Stratton I M, Kohner E M, Aldington S J, Turner R C, Holman R R, Manley S E, Matthews D R
Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology & Metabolism, University of Oxford, UK.
Diabetologia. 2001 Feb;44(2):156-63. doi: 10.1007/s001250051594.
AIMS/HYPOTHESIS: To determine risk factors related to the incidence and progression of diabetic retinopathy over 6 years from diagnosis of Type II (non-insulin-dependent) diabetes mellitus.
This report describes 1919 patients from within the United Kingdom Prospective Diabetes Study (UKPDS), with retinal photographs taken at diagnosis and 6 years later and with complete data available. Photographs were centrally graded for lesions of diabetic retinopathy using the modified Early Treatment of Diabetic Retinopathy Study Final scale. Risk factors were assessed after 3 months diet from the time of diagnosis of diabetes. Patients were seen every 3 months in a hospital setting. Biochemical measurements were done by a central laboratory. End points of vitreous haemorrhage and photocagulation were confirmed by independent adjudication of systematically collected clinical data. The main outcome measures were incidence and progression of retinopathy defined as a two-step Early Treatment of Diabetic Retinopathy Study (ETDRS) final scale change.
Of the 1919 patients, 1216 (63 %) had no retinopathy at diagnosis. By 6 years, 22 % of these had developed retinopathy, that is microaneurysms in both eyes or worse. In the 703 (37 %) patients with retinopathy at diagnosis, 29 % progressed by two scale steps or more. Development of retinopathy (incidence) was strongly associated with baseline glycaemia, glycaemic exposure over 6 years, higher blood pressure and with not smoking. In those who already had retinopathy, progression was associated with older age, male sex, hyperglycaemia (as evidenced by a higher HbA1c) and with not smoking.
CONCLUSION/INTERPRETATION: The findings re-emphasise the need for good glycaemic control and assiduous treatment of hypertension if diabetic retinopathy is to be minimised.
目的/假设：确定与II型（非胰岛素依赖型）糖尿病诊断后6年糖尿病视网膜病变的发生和进展相关的危险因素。
本报告描述了来自英国前瞻性糖尿病研究（UKPDS）的1919例患者，这些患者在诊断时和6年后拍摄了视网膜照片，且有完整的数据。使用改良的糖尿病视网膜病变早期治疗研究最终量表对糖尿病视网膜病变的病变进行集中分级。从糖尿病诊断时起3个月饮食后评估危险因素。患者每3个月在医院就诊一次。生化测量由中央实验室进行。通过对系统收集的临床数据进行独立判定，确认玻璃体出血和光凝的终点。主要结局指标是视网膜病变的发生和进展，定义为糖尿病视网膜病变早期治疗研究（ETDRS）最终量表两步变化。
在1919例患者中，1216例（63%）在诊断时没有视网膜病变。到6年时，其中22%发生了视网膜病变，即双眼出现微动脉瘤或更严重的病变。在诊断时患有视网膜病变的703例（37%）患者中，29%进展了两个或更多量表步骤。视网膜病变的发生（发病率）与基线血糖、6年的血糖暴露、较高的血压和不吸烟密切相关。在已经患有视网膜病变的患者中，进展与年龄较大、男性、高血糖（以较高的糖化血红蛋白水平为证）和不吸烟有关。
结论/解读：这些发现再次强调，如果要将糖尿病视网膜病变降至最低，需要良好的血糖控制和积极治疗高血压。
