assumed to be due to impaired retinal autoregulation, involving both pressure autoregulation and metabolic autoregulation. The disease displays regional differences, with signs of hyperperfusion in the macular area and capillary occlusion with retinal ischemia in the peripheral retinal areas. It can be hypothesized that these regional differences in the occurrence of retinopathy lesions may reflect differences in the capacity of retinal arterioles to autoregulate the diameter of retinal arterioles.     

MPV may reflect subcinical platelet activation in diabetic patients with and without diabetic retinopathy

Purpose

To search subclinical platelet activation via detecting three important platelet activation parameters; mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) in diabetic retinopathy (DR) in comparison with those in healthy adults as controls.

Methods

This prospective study included 140 patients who were followed-up at the Ankara Ulucanlar Eye Education and Research Hospital, and 40 normal subjects. All patients and control subjects underwent complete ophthalmologic evaluation. Of patients with type 2 diabetes, 43 cases with diabetes mellitus (DM) have no DR (Group 1), 45 cases with DM have nonproliferative DR (NPDR) (Group 2), and 52 cases with DM have proliferative DR (PDR) (Group 3). In addition, 40 age- and sex-matched healthy controls (Group 4) were included into the study. MPV, PDW, and PCT were measured in the studied groups.

Results

The MPV levels were significantly altered in Group 1, Group 2, and Group 3 patients when compared with those in the controls (P<0.05), whereas PDW and PCT levels were not significantly changed among groups (P>0.05).

Conclusion

The data provided a significant association between MPV levels and DM. Diabetic patients have increased MPV values compared with healthy subjects, but MPV levels were not altered together with the DR stage. Diabetic and DR patients have no different PDW and PCT values compared with healthy subjects. MPV may be a clue for the reflection of subclinical platelet activation in DM regardless of the DR stage.     

糖尿病视网膜病变发生的相关危险因素分析

目的 评价糖尿病视网膜病变(DR)的相关危险因素。方法 对186例2型糖尿病患者可能诱发DR的危险因素如年龄、性别、病程、血压、体重指数、空腹血糖、血清胆固醇、甘油三酯、尿素氮、肌酐、尿白蛋白排泄率进行了前瞻性研究。并用单因素χ^2检验和多因素logistic回归分析筛选和判定DR发生的危险因素。结果 115例患者合并有DR，占61．83％。经logistic回归分析，发现病程、空腹血糖、甘油三酯、尿白蛋白排泄率与DR有显著相关。结论 病程、空腹血糖、甘油三酯、尿白蛋白排泄率为DR发生的重要危险冈素，应重视并针对其危险因素加以预防。     

糖尿病视网膜病变病程进展的多因素分析

目的探讨影响糖尿病视网膜病变（diabetic retinopathy，DR）病程进展的相关因素。设计病例观察研究。研究对象90例确诊为DR并未经眼部治疗的患者。方法经眼底荧光素血管造影术（FFA）检查并分型确诊为DR患者90例，记录病史、眼部检查、全身合并症。主要指标DR类型与发病年龄、性别、病程、体重指数（BMI）、眼压、屈光度、玻璃体后脱离、血压、血糖、糖化血红蛋白、肌酐、尿素氮、及全身合并症的相关性。结果DR患者在不同的病程阶段空腹血糖、糖化血红蛋白、尿素氮、周围神经病变，是否胰岛素治疗和有无口服降糖药6个因素有显著性差异。在logistic回归检验中，糖化血红蛋白、尿素氮和周围神经病变三个因素被认为是与DR病程进展相关的三个危险因素。结论对于DR患者应注意对其糖化血红蛋白和尿素氮指标的检测。对于合并周围神经病变的患者，应采取更积极的治疗手段。     

糖尿病视网膜病变发生危险因素的病例对照分析

目的探讨糖尿病视网膜病变(DR)发生的相关危险因素。方法收集107例糖尿病视网膜病变(DR)患者和不伴有视网膜病变的糖尿病(NDR)患者102例,分别就其可能诱发DR的危险因素如病程、空腹血糖、糖化血红蛋白、血压、血脂、纤维蛋白原水平和尿白蛋白等因素进行病例对照研究。结果通过单因素方差分析发现,糖尿病患者的病程长、空腹血糖升高、血中糖化血红蛋白升高、高血压病、尿白蛋白升高和血浆纤维蛋白原升高与DR的发病呈显著正相关,血清甘油三酯、胆固醇与DR发病无显显相关关系。结论糖尿病视网膜病变的发生和发展与患者的病程、血糖水平、糖化血红蛋白、合并高血压病、尿蛋白以及血浆纤维蛋白原水平升高有关,预防上述危险因素,可减少DR的发生发展。     

The relationships between risk factors and the distribution of retinopathy lesions in type 2 diabetes

PURPOSE: Previous studies have shown that the progression of diabetic retinopathy to vision-threatening lesions may be related to the development of retinopathy lesions in specific retinal areas. The purpose of the present study was to examine whether the occurrence of retinopathy in these retinal areas is related to known risk factors for progression of retinopathy in type 2 diabetes. METHODS: A total of 377 randomly selected patients with type 2 diabetes underwent examinations which included measurement of blood pressure, haemoglobin A1c and cholesterol, and a full eye examination including fundus photography. The fundus photographs were digitized and a computer-assisted technique was used to quantify retinopathy lesions in the macular area, around the vascular arcades and in the retinal periphery. Only the number of microaneurysms/haemorrhages was sufficient for statistical analysis. RESULTS: Patients with retinopathy had significantly longer diabetes duration, and higher blood pressure and HgbA1c than patients without retinopathy. However, among the patients with retinopathy there was no correlation between these risk factors and the overall number of microaneurysms/haemorrhages or the number of these lesions in the local areas of the fundus studied. CONCLUSIONS: The localized distribution of retinopathy lesions does not correlate with known risk factors and background factors for the development of diabetic retinopathy in the early stages of the disease. Future improvements of grading systems for diabetic retinopathy should focus on a quantification of the overall number and dynamics of retinopathy lesions in the early stages of retinopathy and the regional distribution and dynamics of lesions in more advanced stages of retinopathy.     

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。     

糖尿病视网膜病变危险因素logistic回归分析

目的 了解安徽省糖尿病患者中糖尿病视网膜病变（ＤＲ）的患病率及其危害因素。方法 以安徽省六地市自然人群中糖尿病患者２１６人为样本,进行年龄、性别、体重指数、血压、教育水平、病程、空腹血糖、血清胆固醇、甘油三酯、尿白蛋白排泄率、眼底等检查。结果 ６７例患者合并有ＤＲ,占３１．０％。单纯型者６２例,占２８．７％,增生型者５例,占２．３％。经Ｌｏｇｉｓｔｉｃ回归分析,发现病程、空腹血糖、收缩压及尿白蛋白排泄率与ＤＲ有显著相关关系。结论 病程、空腹血糖、收缩压、尿白蛋白排泄为ＤＲ的重要危险因素。     

Incidence of and risk factors for diabetic retinopathy in diabetic clinic attenders

The incidence and risk factors for the development of diabetic retinopathy during a mean (SD) follow-up period of 4.6 (2.9) (range 1-12.4) years have been examined among 3424 patients (1878 males and 1546 females) with diabetes mellitus from three outpatient clinics at the University Hospital, Nottingham. The mean (SD) age of participants was 49.2 (17.9) years with a mean (SD) duration of diabetes of 7.3 (9.0) years at initial registration. Among the 3424 patients free of retinopathy at initial registration who attended the clinic at least twice in the period 1979-1992, the incidence of any retinopathy was 59.6 (57.8 male and 61.8 female) per 1000 person-years based on 15,571 person-years of follow-up. The incidence rate of retinopathy was 72% higher among insulin-treated than among non-insulin-treated noninsulin-dependent diabetes mellitus (NIDDM) clinic attenders. Using a Cox's Proportional Hazards Model for insulin-dependent diabetes (IDDM) and NIDDM (insulin and non-insulin-treated) diabetes separately, longer duration of diabetes, higher systolic blood pressure and poor metabolic control were significant independent predictors of retinopathy for all three groups. Never smoking was a significant independent predictor of retinopathy for the insulin-dependent diabetes groups. Lower body mass index, proteinuria and age were predictors of retinopathy only for non-insulin-treated NIDDM patients. Gender and creatinine had no significant independent association with retinopathy when other covariates were considered. These findings will help the identification of those patients at particular risk of retinopathy so that clinic time for screening of eyes can be appropriately focused.     

糖尿病性视网膜病变相关危险因素分析

目的 分析糖尿病性视网膜病变(DR)发生的相关危险因素.方法 对322例糖尿病患者的DR进行分期并对相关因素如年龄、性别、病程、体重指数、空腹血糖、血压等进行统计分析.结果 糖尿病患者的病程、收缩压、空腹血糖的差异具有统计学意义;年龄、性别、体重指数、舒张压、生活习惯等指标差异无统计学意义.结论 糖尿病的病程、高血压、空腹血糖是DR发生的主要危险因素.     

糖尿病视网膜病变相关危险因素分析

目的 分析糖尿病（DM）发生糖尿病视网膜病变（DR）的危险因素,为DM并发症的预防和治疗提供理论依据。方法 采用多中心大样本的临床横断面研究方法,对630例DM患者的DR的分期与相关因素如病程、体重指数、血糖控制、血脂、血压等进行统计学分析。结果 DR临床前期、非增生期与增生期患者的DM平均病程、HbA1c水平、收缩压差异有统计学意义（P〈0.01）;DR各期体重指数、空腹及餐后血糖、血脂等指标差异无统计学意义。结论 DM的病程、血糖控制与血压是DR发生的主要危险因素,因此在DM二级预防中要加强降糖、降压等综合治疗。     

Risk factors for progression of diabetic retinopathy in Alberta First Nations communities

ObjectiveThe Screening for Limb, I-Eye, Cardiovascular, and Kidney Complications (SLICK) Program was implemented in 1999 to improve diabetic care for Alberta First Nations individuals living on reserve. The purpose of this review is to determine the rate and predictors of progression of diabetic retinopathy (DR) over a 10-year period.DesignCohort study.ParticipantsNine hundred and eighty First Nations patients with diabetes that underwent at least 2 teleophthalmology examinations during the study period.MethodsPatients underwent serial laboratory testing, and stereoscopic, mydriatic, retinal photography. Modified Early Treatment Diabetic Retinopathy Study grading of retinal images was performed via teleophthalmology. Progression was defined as an increase of 2 or more steps on the Diabetes Control and Complications Trial classification.ResultsAt baseline, most patients had no diabetic retinopathy (n = 777, 79.3%) whereas 203 people (20.7%) had either nonproliferative DR (n = 179, 18.3%) or proliferative DR (n = 24, 2.5%). Two-step progression occurred in 163 patients (16.6%), with only a minority of these individuals progressing to proliferative DR (n = 23). The median time to progression was 7.6 years. Multivariate Cox regression demonstrated that elevated hemoglobin A1C (hazard ratio [HR] = 1.42; p < 0.0001) and systolic blood pressure (HR = 1.24 per 10 mm Hg; p = 0.009) were independent predictors of progression of DR.ConclusionsThis population-based study has shown that the rate and predictors of progression of DR among First Nations individuals parallels non-First Nations populations, with HbA1C and systolic blood pressure being the strongest predictors. These findings suggest that targeted, individualized care to reduce blood pressure and control blood sugars could reduce progression of diabetic retinopathy, and possibly blindness in First Nations individuals living on reserve.     

血脂、血压对早期糖尿病视网膜病变进展的影响

目的探讨血脂、血压对早期糖尿病视网膜病变（DR）进展的影响。方法收集DR-0期,轻、中、重度非增生性糖尿病视网膜病变（NPDR）各20例,对照组30例,记录血脂、血压在不同分组中的测量值,分析其与早期DR发生发展的关系。结果 DR组的收缩压（SBP）、胆固醇（CHO）、甘油三酯（TG）明显高于正常对照组,而高密度脂蛋白（HDL）则低于对照组;且TG与DR的病变程度呈显著正相关。结论 CHO、TG是DR的危险因素,HDL是DR的保护因素,且TG可能与DR的发展有相关性。     

早期糖尿病视网膜病变进展的危险因素

目的探讨早期糖尿病视网膜病变（DR）进展的相关危险因素。方法收集DR-0期,非增生性糖尿病视网膜病变（NPDR）轻、中、重期各30例,正常对照组40例,记录年龄、病程、血糖、血压、血脂、血小板参数、凝血功能在不同分组中的测量值,分析其与早期DR发生发展的关系。结果DR组的糖化血红蛋白（HbA1C）、空腹血糖（FBG）、收缩压（SBP）、胆固醇（CHO）、甘油三酯（TG）、低密度脂蛋白（LDL）及纤维蛋白原（FG）明显高于正常对照组,而高密度脂蛋白（HDL）则低于对照组;且病程、HbA1C、TG与DR的病变程度呈显著正相关。结论HbA1C、FBG、SBP、CHO、TG、LDL、FG是DR的危险因素,且病程、HbA1C、TG可能与DR的发展有相关性。     

Prevalence and risk factors for diabetic retinopathy among Omani diabetics

AIMS—To study the prevalence of diabetic retinopathy in a population of patients attending a diabetic clinic and to evaluate the medical risk factors underlying its development.
METHODS—500 randomly selected diabetic patients attending the diabetes clinic in Al Buraimi hospital were referred to the ophthalmology department where they were fully evaluated for the absence or presence of retinopathy. Any retinopathy present was graded as mild non-proliferative retinopathy (NPR), moderate-severe NPR, and proliferative retinopathy. Several risk factors were then evaluated in order to delineate those related to occurrence of retinopathy in general as well as to the different grades of retinopathy in particular.
RESULTS—Diabetic retinopathy was detected in 212 patients (42.4%), with mild NPR present in 128 patient (25.6% of the total population), moderate-severe NPR in 20 patients (4%), and proliferative diabetic retinopathy present in 64 patients (12.8%). Factors significantly related to occurrence of retinopathy were age of the patient, duration of diabetes, presence of ischaemic heart disease, presence of hypertension, a high fasting capillary glucose level as well as elevated serum levels of urea, creatinine, cholesterol, and triglycerides. After adjustment for covariates, it was found that duration of diabetes was the only risk factor associated with mild NPR, while high diastolic blood pressure and high levels of serum creatinine, cholesterol, and triglycerides were significantly associated with the occurrence of proliferative retinopathy.
CONCLUSIONS—In addition to glycaemic control, lowering of blood lipids as well as diastolic blood pressure (in hypertensive patients) may be effective in lowering the incidence of retinopathy in compromised patients.

Keywords: diabetic retinopathy; Oman; diabetics     

糖尿病视网膜病变危险因素与预防研究进展

糖尿病视网膜病变（diabetic retinopathy,DR）是糖尿病（diabetes mellitus,DM）的常见慢性并发症之一,属于微血管病变,是工作人群及中老年人视力减退甚至导致失明的主要原因。1/3~1/2的糖尿病患者同时伴有视网膜病变,DR与糖尿病病程、高血糖、高血压及高血脂等危险因素均密切相关。个体血糖和血压的最优控制仍然是预防DR发生和阻止病变进展的基石,抗血管内皮因子治疗被认为是目前最有效的糖尿病性黄斑水肿的治疗方案。这些有效的防治手段,患者及医生意识的提高,定期筛查DR,将有效改善DR患者的预后,减少因DR导致失明患者的人数,进一步提高患者的生存质量。     

南昌市社区糖尿病视网膜病变患病率及危险因素分析

目的　调查南昌市部分社区４０岁及以上人群中２型糖尿病患者糖尿病视网膜病变（ｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ,ＤＲ）的患病率和相关危险因素。方法　采用分层整群随机抽样的方法对４０岁及以上人群进行问卷调查,并进行身体质量指数、血压、血脂、２４ｈ尿蛋白等检测,同时行眼科相关检查:视力、裂隙灯、验光、眼压、直接眼底镜、眼底照相及荧光眼底血管造影,分析ＤＲ相关危险因素。结果　有９７７６名调查对象接受检查,受检率９７．７６％,８３１例确诊为２型糖尿病,其中有７８０人接受了眼科检查,除５０例屈光介质混浊较重无法看清眼底者外,７３０例患者中确诊ＤＲ者２２３例,占糖尿病患者的３０．５％,其中背景型ＤＲ患者２１１例,占糖尿病患者的２８．９％,增殖型ＤＲ患者１２例,占糖尿病患者的１．６％。多因素分析显示糖尿病病程长、高血糖、高血压、高血脂、高２４ｈ尿微量蛋白是ＤＲ的显著危险因素,而年龄、性别等与ＤＲ发病相关性不大。结论　南昌市社区４０岁及以上人群２型糖尿病患者中ＤＲ的患病率较高,糖尿病病程长、高血压、高血糖、高血脂、高２４ｈ尿微量蛋白是ＤＲ发生的危险因素。