Tung Tao-Hsin, Chen Shih-Jen, Liu Jorn-Hon, Lee Fenq-Lih, Li An-Fei, Shyong Mong-Ping, Chou Pesus
Community Medicine Research Center & Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
Eur J Epidemiol. 2005;20(4):317-23. doi: 10.1007/s10654-004-6651-z.
The purpose of this follow-up study was conducted to assess the incidence and risk factors of diabetic retinopathy (DR) among type 2 diabetics in Kinmen, Taiwan. A penal of eye screening regimes were performed yearly for 971 type 2 diabetics by two senior ophthalmologists using indirect ophthalmoscopy and 45-degree color fundus photography to examine fundus after dilating pupils from 1999 to 2002. 74.7% (725/971) of diabetics had been screened at least two times during this period. Among the 548 type 2 diabetics who had no DR at first screening, 93 subjects developed any type of DR. The 3-year 18.2% cumulative incidence was (95% CI: 14.8-21.5%) and incidence density was 6.62% per year (95% CI: 5.36-8.06% per year). Using Cox regression model, HbAlc revealed the significantly dose response relationship to the development of DR (chi2-test for trend = 9.41, p < 0.05) after controlling for confounding factors. Other independent predictors related to the development of DR included duration of diabetes (RR: 1.09, 95% CI: 1.05-1.13), higher systolic blood pressure (>140 vs. < 140 mm Hg, RR: 1.96, 95% CI: 1.23-3.12), and higher triglyceride (> 200 vs. < 200 mg/dl, RR: 1.60, 95% CI: 1.01-2.54). In conclusion, in addition to poor glycemic control of which is the most significant risk factor for the development of DR, longer duration of diabetes, higher systolic blood pressure, and elevated serum triglyceride levels were also associated with the development of DR among type 2 diabetics in Kinmen.
这项随访研究的目的是评估台湾金门地区2型糖尿病患者糖尿病视网膜病变（DR）的发病率及危险因素。1999年至2002年期间，两位资深眼科医生每年对971例2型糖尿病患者进行一系列眼部筛查，使用间接检眼镜和45度彩色眼底摄影技术在散瞳后检查眼底。在此期间，74.7%（725/971）的糖尿病患者至少接受了两次筛查。在首次筛查时无DR的548例2型糖尿病患者中，有93例出现了任何类型的DR。3年累计发病率为18.2%（95%置信区间：14.8 - 21.5%），发病密度为每年6.62%（95%置信区间：每年5.36 - 8.06%）。使用Cox回归模型，在控制混杂因素后，糖化血红蛋白（HbAlc）显示出与DR发生存在显著的剂量反应关系（趋势χ2检验 = 9.41，p < 0.05）。与DR发生相关的其他独立预测因素包括糖尿病病程（风险比：1.09，95%置信区间：1.05 - 1.13）、较高的收缩压（>140 vs. < 140 mmHg，风险比：1.96，95%置信区间：1.23 - 3.12）以及较高的甘油三酯水平（> 200 vs. < 200 mg/dl，风险比：1.60，95%置信区间：1.01 - 2.54）。总之，除血糖控制不佳是DR发生的最主要危险因素外，糖尿病病程较长、收缩压较高以及血清甘油三酯水平升高也与金门地区2型糖尿病患者DR的发生有关。
