Janghorbani M, Jones R B, Murray K J, Allison S P
Dept. Epidemio. & Biostat. School of Public Health, Isfahan University of Medical Sciences, Iran.
Ophthalmic Epidemiol. 2001 Dec;8(5):309-25. doi: 10.1080/09286586.2001.11644259.
The incidence and risk factors for the development of diabetic retinopathy during a mean (SD) follow-up period of 4.6 (2.9) (range 1-12.4) years have been examined among 3424 patients (1878 males and 1546 females) with diabetes mellitus from three outpatient clinics at the University Hospital, Nottingham. The mean (SD) age of participants was 49.2 (17.9) years with a mean (SD) duration of diabetes of 7.3 (9.0) years at initial registration. Among the 3424 patients free of retinopathy at initial registration who attended the clinic at least twice in the period 1979-1992, the incidence of any retinopathy was 59.6 (57.8 male and 61.8 female) per 1000 person-years based on 15,571 person-years of follow-up. The incidence rate of retinopathy was 72% higher among insulin-treated than among non-insulin-treated noninsulin-dependent diabetes mellitus (NIDDM) clinic attenders. Using a Cox's Proportional Hazards Model for insulin-dependent diabetes (IDDM) and NIDDM (insulin and non-insulin-treated) diabetes separately, longer duration of diabetes, higher systolic blood pressure and poor metabolic control were significant independent predictors of retinopathy for all three groups. Never smoking was a significant independent predictor of retinopathy for the insulin-dependent diabetes groups. Lower body mass index, proteinuria and age were predictors of retinopathy only for non-insulin-treated NIDDM patients. Gender and creatinine had no significant independent association with retinopathy when other covariates were considered. These findings will help the identification of those patients at particular risk of retinopathy so that clinic time for screening of eyes can be appropriately focused.
在诺丁汉大学医院的三家门诊诊所中，对3424例糖尿病患者（1878例男性和1546例女性）进行了研究，观察了平均（标准差）4.6（2.9）年（范围1 - 12.4年）随访期内糖尿病视网膜病变发生的发病率及危险因素。参与者的平均（标准差）年龄为49.2（17.9）岁，初始登记时糖尿病的平均（标准差）病程为7.3（9.0）年。在1979 - 1992年期间至少就诊两次的3424例初始登记时无视网膜病变的患者中，基于15571人年的随访，任何视网膜病变的发病率为每1000人年59.6例（男性57.8例，女性61.8例）。在胰岛素治疗的非胰岛素依赖型糖尿病（NIDDM）门诊患者中，视网膜病变的发病率比未接受胰岛素治疗的患者高72%。分别对胰岛素依赖型糖尿病（IDDM）和NIDDM（胰岛素治疗和非胰岛素治疗）患者使用Cox比例风险模型，糖尿病病程较长、收缩压较高和代谢控制不佳是所有三组视网膜病变的显著独立预测因素。从不吸烟是胰岛素依赖型糖尿病组视网膜病变的显著独立预测因素。较低的体重指数、蛋白尿和年龄仅是未接受胰岛素治疗的NIDDM患者视网膜病变的预测因素。当考虑其他协变量时，性别和肌酐与视网膜病变无显著独立关联。这些发现将有助于识别那些有视网膜病变特殊风险的患者，以便能适当地集中门诊时间进行眼部筛查。
