江苏省城乡居民不同糖代谢状态人群视网膜病变患病率及相关因素分析

目的比较江苏省城乡居民不同糖代谢状态人群视网膜病变患病率并分析其相关影响因素。方法本研究为横断面研究。于2017年4至7月采用分层多阶段随机抽样对江苏省盐城盐都区、镇江句容市抽取4 074名18~70岁居民进行问卷调查、体格检查、血糖检测和眼底筛查。以糖尿病视网膜病变(DR)早期治疗研究分级≥20定义为糖尿病特征性视网膜病变。根据血糖检测结果将研究对象分为血糖正常组(NGR组)、糖尿病前期组(IGR组)及初诊2型糖尿病组(T2DM组)。收集上述研究对象的人口学特征、疾病史等一般资料,测量收缩压(SBP)和舒张压(DBP),计算体质指数(BMI)、腰臀比和腰围身高比,检测空腹血糖(FPG)、口服葡萄糖耐量试验餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)、丙氨酸氨基转移酶(ALT)等指标。采用χ²检验比较相同糖代谢状态不同特征人群视网膜病变患病率,采用1∶4匹配的条件logistic回归分析法对DR的影响因素进行单因素和多因素分析。结果最终纳入3 666例受试者,其中NGR组1 915例,IGR组1 186例,新诊断T2DM组565例。新诊断T2DM组中DR患病率最高,为10.27%(58/565),其次是IGR患者,为4.38%(52/1 186),NGR人群中糖尿病特征性视网膜病变患病率为2.77%(53/1 915)。三组视网膜病变患病率在不同性别、年龄、职业、教育程度、有无糖尿病家族史、吸烟史、饮酒史之间的差异无统计学意义(均P>0.05)。NGR组中,肥胖者糖尿病特征性视网膜病变患病率显著高于体重正常及过低者分别为5.05%(14/277)和2.57%(22/856)、2.17%(17/782),P=0.044]。新诊断T2DM组中,高血压者DR患病率显著高于非高血压者分别为12.57%(42/334)和6.93%(16/231),P=0.032]。1∶4匹配的病例对照单因素分析结果显示,有糖尿病家族史、高SBP、高DBP、高BMI、高FPG、高2hPG、高HbA1c、高ALT可能与DR的发生有关(均P<0.05)。多因素logistic分析结果显示,收缩压≥180 mmHg(1 mmHg=0.133 kPa),腰围身高比≥0.5,高BMI和高FPG是DR的危险因素(优势比分别为6.130、2.738、1.128、1.449,均P<0.05)。结论江苏省城乡居民不同糖代谢状态人群视网膜病变患病率较高,NGR和IGR人群中已有糖尿病特征性视网膜病变发生。高血压、高血糖及肥胖均会增加各类糖代谢状态人群发生DR的风险。

Prevalence and related factors of retinopathy in residents with different glucose metabolism in Jiangsu province

Objective To compare the prevalence of retinopathy in residents with different glucose metabolism in Jiangsu province and analyze its related factors.Methods This study was a cross-sectional study.We recruited 4047 urban and rural 18-70 years old residents in two cities of Jiangsu province using stratified multistage random sampling and conducted a questionnaire survey,physical examination,blood glucose testing and diabetic retinopathy(DR)screening among the residents from April to July 2017.Early Treatment Diabetic Retinopathy Study classification≥20 was defined as the“diabetes-specific”retinopathy.The subjects were divided into three groups according to the results of blood glucose testing:normal glucose regulation group(NGR group),impaired glucose regulation group(IGR group)and newly diagnosed type 2 diabetes mellitus group(T2DM group).The ordinary data such as demographic characteristics,disease history were collected,systolic blood pressure(SBP)and diastolic blood pressure(DBP)were measured,body mass index(BMI),waist hip ratio(WHR)and waist-to-height ratio were calculated,fasting plasma glucose(FPG),oral glucose tolerance test 2-hour postprandial blood glucose(2hPG),glycated hemoglobin A1c(HbA1c),alanine aminotransferase(ALT),and other indicators were detected.Chi-square test was used to compare the prevalence of retinopathy among people with different characteristics of the same glucose metabolism state,and 1∶4 matched conditional logistic regression was used to conduct univariate and multivariate analyses on DR.Results Finally,3666 subjects were included in the study,including 1915 cases in the NGR group,1186 cases in the IGR group and 565 cases in the T2DM group.The prevalence of DR in the T2DM group was the highest10.27%(58/565)],followed by IGR4.38%(52/1186)]and the prevalence of“diabetes-specific”retinopathy in NGR was 2.77%(53/1915).There was no statistically significant difference in the prevalence of retinopathy among different gender,age,occupation,education level,family history of diabetes,smoking history,alcohol consumption history in both three groups(all P>0.05).In NGR group,the prevalence of“diabetes-specific”retinopathy in the obese group was significantly higher than that in the normal and underweight groups5.05%(14/277),2.57%(22/856)and 2.17%(17/782),respectively,P=0.044].In the T2DM group,the prevalence of DR in the hypertension group was significantly higher than that in the non-hypertension group12.57%(42/334)and 6.93%(16/231),respectively,P=0.032].The results of 1∶4 matched case-control univariate analysis showed that family history of diabetes,high SBP,high DBP,high BMI,high FPG,high 2hPG,high HbA1c and high ALT may be related to the occurrence of DR.The results of multivariate analysis showed that SBP≥180 mmHg(1 mmHg=0.133 kPa),the waist-to-height ratio≥0.5,high BMI and high FPG were risk factors for DR(the odds ratios were 6.130,2.738,1.128 and 1.449,respectively,P<0.05).Conclusions The prevalence of retinopathy was high in urban and rural residents of Jiangsu province with different glucose metabolic states,and“diabetes-specific”retinopathy had occurred in NGR and IGR populations.Hypertension,hyperglycemia and obesity all increase the risk of DR in people with various metabolism states.