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中国糖尿病视网膜病变患病率和风险因素:一项多医院横断面研究

Zhang, G., Chen, H., Chen, W., Zhang, M.

期刊名称:The British journal of ophthalmology

卷期:2017年第101卷第12期

摘要

摘要:目的:在一个多医院DR筛查项目(生命线表达糖尿病视网膜病变筛查项目)中确定中国糖尿病患者糖尿病视网膜病变(dr)和视力威胁性糖尿病视网膜病变(stdr)的患病率和危险因素。方法:20141月至20167月在中国大陆(南部和北部)的8家医院的糖尿病患者入选该项目。所有参与者进行了标准化面试和考试,并接受了数字眼底摄影检查。根据英国国家筛查计划的分级标准,由视网膜专家在汕头国际眼联络中心阅片中心根据视网膜底片照片对DR严重程度进行分级。STDR定义为存在前增殖性DRR2),增殖性DRR3)和/或黄斑病变(M1)。结果:共有16305例糖尿病患者进行DR筛查。15078例(92.5%)的眼底照片可分级。任何DRSTDR的年龄性别标准化患病率分别为27.9%(95Cl27.228.6%)和12.6%(95Cl12.113.1%)。多因素logistic回归分析显示,年龄较小(OR,0.967),糖尿病病程较长(OR,1.093),血红蛋白a1c较高(OR,1.115),空腹血糖较高(OR,1.074),收缩压较高(OR,1.014),心率更快(OR,1.010),更高的低密度脂蛋白(OR,1.149),更低的甘油三酯(OR,0.975),更高的血液尿素氮(BUN)(OR,1.012)和血清肌酸酐水平升高(OR,1.003)与DR存在有关。结果发现,除了BUN和甘油三酯外,其他类似的危险因素都被发现。糖尿病患者中DRSTDR的患病率分别为27.9%和12.6%。与西方糖尿病人群相比,中国糖尿病患者的DRSTDR发病率相似。

PURPOSE:To determine the prevalence and risk factors for diabetic retinopathy (DR) and sight-threatening diabetic retinopathy (STDR) in a multi-hospital-based DR screening programme among patients with diabetes in China, the Lifeline Express Diabetic Retinopathy Screening Program.METHODS:Patients with diabetes in eight hospitals across mainland China (both southern and northern) from January 2014 to July 2016 were recruited in this programme. All participants underwent a standardised interview and examinations and received digital fundus photography. DR severity was graded from retinal fundus photographs by retina specialists in the reading centre of Joint Shantou International Eye Center, according to the grading standards of the English National Screening Programme. STDR was defined as the presence of preproliferative DR (R2), proliferative DR (R3) and/or maculopathy (M1).RESULTS:16305 patients with diabetes were screened for DR in total. Fundus photographs were gradable for 15078 patients (92.5%). The age-gender-standardised prevalence of any DR and STDR was 27.9% (95% CI, 27.2% to 28.6%) and 12.6% (95% CI, 12.1% to 13.1%), respectively. In the multiple logistic regression analysis, younger age (OR, 0.967), longer duration of diabetes (OR, 1.093), higher haemoglobin A1c (OR, 1.115), higher fasting plasma glucose (OR, 1.074), higher systolic blood pressure (OR, 1.014), faster heart rate (OR, 1.010), higher low-density lipoprotein (OR, 1.149), lower triglycerides (OR, 0.975), higher blood urea nitrogen (BUN) (OR, 1.012) and elevated serum creatinine level (OR, 1.003) were associated with the presence of DR. Similar risk factors, except for BUN and triglycerides, were found for STDR.CONCLUSIONS:The prevalence of DR and STDR in diabetes was 27.9% and 12.6%,respectively in this multi-hospital-based population across China. Compared with Western population with diabetes, similar risk factors for DR and STDR were found in Chinese patients with diabetes.


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