摘要背景 糖尿病视网膜病变(DR)和糖尿病性黄斑水肿(DME)是2型糖尿病常见的眼底并发症,目前国外关于2型糖尿病人群DR和DME发病率及危险因素的研究结果差异较大,可能与研究对象的种族不同有关,而中国的相关流行病学调查研究较少. 目的 了解中国2型糖尿病患者中DR和DME的5年发病率,探讨其危险因素.方法 采用横断面研究方法,对2007-2012年上海市新泾社区中805例2型糖尿病患者的DR和DME的发病率进行流行病学调查,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,结合OCT和荧光素眼底血管造影(FFA)成像依据目前通用的国际临床分类方法对DR和DME进行分级.将DR和DME发病作为结局变量,分析2型糖尿病患者DR和DME5年发病的独立影响因素. 结果 基线调查时无DR的2型糖尿病患者322例,其中151例在终末调查时发生DR,5年累积发病率为46.89％.多元Logistic回归结果显示,高血糖[优势比(OR)=1.12,95％可信区间(CI):1.01 ～ 1.24,P=O.03]和高血压(OR=1.80,95％ CI:1.14～2.86,P=0.01)是DR发病的独立危险因素.基线调查时无DME的2型糖尿病患者629例,其中124例在5年后发生DME,5年累积发病率为19.71％.多元Logistic回归结果显示,高血糖是DME唯一的独立影响因素(OR=1.36,95％ CI:1.24 ～ 1.49,P＜0.01).结论 高血糖和高血压在中国2型糖尿病患者DR和DME的发病中发挥重要作用,中国2型糖尿病患者应严格控制血糖和血压水平.

abstractsBackground Diabetic retinopathy (DR) and diabetic macular edema (DME) are common complications of diabetes.Currently abroad study results of incidence and risk factors of DR and DME in type 2 diabetes population varied largely depending on the ethnical difference.However,relevant epidemiological study is rare in China.Objective This survey was to assess the 5-year incidence and risk factors of DR and DME in Chinese type 2 diabetic patients.Methods A prospective cross-sectional study was performed under the informed consent of the patients.An epidemiological survey for 5-year incidence and risk factors of DR and DME was organized and carried out in 805 type 2 diabetes patients in Shanghai Xinjing Community from 2007 to 2012,and 2007 scheduled as the baseline survey and 2012 scheduled as final survey.The comprehensive examinations were carried out annually during the 5 years,including sociodemographic information,systemic examination and ophthalmological test.DR onset and DME onset grading were performed by OCT and fundus fluorescein angiography (FFA) images based on current international classification.Cumulative incidence of 5 years for DR and DME was determined as the outcome variables,and the associations between potential risk factors and the outcomes were analyzed.Results In the baseline time,non-DR were found in 322 type 2 diabetic patients,of which 151 participants developed DR during the follow-up duration,with the 5-year cumulative incidence rate 46.89％.The independent risk factors for DR occurrence were hyperglycemia (odds ratio [OR] =1.12,95 ％ confidence interval [CI]:1.01-1.24,P =0.03) and hypertension (OR=1.80,95％ CI:1.14-2.86,P =0.01).In the baseline time,629 type 2 diabetes patients were non-DME,of which 124 participants developed DME during the follow-up duration,with the 5-year cumulative incidence rate 19.71％.Hyperglycemia appeared to be the only independent risk factor of DR onset (OR =1.36,95％ CI:1.24-1.49,P＜0.01).Conclusions Hyperglycemia and hypertension play an important role in the pathogenesis and development of DR and DME in Chinese type 2 diabetic patients,and intensive glycemic control and hypertension control should be emphasized in diabetic patients.