2型糖尿病视网膜病变相关因素分析

目的 分析影响2型糖尿病视网膜病变(DR)的相关因素. 方法 对635例2型糖尿病患者的眼底、血压、HbA1c、FPG、Cr、血尿酸及尿微量白蛋白∕肌酐比(UACR)等临床资料进行回顾性分析. 结果 2型糖尿病患者DR总患病率为23.9%,其中非增生性DR占20.6%,增生性DR占3.3%; DR患者的病程、HbA1c、Cr、SBP、UACR和FPG均高于单纯DM患者(P<0.05);增生性DR患者的病程显著长于非增生性DR患者(P<0.01).Logistic多元回归分析显示,病程是DR发病的独立危险因素. 结论 DR与糖尿病病程、HbA1c、Cr、SBP、UACR及FPG等的升高有关,病程是DR发生的重要危险因素.     

内皮祖细胞功能障碍与糖尿病性视网膜病变的相关研究进展

糖尿病性视网膜病变(DR)是以微血管病变为主要临床表现的视网膜疾患,流行病学调查表明,社区糖尿病人群中DR患病率可高达27.3%[1],在我国DR已成为成人双眼盲的首位疾病.     

糖尿病视网膜病变的筛查与治疗——2015年ADA诊疗指南解读

<正>糖尿病视网膜病变(DR)是糖尿病高度特异性微血管并发症,是导致成年人群失明的主要原因。在2型糖尿病成年患者中,大约有20%~40%出现视网膜病变,8%有严重视力丧失。2型糖尿病患者也是发生其他眼部疾病的高危人群,这些眼病包括白内障、青光眼、视网膜血管阻塞及缺血性视神经病变等。已有共识,糖尿病视网膜病变的主要危险因素包括     

糖尿病眼病

糖尿病眼病是糖尿病最常见的并发症之一,是当前人类致盲的主要原因。糖尿病眼病分为糖尿病视网膜病变（DR）和非视网膜眼部并发症。在1型和2型糖尿病中,糖尿病视网膜病变是特异性很高的血管并发症,病程长是重要的危险因素,患糖尿病20年后几乎所有的1型糖尿病和60％的2型糖尿病都出现不同程度的视网膜病变。DR是21～74岁人群中严重视力减退的重要原因。非视网膜眼部并发症包括白内障、青光眼和前部缺血性视神经病变。下面就糖尿病眼病研究进展综述如下。     

内分泌医生教程——从ADA指南看糖尿病视网膜病变

<正>糖尿病视网膜病变(DR)是糖尿病高度特异性微血管并发症,是导致成年人群失明的主要原因。在2型糖尿病成年患者中,大约有20%~40%出现视网膜病变,8%有严重视力丧失。目前对晚期的糖尿病视网膜病变没有很好的治疗方法,减少糖尿病性盲的关键在于早期发现无症状的DR,使患者在失明前得到治疗。因此,了解DR的发病状况及危险因素并作出必要的干预,对降低其发病率和致盲率有着重要     

糖尿病视网膜病变的患病率和危险因素分析

目的探讨糖尿病视网膜病变的患病率及其发生、发展的相关危险因素。方法选取2014年4月—2016年2月在该院内分泌科住院且行眼底照相的2型糖尿病患者175例为研究对象,根据是否合并有糖尿病视网膜病变(DR)分为糖尿病视网膜病变组(DR)80例,非糖尿病视网膜病变(NDR组)95例,分别比较年龄、病程、身高、体重、血压、计算体重指数(body mass index,BMI)、空腹血糖、糖化血红蛋白、尿素氮、肌酐、甘油三酯、总胆固醇、高密度脂蛋白、低密度脂蛋白、24 h尿蛋白等生化指标两组间比较,DR的危险因素分析采用Logistic回归分析其与糖尿病视网膜病变的关系。结果 175例DM患者中,DR组80例(45.7%),DR中增值性糖尿病患者5例(6.25%),NDR组95例(54.3%)。两组病例之间性别、BMI、FPG、HbAlc、胆固醇、低密度脂蛋白、舒张压、空腹血糖差异无统计学意义(P0.05)。DR组病程、甘油三酯、血肌酐、血尿素氮、24 h尿蛋白、年龄、收缩压与NDR组相比较差异有统计学意义(P=0.01、0.02、0.028、0.016、0.03、0.013、0.023,P0.05)。所得结果通过非条件Logistic回归对糖尿病视网膜病变的相关因素进行分析,结果证实:糖尿病病程为糖尿病患者中糖尿病视网膜病变的独立危险因素(OR=1.25,P0.005)。结论 DR的发生多种因素有关,其中病程是其独立危险因素。     

2型糖尿病患者糖尿病视网膜病变相关危险因素分析

目的分析2型糖尿病患者发生糖尿病视网膜病变（DR）的相关危险因素。方法采用SPSS11.0统计软件对DR患者的性别、年龄、病程、收缩压、舒张压、糖化血红蛋白、甘油三脂、总胆固醇、低密度脂蛋白、8 h尿白蛋白排泄率（UAE）等因素作二项分类Logistic分析。结果 Logistic分析显示,糖尿病病程、收缩压、合并蛋白尿与2型糖尿病患者DR的发生有关（P均〈0.001）。结论糖尿病病程、收缩压、合并蛋白尿是2型糖尿病患者发生DR的危险因素。     

2型糖尿病患者HbA1c水平与糖尿病视网膜病变DR分期的相关性

目的探讨2型糖尿病患者HbA1c水平与糖尿病视网膜病变DR分期的相关性。方法选取2019年11月—2020年8月就诊于承德市中心医院内分泌科,并诊断为2型糖尿病的患者265例,根据眼底检查结果分为非糖尿病视网膜病变(NDR)组(n=156)及糖尿病视网膜病变(DR)组(n=109)。收集两组患者的临床资料包括性别、年龄、糖尿病病程、吸烟史、随机血糖、糖化血红蛋白、血脂、25-羟基维生素D、甲状旁腺激素等。为进一步分析将DR组患者根据HbA1c水平分为两个亚组:HbA1c<10%组;HbA1c≥10%组;比较HbA1c水平与糖尿病视网膜病变DR分期的相关性。结果与NDR组比较,DR组HbA1c水平显著升高[(8.83±1.98)%vs(9.35±1.87)%],差异有统计学意义(P<0.05)。多元Logistic回归分析提示糖尿病病程、HbA1c水平与2型糖尿病患者发生糖尿病视网膜病变独立相关(OR=1.174,95%CI:1.111~1.124;OR=1.234,95%CI:1.021~1.492,P<0.05)。亚组分析结果表明,HbA1c≥10%组(n=35)增殖期(PDR)者较HbA1c<10%组(n=74)明显增多,差异有统计学意义(P<0.05)。结论HbA1c水平与2型糖尿病患者并发糖尿病视网膜病变独立相关。     

重视对糖尿病视网膜病变的预防与治疗

糖尿病视网膜病变(DR)是糖尿病(DM)慢性微血管病变在眼部的并发症，严重影响患者的生活质量。对DR的预防与治疗应十分重视。     

糖尿病眼病28例临床分析

目的研究糖尿病对眼病病人,病情控制、症状影响。方法对2010年2月—2013年9月期间因眼病就医的28例糖尿病眼病患者进行临床分析。结果在与糖尿病相关的多种眼病中,糖尿病视网膜病变(DR)最为常见,在糖尿病病程超过20年的患者中几乎所有的l型糖尿病及60%的2型糖尿病患者会发生不同程度的视网膜病变。非视网膜眼部并发症包括白内障、青光眼和前部缺血性视神经病变。结论糖尿病眼病是常见的一种慢性糖尿病并发症,可引起患者眼部多种疾病甚至失明。     

Diagnostic accuracy of direct ophthalmoscopy for detection of diabetic retinopathy using fundus photographs as a reference standard

AimsTo determine the diagnostic accuracy of direct ophthalmoscopy for the presence and severity of diabetic retinopathy (DR) using fundus photographs as a reference standard.MethodsPatients with type 2 diabetes attending the outpatient department (OPD) of a tertiary care diabetes center, from October 2009 to March 2010 were recruited in the study after obtaining signed informed consent. Patients with type 1 diabetes and gestational diabetes or having eye problems were excluded. After checking visual acuity, direct ophthalmoscopy of each eye was done by diabetologist, followed by photography of two fields of retina by fundus camera. DR was graded by a retinal specialist, according to International Diabetic Retinopathy Disease Severity Scale. According to severity, patients with DR were grouped into non-sight threatening diabetic retinopathy (NSTDR) and sight threatening diabetic retinopathy (STDR). Sensitivity and specificity of direct ophthalmoscopy for detection of any retinopathy, NSTDR and STDR was calculated.ResultsA total of 728 eyes were examined by direct ophthalmoscopy as well as fundus photography. Sensitivity (95% CI) of direct ophthalmoscopy for any retinopathy, NSTDR and STDR was found to be 55.67% (50.58–60.78), 37.63% (32.67–42.59) and 68.25% (63.48–73.02) respectively. Whereas, specificity of direct ophthalmoscopy was found to be 76.78% (72.45–81.11), 71.27% (CI: 66.63–75.91) and 90.0% (86.93–93.07) for any retinopathy, NSTDR and STDR respectively.ConclusionThe sensitivity and specificity of direct ophthalmoscopy performed by the diabetologist for the presence and severity of DR was lower compared to the recommended level of sensitivity and specificity of a screening test of DR.     

The Five-year Incidence of Blindness after Introducing a Screening Programme for Early Detection of Treatable Diabetic Retinopathy

The incidence of moderate visual impairment and blindness due to diabetic retinopathy was studied 5 years after introducing a screening system for early detection of treatable retinopathy. Photocoagulation was performed in patients with clinically significant macular oedema, severe preproliferative, and proliferative retinopathy. Eighty-eight percent of 470 Type 1 and 88 % of 388 Type 2 diabetic patients were still available for follow-up. In the Type 1 group, the five-year incidence of blindness and moderate visual impairment were 0.5 % and 1.2 %, respectively. Corresponding figures for the Type 2 diabetic patients were 0.6 % and 1.7 %, respectively. The majority of patients with loss of vision had severe retinopathy at baseline. Among those who entered the screening programme with no or mild retinopathy, loss of vision occurred in only one of the Type 1 and four of the Type 2 diabetic patients. It is concluded that the risk for visual impairment and blindness due to diabetes can be substantially reduced by using programmes for early detection of and effective treatment of diabetic retinopathy.     

Screening coverage for diabetic retinopathy using a three-field digital non-mydriatic fundus camera

AIMS: Guidelines for regular screening of diabetic retinopathy (DR) have been published in the Spanish and European literature since 1992, but screening for DR is still in its early stages in Spain. The aim of this paper is to estimate the prevalence of screening coverage for DR and prevalence of DR itself using three-field digital non-mydriatic fundus photography to determine whether these guidelines had been implemented. METHODS: Data on age, gender, diabetes and previous eye examinations were recorded on a specially designed questionnaire. Three 45 degrees digital images per eye were taken using a three-field digital non-mydriatic fundus camera with two photographic procedures (both eyes versus the eye with the poorer visual acuity). RESULTS: A total of 183 patients with diabetes participated. The median age and duration of diabetes was 63 years and 10 years, respectively. Only six patients (3.3%) could not be completely graded. Screening coverage for DR was 38.5% in patients with type 2 diabetes and a duration less than 5 years versus those with longer diabetes duration (P=0.007); 20.5% of these patients had DR. CONCLUSIONS: This study highlights the need for heightened awareness of the importance of screening for retinopathy in people with type 2 diabetes and duration of diabetes under 5 years.     

Ocular problems in older Americans with diabetes

Data from the Wisconsin Epidemiologic Study of Diabetic Retinopathy from persons with diabetes of older onset whose average age was 65.4 years indicate that 9.9% of the men and 13.3% of the women had some degree of visual impairment, and 1.4% of men and 1.7% of women were legally blind (with an visual acuity of 20/200 or worse in the better eye). Poorer visual acuity was strongly associated with increasing duration of diabetes, but age was also an important factor, with rates of legal blindness increasing markedly after the seventh decade of life in groups of any duration. Conditions responsible for legal blindness were diabetic retinopathy or maculopathy, cataracts, glaucoma, and macular degeneration. Incidence of blindness 4 years after the initial evaluation was related to insulin use, younger age at examination, longer duration of diabetes, and more severe retinopathy at baseline. Worsening of vision was related to higher levels of glycosylated hemoglobin and the presence of macular edema on diabetic retinopathy at baseline. These data indicate that there is a high prevalence of ocular problems among people with diabetes of older onset. The practitioner should suggest to these patients that, soon after the diagnosis of diabetes, they have an ophthalmologic evaluation to determine whether asymptomatic problems are present. This action may lead to timely intervention to prevent loss of vision in some patients.     

普罗布考治疗非增殖型糖尿病视网膜病变临床观察

目的 研究普罗布考对2型糖尿病非增殖型糖尿病视网膜病变患者血脂、抗氧化能力、视功能及眼底形态的影响,为普罗布考防治早期糖尿病视网膜病变提供临床依据.方法 纳入66例伴非增殖型糖尿病视网膜病变的2型糖尿病患者127眼,随机分为对照组和治疗组,对照组进行强化降血糖和降血压治疗,治疗组在强化治疗基础上口服普罗布考0.375 g,每天2次,总疗程为12个月.治疗前后两组患者均进行了血脂、血清总抗氧化能力、视力、眼底及眼底荧光血管造影检查.结果 共有62例120眼完成研究,普罗布考显著降低了患者总胆固醇、甘油三酯和低密度脂蛋白胆固醇水平,显著提高患者总抗氧化能力和视力(P<0.01),明显改善患者眼底微血管瘤、出血及渗出,且显著降低患者眼底黄斑水肿(P<0.05),对于减少毛细血管无灌注区也有一定作用.结论 普罗布考对于非增殖型糖尿病视网膜病变患者除了降脂作用外,还可提高患者总抗氧化能力,改善患者视功能,降低患者视网膜微血管病变及降低患者黄斑水肿发生率,提示普罗布考对非增殖型糖尿病视网膜病变患者具有一定的治疗作用.     

糖尿病视网膜病变在不同糖代谢状态的检出率及其危险因素分析

目的:研究不同糖代谢状态人群糖尿病视网膜病变(DR)的检出率,并探讨其相关危险因素。方法:选取2011年8月至12月在大连市中心医院内分泌科接受糖尿病社区普查并完成免散瞳眼底照相的居民,按登记序列号顺序抽取糖耐量正常者499例、糖耐量异常者490例、糖尿病病程0.05);糖尿病病程<10年组DR检出率为7.21%,病程≥10年组为26.65%(P<0.05),其中糖尿病病程及HbA1c与DR呈显著正相关。结论:糖尿病病程≥10年的患者视网膜病变检出率最高。病程及HbA1c是DR的独立危险因素。     

The Effect of Glycaemic Control and the Introduction of Insulin Therapy on Retinopathy in Non-insulin-dependent Diabetes Mellitus

To study the progression of diabetic retinopathy in relation to diabetes treatment and glycaemic control in patients with non-insulin dependent (Type 2) diabetes mellitus (NIDDM), we performed a prospective study in a cohort of 1378 diabetic patients, aged ⩾40 years at diagnosis, of whom 333 were treated with insulin, and 1045 with oral antihyperglycaemic agents or diet alone. In the latter group 174 patients changed to insulin therapy during follow-up. We used the Wisconsin scale to grade retinopathy, recorded blindness (visual acuity ⩽0.1) and visual impairment (visual acuity 0.2–0.4), and measured the average HbA_1c for each patient during a mean 3.1-year study period. In a multivariate analysis, patients who changed treatment from oral agents or diet alone to insulin therapy had a relative risk of 2.0 (95 % confidence interval 1.7–2.3) for progression of retinopathy ⩾3 levels compared with all other patients in the study. The increase in risk remained even after controlling for mean HbA_1c (relative risk 1.6; 95 % confidence interval 1.3–1.9). Progression ⩾3 levels was significantly associated with a higher incidence of macular oedema and deterioration of visual acuity (p < 0.001). The relative risk for blindness/visual impairment due to retinopathy was 2.7 (95 % confidence interval 1.8–4.0) in the group with changed treatment compared with all the other patients in the study. Poor glycaemic control (HbA_1c %) before the start of insulin therapy and any retinopathy at baseline were significant risk factors for progression in the group with changed treatment (both p < 0.01). In the whole study group, poor glycaemic control was significantly associated with retinopathy progression ⩾3 levels; the relative risk for those having mean HbA_1c above the median being 1.7 (95 % confidence interval 1.4–2.1), compared to those with a HbA_1c value below the median. Moderate non-proliferative diabetic retinopathy at baseline was also associated with progression (relative risk 2.5; 95 % confidence interval 1.4–4.5). In contrast, insulin treatment at baseline was not associated with an increased risk of retinopathy progression. In conclusion, while hyperglycaemia was a risk factor for the progression of retinopathy in all patients, change of treatment from oral drugs to insulin was associated with a 100 % increased risk of retinopathy progression and a 3-fold increased risk of blindness/visual impairment. © 1997 by John Wiley & Sons, Ltd.     

糖尿病视网膜病变黄斑厚度定量分析

目的：研究糖尿病视网膜病变（DR）患者黄斑水肿情况及与荧光渗漏和视功能关系。方法：应用视网膜厚度分析仪（RTA）对18例（25眼）单纯型糖尿病视网膜病变的黄斑区视网膜进行扫描并对其厚度进行定量测量，并与荧光造影结果及视力进行对比分析，结果：RTA检查可清晰的观察到DR患者黄斑区的形态改变；矫正视力负对数之间呈现正相关关系。结论：DR患者黄斑区毛细血管渗漏与组织再吸收失衡是引起黄斑水肿的关键因素，黄斑水肿是导致视力下降的重要原因，RTA检查可为糖尿病黄斑水肿提供客观和精确的诊断依据。     

Visual disability due to diabetes in Cracow voivodeship

Visual impairment and blindness are major complications of diabetes and are regarded as the most serious disability by most of patients. The purpose of the study was to determine the incidence and prevalence due to diabetes-induced visual disability in 1991-1999 in the former Cracow voivodeship with population of 1,245,047 inhabitants. A register of visual disability was established using independent sources of information. On the end of 1999 the register had included 122 diabetics with visual disability--66 women (54.1%) and 56 men (45.9%). The patients with type 2 diabetes predominated--92 subjects (75.4%). The remaining 30 patients (24.6%) had type 1 diabetes. Grade 1 visual disability was diagnosed in 82 subjects (67.2%) whereas grade 2 visual disability in 40 patients (32.8%). Grade 1 visual disability was defined as visual acuity in a better eye < 0.05 and visual field narrowing < 20%. The criteria of grade 2 were visual acuity after correction in a better eye 0.05-0.1 and visual field narrowing 20-30%. According to the register of the Cracow Branch of the Polish Association of the Blind diabetics made up 6.2% of all visual disability cases. In 1991-1999 the incidence of visual disability due to diabetes did not increase significantly. The mean incidence rate was 0.9/100,000 population. However, there was a significant increasing trend in prevalence with mean annual increase of 0.24/100,000 population (95% CI 0.17-0.31/100,000).     

The Prevalence and Causes of Visual Impairment and Blindness Among Older Adults in the City of Lodz,Poland

To investigate the prevalence and causes of visual impairment and blindness in a sample of Polish older adults.The study was designed in a cross-sectional and observational manner. Data concerning the vision status were assessed in 2214 eyes from 1107 subjects of European Caucasian origin; most of whom live in the city of Lodz, in central Poland. Visual impairment was defined as distance visual acuity <20/40 in the worse-seeing eye. Low vision was defined as best-corrected visual acuity (BCVA) <20/40 but >20/200 in better-seeing eye, and blindness was defined as BCVA ≤20/200 in both eyes (United States criteria).Visual impairment was found in 27.5% subjects in the worse-seeing eye. Multiple regression analysis showed that increasing age (OR 0.98, 95% CI 0.97–0.99) and female gender (OR 1.47, 95% CI 1.11–1.93) were independent risk factors. No association was found between visual impairment and socioeconomic status of subjects. Noncorrectable visual impairment was found in 7.0% of subjects, including 5.2% of subjects with unilateral and 1.8% of subjects with bilateral visual impairment. Low vision and blindness accounted for 1.3% and 0.5%, respectively, and were only associated with older age (OR 1.05, 95% CI 1.02–1.10). Retinal diseases represented the major cause of noncorrectable visual impairment and accounted for more than half of causes of blindness.Provision of appropriate refractive correction improves visual acuity in 75% subjects presenting with visual impairment. Retinal diseases are a major cause of noncorrectable visual impairment and blindness in this older population.