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。

Risk factors for incidence and progression of retinopathy in type 2 diabetes in Dongguan city

Background Diabetic retinopathy （DR） is one of primary causes of blindness in young adults with the increase of incidence of diabetes mellitus （ DM）. To strengthen the anlysis of risk factors for incidence and progression of retinopathy is very important for the prevention and control of DR in China. Objective The aim of this study was to describe the risk factors associated with DR in type 2 DM patients aged 40 years and older in Hengli town,Dongguan city in Southern China. Methods A population-based cross-sectional study was performed. A total of 8952 Han Chinese from 16 villages and a community participated in the census of DM based on the diagnosis criteria of American Diabetic Association （2010 Version）,and then the DR was screened and staged from the DM patients according to International Clinical Classification System of DR and DME （Sydney, 2002 ）. Participants underwent standardized interview, physical, laboratory and ocular examination. Ocular examination included visual acuity（best corrected visual acuity and presenting visual acuity） ,intraocular pressure,anterior and posterior segment examinations ,fundus and optic disc photography.x^2 test, independent sample t test and one way analysis of virance was respectively used to compare the differences of examing indexes between DR and non-DR （NDR）. Univariate and stepwise logistic regression analysis were used to identify independent risk factors. Results Stepwise logistic regression analysis revealed that male,longer DM course, systolic pressure, hyperglycemia and glycosylated hemoglobin were the independent risk factors of DR. Compared with females, males had a higher risk of DR （ OR = 1. 914） （95 %CI： 1. 382-2. 651）. The risk of DR was significantly increased in the DM patients with the duration of 1-4 years, 5-9 years and ≥ 10 years in comparison with newly diagnosed DM patients （ OR = 3. 336,95 % CI： 2. 322-4. 880 ; OR = 3. 890,95% CI：2. 327 -6. 503; OR = 12. 499,95% CI： 6. 607 - 23. 647 ）. DM patients with blood pressure 120 - 139 mmHg and ≥ 140 mmHg showed a higher risk of having any DR than those with blood pressure ≤ 120 mmHg （OR = 1. 953,95 % CI：1.081-3. 528 ; OR = 1. 950,95 % CI： 1. 076 - 3. 532 ）. Compared with DM patients with fasting blood glucose ≤5.6 mmol/L,DM patients with 5.6-6.9 mmol/L and ≥7.0 mmol/L had a higher risk of having any DR （ OR = 1. 567,95 % CI： 0. 889 - 2. 732 ） and OR = 2. 170,95 % CI： 1. 252 - 3.761 ）. Compared with DM patients with glycosylated hemoglobin〈6.5% ,DM patients with ≥6.5% had a higher risk of having any DR （ OR= 1. 577,95% CI： 1. 105-2. 253 ）. Conclusions This study indicates that male, duration of diabetes, systolic pressure, hyperglycemia and glycosylated hemoglobin are independent risk factors of DR in type 2 DM patients. These findings suggest that controlling hyperglycemia ,hypertension and body weight index may lower the risk of having DR associated with type 2 DM.