社区2型糖尿病患者自我管理行为与糖尿病视网膜病变的相关分析

目的 了解社区2型糖尿病（T2DM）患者自我管理行为与糖尿病视网膜病变（DR）的关系。设计 横断面研究。研究对象 2015年7月在深圳市银湖社康中心进行年度体检的T2DM患者252例。方法 采用糖尿病患者自我管理行为量表进行问卷调查,根据结果将患者分为自我管理行为良好、中等、不良。同时测定空腹血糖（FBG）、糖化血红蛋白（HbA1c）。根据眼底检查分为无糖尿病视网膜病变（DWR）、非增生性糖尿病视网膜病变（NPDR）和增生性糖尿病视网膜病变（PDR）,比较DR患者与DWR患者的自我管理行为以及血糖指标控制情况。主要指标 糖尿病自我管理行为、FBG、HbA1c水平。结果 252例T2DM患者中228例（90%）完成调查,其中DR者62例（27.2%）,病程10年以上DR患者34例（54.8%）,明显多于DWR患者（65例,39.2%）（χ2=4.519,P=0.034）。228例T2DM患者自我管理行为良好率20.6%、中等50.9%、不良28.5%;其中,DR患者自我管理行为良好率11.3%低于DWR患者 （24.1%）（χ2=4.524,P=0.033）。228例T2DM患者血糖控制达标率FBG 29.4%、HbA1c 28.5%;其中DR患者血糖控制达标率FBG 19.4%、HbA1c 17.7%,低于DWR患者FBG 33.1%、HbA1c 32.5%（χ2=4.129,P=0.042;χ2=4.844,P=0.028）。病程为<5年、5~10年、>10年的T2DM患者自我管理行为不良率分别为15.0%、20.2%、41.4%（χ2=16.764,P=0.002）。分级为DWR、NPDR、PDR的T2DM患者自我管理行为不良率分别为25.9%、28.0%、66.7%（χ2=9.132,P=0.010）。多因素Logistic回归分析模型中,饮食行为（OR=0.241,95%CI:0.163~0.287）、运动行为（OR=0.536,95%CI:0.481~0.692）、遵医嘱用药（OR=0.056,95%CI:0.018~0.172）,FBG达标率（OR= 2.255,95%CI:1.315~3.873）、HbA1c达标率（OR=1.376,95%CI:1.197~1.584）以及糖尿病病程（OR=0.573,95%CI:0.038~0.714）与DR的发生及严重程度相关。结论 糖尿病病程长、饮食控制不佳、较少运动、用药欠规范和FBG、HbA1c控制不达标与DR的发病相关,提高社区T2DM患者自我管理行为有助于血糖控制,降低DR发生的风险。（眼科,2016, 25： 326－329）     

广东省东莞市横沥镇居民2型糖尿病患者糖尿病视网膜病变危险因素分析

背景国外研究表明,随着糖尿病发病率的升高,糖尿病视网膜病变（DR）已成为青壮年患者首要的致盲因素,而加强中国对DR发病危险因素的分析对于DR的防治具有重要意义。目的调查广东省东莞市横沥镇40岁及以上居民2型糖尿病患者发生DR的危险因素。方法采用横断面研究设计及整群抽样法,对广东省东莞市横沥镇40岁及以上居民进行糖尿病和DR发生率的现场流行病学调查。首先根据2010年美国糖尿病协会（ADA）制定的糖尿病诊断标准对糖尿病患者进行筛查,然后根据2002年悉尼国际DR分期标准对糖尿病患者进行DR筛查。所有受检者均接受一般资料调查、问卷调查、体格检查和实验室检查,专科检查包括裸眼视力、矫正视力、日常生活视力、验光检查以及眼压测量（非接触眼压计）、裂隙灯显微镜检查、眼底检查和眼底照相。分别采用,检验、独立样本t检验和单因素方差分析对DR患者与非DR者（NDR）的各项调查和检测结果进行比较,采用Logistic相关回归模型对DR危险因素进行分析。结果Logistic逐步回归分析结果显示,男性、糖尿病病程、收缩压、空腹血糖（FPG）和糖化血红蛋白（HBA1c）是影响2型糖尿病患者发生DR的独立危险因素,其中男性糖尿病患者发生DR的风险明显高于女性患者（OR=1．914,95％CI：1．382～2．651）;糖尿病病程为1—4年、5～9年和≥10年的患者发生DR的风险明显高于新诊断糖尿病患者,分别为新诊断患者的3．336倍（95％CI：2．322～4．880）、3．890倍（95％CI：2．327～6．503）和12．499倍（95％CI：6．607～23．647）;相对于收缩压≤120mmHg（1mmHg=0．133kPa）的糖尿病患者,收缩压为120～139mmHg、≥140mmHg的糖尿病患者发生DR的风险分别为1．953倍（95％CI：1．081～3．528）和1．950倍（95％CI：1．076～3．532）;与FPG≤5．6mmol／L的糖尿病患者比较,FPG为5．6—6．9mmol／L、≥7．0mmol／L的糖尿病患者发生DR风险分别增加1．567倍（95％CI：0．889～2．732）和2．170倍（95％CI：1．252～3．761）;此外,HBA1c≥6．5％的糖尿病患者DR发生风险明显高于HBA1c〈6．5％的糖尿病患者（OR=1．577,95％CI：1．105～2．253）。结论男性、糖尿病病程、平均收缩压、FPG和HBA1c是2型糖尿病患者发生DR的独立危险因素。早期诊断、控制高血糖、高血压等相关危险因素可以减少DR的患病率,并控制其进展。     

检测糖化血红蛋白对糖尿病视网膜病变的临床意义

目的:探讨糖化血红蛋白对糖尿病视网膜病变的临床意义。方法:对本院158例2型糖尿病患者做眼底检查和荧光眼底血管造影检查,分为糖尿病正常眼底(NDR)组83例,糖尿病视网膜病变(DR)组75例,进行糖化血红蛋白(HbA1c)、空腹血糖(FBG)检测。结果:DR组HbA1c值明显高于NDR组(P<0.01),而FBG水平在DR组与NDR组无显著性差异。结论:HbA1c是DR的一个重要检测指标。     

上海市新泾社区2型糖尿病患者5年随访的前瞻性调查研究3.糖尿病视网膜病变和糖尿病黄斑水肿的好转及促进因素

背景 对2型糖尿病患者的长期随访过程中发现,部分糖尿病视网膜病变(DR)和糖尿病黄斑水肿(DME)患者未经眼底激光光凝、内眼手术或眼内药物治疗眼底病变可好转,但其影响因素尚不清楚.目的 探讨中国2型糖尿病患者DR和DME自行好转的发生率及促好转影响因素. 方法 采用前瞻性观察研究方法,于2007-2012年对上海市新泾社区中符合纳入标准的778例2型糖尿病患者进行连续5年的流行病学调查和随访,收集患者一般资料,对患者行全身体格检查、实验室血生化指标检查、眼部检查和眼底照相,眼底照片读片采用盲法.采用国际临床分类方法和视网膜玻璃体增生情况将DR分为无明显DR和轻、中、重度非增生性DR及增生性DR;并将DME分为无、轻度、中度和重度DME.将DR好转和DME好转作为2个结局变量,好转为仅接受全身用药者至少一眼终末DR或DME分级较基线时下降至少1级且对侧眼DR无进展.采用Logistic多元回归分析判断年龄、性别、受教育程度、糖尿病发病年龄、糖尿病病程、肥胖及血肌酐、三酰甘油、总胆固醇和糖化血红蛋白(HbA1c)水平对结局变量的影响.结果 2007年基线调查时发现DR患者456例,其中139例患者5年后至少1眼DR好转,好转率为30.48％.基线检查低HbA1c水平和低血肌酐水平是DR好转的促进因素[HbA1c:优势比(OR)=0.53,95％可信区间(CI)]:0.45 ～0.63,P＜0.01;血肌酐:OR=0.98,95％ CI:0.97 ～0.99,P＜0.01).基线调查时发现DME 158例,其中20例5年后至少1眼好转,好转率为12.66％.高基线血糖水平是DME好转的唯一、独立影响因素(OR=1.47,95％ CI:1.14～1.91,P＜0.01).结论 降低2型糖尿病DR患者的血糖和血肌酐水平有助于DR好转,快速降低血糖水平有助于DME的好转.     

HbA1c变异性对糖尿病视网膜病变的影响及其截断值的判定

目的评估糖化血红蛋白(HbA1c)变异性对2型糖尿病(T2D)患者糖尿病视网膜病变(diabetic retinopathy,DR)的作用,并通过应用受试者工作特征(ROC)曲线找出糖化血红蛋白(HbA1c)变异性用于诊断早期DR的截断值(cut-off值)。方法对3386例T2D患者进行纵向队列研究,随访2～5 a,平均4.0 a,每年行一次散瞳眼底检查。依据患者所有记录的HbA1c值计算其平均值(A1c-Mean)和标准差(A1c-SD),其中HbA1c变异性表达为A1c-SD。收集并分析患者病史和临床资料。采用线性混合效应模型探讨HbA1c变异性等因素对DR的影响,绘制ROC曲线以评价HbA1c变异性对DR早期的诊断价值。结果混合效应结果显示,Alc-Mean、A1c-SD与DR的发展均呈正相关(β=0.049、0.031,均为P<0.05)。ROC曲线分析结果显示,HbA1c变异性曲线下面积(AUC)为0.630,用于诊断早期DR的cut-off值为0.625,敏感度为0.781,特异度为0.573。结论 HbA1c变异性能够预测T2D患者DR的发生,可作为初步预测DR的...     

身体测量值与糖尿病视网膜病变关系

目的：调查身体测量值与成年糖尿病患者糖尿病视网膜病变（DR）的关系。方法：采用以医院为基础的研究,病例为临床诊断为DR,全部病例均经裂隙灯显微镜,进行详细的眼睛检查和眼底造影,40~75岁的326例患者,并采用眼底照片对DR进行分级。对照为未患DR及其它眼部疾病,同期入住同一医院的326例患者组成,采取1∶1匹配。采用自行设计的调查表对研究对象进行调查,内容包括一般情况、生活方式及既往史等,同时对身高、体质量、腰围（WC）及臀围进行测量,并计算体质指数（BMI）和腰臀比（WHR）。采用多因素Logistic 回归模型对患者身体测量值与DR的比值比（OR）及相应的95%可信区间（CI）进行估计。结果：男性病例组体质量、BMI及WHR与对照组相比较差异均具有统计学意义（P<0.05）。而不同研究对象WC和臀围具有显著性差异（P<0.05）。调整年龄及性别后,随着BMI增加,发生DR的危险性并未随之增加;WC >80cm者与DR的发生具有显著关联性（OR=2017,95% CI：1.393~2.920,P=0.000）;WHR >0.88者发生DR的危险性明显增加（OR=2.041,95% CI：1422~2.929,P=0.001）。再进一步调整多种可能的混杂因素后,发现BMI为18.50~23.99kg/m²与DR呈负相关（OR=0.427,95% CI：0.231~0.791,P=0.007）;WC和WHR的结果未发生变化（OR =1.729,95% CI：1.163~2.572,P=0.007;OR=1.991,95% CI：1.353~2.931,P=0.001）。结论：肥胖尤其是腹型肥胖或向心性肥胖在DR的管理方面具有潜在的临床意义,所以应该倡导人们维持正常的WC和WHR,可预防糖尿病和DR的发生。     

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.     

糖化血红蛋白及视觉电生理检测在糖尿病视网膜病变早期诊断的价值

目的:研究糖尿病性视网膜病变(diabetic retinopathy,DR)时糖化血红蛋白(hemoglobin A1c,HbA1c)及视网膜振荡电位(oscillatory potentials,Op)的动态变化。方法:对确诊的2型糖尿病患者用检眼镜检查进行筛选,以眼底荧光素血管造影(fundus fluorescein angiography,FFA)进行明确分期,对各期患者在3a内定期行HbA1c测定6次,行Op检查2次,最后1次检测配合FFA检查,统计分析结果。结果:HbA1c水平控制在4.99%±0.58%为预防DR发生发展的安全参考值;HbA1c水平持续在9.77%±1.57%时,DR进展明显加快;Op总波幅下降副度<10.6±4.9μV可作为预测视网膜病变未进展的参考值;Op总波幅下降幅度>31.6±9.7μV,则可作为预测2型糖尿病患者发生DR或DR发生进展的依据。结论:HbA1c,OP结合,能预测DR的发展。     

2型糖尿病发生增生性糖尿病视网膜病变的 危险因素 

目的探讨2型糖尿病发生增生性糖尿病视网膜病变( proliferative diabetic retinopathy，PDR) 的患病率和危险因素。方法对1994~2001年首次在我院糖尿病中心就诊的2型糖尿病患者 2 739例，进行眼并发症筛查中散瞳检查眼底和荧光素眼底血管造影 (fundus fluorescein angiography, FFA) 确定为糖尿病性视网膜病变（diabetic retinopathy, DR）患者的临床资料进行回顾性分析。同期检测患者的血压、空腹和餐后血糖，糖化血红蛋白（HbA1c）、血脂、肌酐和尿白蛋白含量。结果2型糖尿病DR总患病率为27.8%（761/2 739），PDR的患病率为4.2%（114/2 739），占所有DR患者的15%。PDR病变组的病程、空腹血糖、糖化血红蛋白、血压水平和尿白蛋白含量均高于对照组（P＜0.01，糖化血红蛋白低于0.05）。Logistic多元回归分析显示，影响PDR发病的危险因素是病程（r=0.15, P＜0.01）和尿白蛋白含量（r=0.08, P＜0.05）。病程为5年和5年以上的患者，并发PDR的危险因素是尿白蛋白含量和空腹血糖水平（r=0.13, P＜0.05）。进一步分析表明病程为5年以内、5~10年和大于10年的患者，PDR的患病率分别为2.3%、5.9%、12.4%。无蛋白尿、微量蛋白尿和显性蛋白尿组PDR的患病率分别为2.1%、5.3%、18.8%。结论2型糖尿病并发PDR与糖尿病病程、尿白蛋白含量、空腹血糖、糖化血红蛋白和血压水平增高有关。其中病程、尿白蛋白含量和空腹血糖水平是影响PDR发病的危险因素。(中华眼底病杂志,2003,19:338-340)     

葡萄糖目标范围内时间和糖化血红蛋白水平与糖尿病视网膜病变风险的相关性研究

目的:观察并分析葡萄糖目标范围内时间（TIR）和糖化血红蛋白（HbA1c）与糖尿病视网膜病变（DR）发生风险的相关性。方法:回顾性临床研究。2020年3月至2021年8月于潍坊医学院附属医院内分泌代谢病科住院治疗的2型糖尿病（T2DM）患者91例纳入研究。所有患者均行欧堡免散瞳超广角激光扫描检眼镜、HbA1c及持续葡萄...     

Diabetes onset at an earlier age and high HbA1c levels as risk factors of diabetic retinopathy

AIM:To assess the effect of age at diabetes onset and uncontrollable high Hb A1 c levels on the development of diabetic retinopathy(DR)among Chinese type 2 diabetes mellitus(DM)patients.METHODS:This was a cross-sectional survey of diabetic patients in Subei district,China.Data covering physical measurements,fasting blood-glucose(FBG),glycosylated hemoglobin(Hb A1 c),blood lipid,urinary albumin/creatinine ratio(UACR),ocular fundus examination,and diabetes treatment records were collected.An independent sample t-test were used to analyze differences.A Logistic regression analysis was applied to study the independent risk factors of DR.RESULTS:A total of 1282 patients with type 2 DM were enrolled,and 191 cases had DR(14.9%).The age at diabetes onset,education level,alcohol consumption,Hb A1 c level,UACR level,and hypoglycemic drugs were independent influencing factors for DR.The older the onset of diabetes,the less likely to develop DR(OR:0.958,95%CI:0.942-0.975,P=0.000).Patients were then divided in terms of age at diabetes onset as follows:<50 y,50-59 y,60-69 y,and≥70 y.Compared with diabetes onset age<50 y,50-59 y(OR:0.463,95%CI:0.306-0.699,P=0.000),60-69 y(OR:0.329,95%CI:0.203-0.535,P=0.000)and≥70 y(OR:0.232,95%CI:0.094-0.577,P=0.002)were at a lower risk of DR.The prevalence of DR was highest in patients with diabetes onset age<50 y(29.5%,P<0.05).The Hb A1 c level(8.67±1.97)%and proportion of insulin injection(52.5%)in patients with diabetes onset<40 y were higher than in patients with older diabetes onset age(P<0.05).CONCLUSION:Diabetes onset at an earlier age and uncontrollable high Hb A1 c level could be independent risk factors for DR.     

Risk factors for diabetic retinopathy in northern Chinese patients with type 2 diabetes mellitus

AIM: To investigate the prevalence and risk factors of diabetic retinopathy (DR) in northern Chinese patients with type 2 diabetes mellitus (T2DM). METHODS: This retrospective cross-sectional study was performed between May 2011 and April 2012. A total of 1100 patients (male/female, 483/617) were included in this study. DR was defined following the Early Treatment Diabetic Retinopathy Study (ETDRS) severity scale. All included patients accepted a comprehensive ophthalmic examination including retinal photographs. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence interval (CI) after adjusting for age and gender. RESULTS: Retinopathy was present in 307 patients with a prevalence of 27.9%. In univariate logistic analysis, presence of DR was associated with longer duration of diabetes (OR, 5.70; 95%CI, 2.91-12.56), higher concentration of fasting blood glucose (OR, 12.94; 95%CI, 2.40-67.71), higher level of glycosylated hemoglobin HbA1c (OR, 5.50; 95%CI, 3.78-11.97) and insulin treatment (OR, 6.99; 95%CI, 1.39-35.12). The lifestyle of patients with T2DM including smoking, alcohol consumption and regular exercise seemed not associated with the development of DR. CONCLUSION: Our study suggests that fasting serum glucose concentration, HbA1c level, duration of diabetes and insulin treatment are potential risk factors for DR in northern Chinese patients with T2DM, while the lifestyle of included patients seems not associated with DR.     

Inhibition of TGF-β2-induced migration and epithelial-mesenchymal transition in ARPE-19 by sulforaphane

AIM: To investigate the effects of sulforaphane (SFN) on transforming growth factor (TGF)-β2 stimulated migration and epithelial-mesenchymal transition (EMT) in ARPE-19 cells. METHODS: ARPE-19 cells were cultured in the presence or absence of SFN or TGF-β2. SFN toxicity was assessed by performing a lactate dehydrogenase assay (LDH) and 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium (MTS) assays, and cell migration was evaluated by Transwell migration assay. Actin stress fiber formation in ARPE-19 cells was determined using immunofluorescence analysis. Immunoblotting analysis was used to determine fibronectin and α-smooth muscle actin expressions along with the degree of Smad and Akt phosphorylation. RESULTS: SFN inhibited ARPE-19 migration. Additionally, SFN attenuated TGF-β2-induced appearance of actin stress fibers as well as fibronectin and α-smooth muscle actin expressions in these cells. SFN also hindered the TGF-β2-stimulated phosphorylation of Smad2, Smad3, and Akt. SFN showed no cytotoxicity towards ARPE-19 cells. CONCLUSION: SFN inhibits TGF-β2-stimulated migration and EMT in ARPE-19 cells, probably by preventing the establishment of actin stress fibers and Akt and Smad2/3 signaling.     

Prevalence and risk factors of diabetic retinopathy in patients with type 2 diabetes in Shanghai

AIM: To predict postoperative intraocular lens (IOL) position using the Sirius anterior segment analysis system and investigate the effect of Lens position and IOL type on postoperative refraction. METHODS: A total of 97 patients (102 eyes) were enrolled in the final analysis. An anterior segment biometry measurement was performed preoperatively with Sirius and Lenstar. The results of predicted lens position (PLP) and IOL power were automatically calculated by the software used by the instruments. Effective lens position (ELP) was measured manually using Sirius 3mo postoperatively. A Pearson’s correlation analysis and linear regression analysis were used to determine the correlation of lens position to other parameters. RESULTS: PLP and ELP were positively correlated to axial length (AL; r=0.42, P<0.0001 and r=0.49, P<0.0001, respectively). There was a weak correlation between the peLP (ELP-PLP) and the prediction error of spherical refraction (peSR; r=0.34, P<0.0001). The peLP of the Softec HD IOL differed statistically from those of both the TECNIS ZCB00 and Sensor AR40E IOLs. Multiple linear regression was used to obtain the prediction formula: ELP=0.66+0.63 [aqueous depth (AQD)+0.6LT] (r=0.61, P<0.0001), and ELP was found to have the strongest correlation with a new variable (AQD+0.6 LT). CONCLUSION: The Sirius anterior segment analysis system is helpful to predict ELP, which reduces postoperative refraction error.     

Type 2 Diabetes,Fasting Glucose,Hemoglobin A1c Levels and Risk of Primary Open-Angle Glaucoma: A Mendelian Randomization Study

PurposeTo evaluate the potential causal associations between type 2 diabetes and fasting glucose and HbA1c levels and the risk of primary open-angle glaucoma (POAG) in European and East Asian populations.MethodsWe selected genetic variants (P < 5 × 10⁻⁸) for type 2 diabetes (898,130 Europeans; 433,540 East Asians), fasting glucose, and HbA1c (196,991 Europeans; 36,584 East Asians) from three meta-analyses of genome-wide association studies (GWAS). The GWAS for POAG provided summary statistics (192,702 Europeans; 46,523 East Asians). Mendelian randomization (MR) analysis was accomplished using the inverse variance–weighted method, weighted-median method, MR Egger method, and MR-Pleiotropy RESidual Sum and Outlier test.ResultsGenetically predicted type 2 diabetes was potentially positively associated with POAG in the European ancestry (body mass index [BMI]–unadjusted: odds ratio [OR] = 1.07, 95% confidence interval [CI], 1.01–1.14, P = 0.028; BMI-adjusted: OR = 1.07, 95% CI, 1.01–1.15, P = 0.035), but not in the East Asian ancestry (BMI-unadjusted: OR = 1.01, 95% CI, 0.95–1.06, P = 0.866; BMI-adjusted: OR = 1.00, 95% CI, 0.94–1.05, P = 0.882). There was no evidence to support a causal association of fasting glucose (European: OR = 1.19, P = 0.157; East Asian: OR = 0.94, P = 0.715) and HbA1c (European: OR = 1.27, P = 0.178; East Asian: OR = 0.85, P = 0.508) levels with POAG.ConclusionsThe causal effect of type 2 diabetes on the risk of POAG is different in European and East Asian populations. The point estimates of fasting glucose and Hb1Ac with POAG are large but not statistically significant, which prompts the question of statistical power.     

候选基因多态性与糖尿病视网膜病变相关性的Meta分析

目的 候选基因多态性位点与2型糖尿病患者（type 2 diabetes mellitus，T2DM）的糖尿病视网膜病变（diabetes retinopathy，DR）相关性的Meta分析。设计 Meta分析。研究对象  T2DM的DR候选基因多态性的英文或中文文献。方法 在Pubmed（National Center for Biotechnology Information）、ISI（Web of Kowledge）、Embase和中国知网（China National Knowledge Internet，CNKI）4个数据库中，系统性检索、收集2019年1月1日以前以中文和英文发表的关于色素上皮源性因子（pigment epithelium derived factor，PEDF）、肿瘤坏死因子（tumor necrosis factor-α，TNF-α）和对氧磷酶-1（paraoxonase 1，PON1）三个基因的多态性位点与DR相关性的文献。采用Stata 12.0软件计算合并优势比（pooled odds ratio，pooled OR），分析组间异质性（Pheterogeneity）和发表偏倚（publication bias）。主要指标 OR值、组间异质性，发表偏倚。结果 共13篇研究纳入本Meta分析，包括2729例DR和3420例糖尿病对照。PEDF基因的 rs12948385位点（显性模型：OR=1.371，95%CI：1.072~1.755，P=0.012；等位基因模型：OR=1.266，95%CI：1.028~1.560，P=0.027）和PON1基因的L55M位点（隐性模型：OR=2.998，95%CI：1.282~7.010，P=0.011）与DR相关；TNF-α基因的rs1800629位点与PDR相关（等位基因模型：OR=1.291，95%CI：1.019~1.636，P=0.034）。结论  PEDF基因的 rs12948385位点、PON1基因的L55M位点可能与DR相关；TNF-α基因的rs1800629位点可能与PDR相关。     

阅读时戴低度凸透镜对小学生近视干预效果评价

目的 评价阅读时戴低度凸透镜对小学生近视的干预效果。 设计 前瞻性队列研究。 研究对象 594例1～5年级的近视高危（双眼裸眼视力≥4.7,－1.0 D≤双眼等效球镜值≤2.0 D）的小学生。阅读时戴低度凸透镜者286例为干预组,平均年龄（7.81±1.48）岁;未戴低度凸透镜者308例为对照组,平均年龄（8.44±1.59）岁。方法 2010年底（基线）和2011年底（终线）分别对594例1～5年级的小学生行屈光度检查。根据终线时的检查结果（取右眼数据）,以近视进展情况（终线右眼等效球镜－基线右眼等效球镜）、近视发病情况作为结局指标,分别采用多重线性回归分析和logistic回归分析评价干预效果,并且按照性别和年级（1～3年级VS 4～5年级）进行分层分析。主要指标 右眼等效球镜度数。结果 干预前后干预组右眼等效球镜变化（-0.35±0.76）D,较对照组（-0.56±0.71）D少（P=0.004）。女生干预组较对照组有效（P=0.003）,男生干预组与对照组无统计学差异（P=0.317）。1～3年级干预组较对照组有效（P<0.001）,而4～5年级干预组与对照组无统计学差异（P=0.678）。终线时,干预组和对照组近视发病率分别为14.3%和29.5%。与对照组相比,干预组近视发病的OR值为0.593（95%CI=0.371~0.946）;按性别分层,男生和女生干预组近视发病的OR值分别为0.704 （95%CI=0.358~1.385）和0.450（95%CI=0.227~0.894）;按年级分层,1～3年级和4～5年级干预组近视发病的OR值分别为0.440（95%CI=0.238~0.813）和1.143（95%CI=0.478~2.731）。结论 阅读时戴低度凸透镜,尤其是女学生和低年级学生,可以减缓近视发展的进程,降低近视发病率,对小学生近视防治起到积极的作用。（眼科,2016, 25：294－298）     

Dietary associations with diabetic retinopathy—A cohort study

Purpose:To assess the role of dietary factors in the development of diabetic retinopathy (DR) in diabetics.Methods:This prospective study was carried out on patients attending the outpatient department of ophthalmology for a period of 1 year. An interview-based 24-hour diet recall was used to document average daily dietary nutrient intakes. Each patient was subjected to a comprehensive ocular examination to look for DR.Results:A total of 261 patients attending the outpatient department of ophthalmology were the participants for this study. The mean (±SD) age of the participants was 57.73 ± 11.29 years, and 67% were men. One hundred and six participants had DR. Univariate analysis revealed sex, duration, fish (times/week), egg (yes/no), rice lunch (yes/no), rice dinner, rice (boiled/white), and total calorie intake to be associated with DR (P < 0.05). Logistic regression multivariable analysis revealed males (OR: 3.20, 95% CI: 1.65–6.19), longer duration of diabetes (OR:1.05,95% CI:1.01-1.11), antioxidant intake (OR: 3.42, 95% CI: 1.65–7.05), and consumption of rice (OR: 3.19, 95% CI: 1.17–8.69) to have significant association with DR (P < 0.05), with the odds of developing DR increasing three times in these patients. The odds of developing DR were lesser with more frequent (>2 times/week) fish consumption (OR: 0.42, 95% CI: 0.18–0.94) and in patients on pharmacological treatment for diabetes mellitus (OR: 0.16, 95% CI: 0.04–0.58). Binary logistic regression revealed chapathi consumption (OR: 9.37, 95% CI: 1.64–53.68) to be associated with severe forms and fish consumption (OR: 0.06, 95% CI: 0.01–1.06) (P < 0.05) to be associated with less severe forms of DR.Conclusion:Males, longer duration of diabetes, antioxidant intake, fish consumption, and consumption of rice were associated with the occurrence of DR. Participants with diabetes who consumed fish more frequently and those who were on pharmacological treatment for diabetes mellitus had a significantly lower risk of DR and frequent fish consumption could reduce the risk of DR progression.