Looker Helen C, Krakoff Jonathan, Knowler William C, Bennett Peter H, Klein Ronald, Hanson Robert L
Diabetes and Arthritis Epidemiology Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona, USA.
Diabetes Care. 2003 Feb;26(2):320-6. doi: 10.2337/diacare.26.2.320.
To examine incidence and progression of retinopathy using retinal photographs in Pima Indians and to compare the results with those obtained when retinopathy is assessed by direct ophthalmoscopy.
We undertook an analysis of examinations conducted between 1 April 1982 and 31 December 1990 in residents of the Gila River Community in central Arizona. Data were taken from 411 people with diabetes who had at least two examinations during this period. Incidence and progression of retinopathy were evaluated by retinal photography and fundoscopy, and hazard rate ratios were calculated for various potential risk factors measured at baseline.
Previously diagnosed retinopathy tended to progress, except in individuals with minimal nonproliferative retinopathy, among whom follow-up examinations were more likely to show no retinopathy. Diabetes duration (hazard rate ratio [HRR], 1.06 per year difference [P = 0.007]), hyperglycemia (HbA(1) HRR, 1.27 per 1% difference [P < 0.0001]), the type of treatment for diabetes (insulin use HRR, 3.06 [P = 0.0007], and oral hypoglycemic use HRR, 2.40 [P = 0.0034], compared with individuals on no pharmacotherapy), and macroalbuminuria (HRR, 2.86, compared with individuals without macroalbuminuria [P = 0.0486]) were associated with the development of retinopathy. Although fundoscopy detected fewer cases of retinopathy, HRRs for most risk factors were similar when retinopathy was assessed by fundoscopy rather than retinal photography.
Although retinopathy tends to worsen over time, some eyes show improvement, especially in patients with minimal nonproliferative retinopathy. As in other populations, glycemic control is the major modifiable risk factor for the development and progression of retinopathy.
利用视网膜照片检查皮马印第安人的视网膜病变发病率及进展情况，并将结果与直接检眼镜评估视网膜病变时所得结果进行比较。
我们对1982年4月1日至1990年12月31日期间在亚利桑那州中部吉拉河社区居民中进行的检查进行了分析。数据取自411名在此期间至少接受过两次检查的糖尿病患者。通过视网膜摄影和检眼镜检查评估视网膜病变的发病率及进展情况，并计算基线时测量的各种潜在风险因素的风险率比。
除了轻度非增殖性视网膜病变患者外，先前诊断出的视网膜病变往往会进展，在这些患者中，后续检查更有可能显示无视网膜病变。糖尿病病程（风险率比[HRR]，每年差异为1.06[P = 0.007]）、高血糖（糖化血红蛋白[HbA(1)]HRR，每1%差异为1.27[P < 0.0001]）、糖尿病治疗类型（与未接受药物治疗的个体相比，使用胰岛素的HRR为3.06[P = 0.0007]，使用口服降糖药的HRR为2.40[P = 0.0034]）以及大量蛋白尿（与无大量蛋白尿的个体相比，HRR为2.86[P = 0.0486]）与视网膜病变的发生相关。尽管检眼镜检查发现的视网膜病变病例较少，但通过检眼镜检查而非视网膜摄影评估视网膜病变时，大多数风险因素的HRR相似。
尽管视网膜病变往往会随着时间推移而恶化，但一些眼睛会有所改善，尤其是轻度非增殖性视网膜病变患者。与其他人群一样，血糖控制是视网膜病变发生和进展的主要可改变风险因素。
