Cohen R A, Hennekens C H, Christen W G, Krolewski A, Nathan D M, Peterson M J, LaMotte F, Manson J E
Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02215-1204, USA.
Am J Med. 1999 Jul;107(1):45-51. doi: 10.1016/s0002-9343(99)00165-5.
To determine the risk factors for retinopathy progression in type 1 (insulin-dependent) diabetes mellitus in a prospective cohort study.
Subjects were 485 participants in the Sorbinil Retinopathy Trial, a randomized trial of aldose reductase inhibition among patients aged 18 to 56 years with type 1 diabetes mellitus (duration of 1 to 15 years) and no or only mild retinopathy. Retinopathy progression, assessed by seven-field stereoscopic fundus photography, was defined as worsening by two or more levels on a standardized grading scale at the end of follow-up (median, 41 months).
The relative risks for retinopathy progression according to successively greater quintiles of total glycosylated hemoglobin level at baseline, after adjusting for age, diabetes duration, sorbinil assignment, and other variables, were 1.0, 2.0, 1.6, 3.7, and 4.4 (P trend <0.0001). Risk increased with greater baseline diastolic blood pressure: 1.0 for <70 mm Hg, 1.2 for 70 to 79 mm Hg, and 1.8 for > or =80 mm Hg (P for trend = 0.04). Diastolic blood pressure was a significant risk factor for progression in participants with mild baseline retinopathy (P for trend <0.02) but not in those without retinopathy at entry. Systolic blood pressure, by comparison, was not associated with progression. Baseline total cholesterol level was a marginally significant predictor of retinopathy progression when examined as a categorical variable (relative risks for increasing quartiles; 1.0, 1.6, 1.8, 1.9; P for trend = 0.03) but not when it was examined as a continuous variable or when hypercholesterolemic patients were compared with those with normal levels. Furthermore, when cholesterol levels were updated in subsequent visits, it was not a significant predictor of progression, and low density lipoprotein (LDL) cholesterol levels did not predict progression no matter how analyzed. Smoking was not associated with progression of retinopathy.
Levels of hyperglycemia and diastolic blood pressure predicted progression of retinopathy in type 1 diabetes mellitus. We found only a suggestion of an association between total cholesterol level (but not of LDL cholesterol level) and progression of retinopathy; resolution of this issue will require additional studies with larger sample sizes and longer follow-up.
在一项前瞻性队列研究中确定1型（胰岛素依赖型）糖尿病视网膜病变进展的危险因素。
研究对象为485名参与Sorbinil视网膜病变试验的受试者，该试验是一项在18至56岁1型糖尿病（病程1至15年）且无或仅有轻度视网膜病变患者中进行的醛糖还原酶抑制随机试验。通过七视野立体眼底摄影评估的视网膜病变进展定义为随访结束时（中位数为41个月）在标准化分级量表上恶化两个或更多级别。
在调整年龄、糖尿病病程、索比尼尔分配及其他变量后，根据基线糖化血红蛋白总水平依次升高的五分位数，视网膜病变进展的相对风险分别为1.0、2.0、1.6、3.7和4.4（P趋势<0.0001）。风险随基线舒张压升高而增加：舒张压<70 mmHg时为1.0，70至79 mmHg时为1.2，≥80 mmHg时为1.8（趋势P = 0.04）。舒张压是基线有轻度视网膜病变参与者进展的显著危险因素（趋势P<0.02），但在入组时无视网膜病变者中并非如此。相比之下，收缩压与进展无关。将基线总胆固醇水平作为分类变量检查时，它是视网膜病变进展的边缘显著预测因素（四分位数增加的相对风险；1.0、1.6、1.8、1.9；趋势P = 0.03），但作为连续变量检查时或高胆固醇血症患者与正常水平患者比较时并非如此。此外，在后续随访中更新胆固醇水平时，它不是进展的显著预测因素，无论如何分析低密度脂蛋白（LDL）胆固醇水平均不能预测进展。吸烟与视网膜病变进展无关。
高血糖水平和舒张压可预测1型糖尿病视网膜病变的进展。我们仅发现总胆固醇水平（而非LDL胆固醇水平）与视网膜病变进展之间存在关联的迹象；解决此问题需要进行样本量更大、随访时间更长的额外研究。
