Cugati S, Cikamatana L, Wang J J, Kifley A, Liew G, Mitchell P
Department of Ophthalmology, Centre for Vision Research, University of Sydney, Sydney, Australia.
Eye (Lond). 2006 Nov;20(11):1239-45. doi: 10.1038/sj.eye.6702085. Epub 2005 Sep 16.
To assess the 5-year incidence of vascular retinopathy and its associations in an older nondiabetic population.
The Blue Mountains Eye Study examined 3654 residents aged 49+ years (82.4% response rate) during 1992-1994, and re-examined 2335 (75.1% of survivors) during 1997-1999. Retinopathy lesions (microaneurysms, haemorrhages, hard or soft exudates) were assessed from 6-field retinal photographs in persons without diabetes. Incident retinopathy was assessed in those at risk. Hypertensive status was defined following the WHO/International Society of Hypertension guidelines.
Of the 2335 re-examined, 195 had retinopathy lesions at baseline and 1725 were at risk of retinopathy after excluding subjects with diabetes (n=261), retinal vein occlusion (n=52) or missing/un-gradable photographs (n=102). The cumulative 5-year incidence was 9.7% (95% confidence intervals (CI) 8.3-11.1%). Age was the only factor significantly associated with incident retinopathy (Pfor trend=0.012). Neither fasting blood glucose (age-sex-adjusted P=0.147) nor hypertension (adjusted Pfor trend=0.43) was associated with incident retinopathy. Of the 195 with retinopathy lesions at baseline, 3.5% developed diabetes, 13.3% progressed, and 72.3% regressed/disappeared over 5 years. Progression was positively associated with elevated blood pressure (BP) (adjusted odds ratio (OR) 1.3, 95% CI 1.1-1.6 per 10 mmHg systolic BP) and inversely associated with fasting glucose level (OR 0.36, CI 0.14-0.92 per mmol/l increase). Aspirin use was weakly associated with regression (OR 2.4, CI 1.0-6.0).
Over 5 years, retinopathy developed in 10% of older people without diabetes, while 72% of baseline lesions regressed. Age was significantly associated with the development of these lesions.
评估老年非糖尿病人群中血管性视网膜病变的5年发病率及其相关因素。
蓝山眼研究在1992 - 1994年对3654名年龄在49岁及以上的居民进行了检查（应答率为82.4%），并在1997 - 1999年对其中2335人（占幸存者的75.1%）进行了复查。对无糖尿病者的6视野视网膜照片进行视网膜病变损害（微动脉瘤、出血、硬性或软性渗出）评估。对有风险者评估新发视网膜病变情况。高血压状态按照世界卫生组织/国际高血压学会指南进行定义。
在复查的2335人中，195人在基线时存在视网膜病变损害，排除糖尿病患者（n = 261）、视网膜静脉阻塞患者（n = 52）或照片缺失/无法分级者（n = 102）后，1725人有发生视网膜病变的风险。5年累积发病率为9.7%（95%置信区间（CI）8.3 - 11.1%）。年龄是与新发视网膜病变显著相关的唯一因素（趋势P值 = 0.012）。空腹血糖（年龄 - 性别调整后P = 0.147）和高血压（趋势调整后P值 = 0.43）均与新发视网膜病变无关。在基线时有视网膜病变损害的195人中，3.5%在5年内患糖尿病，13.3%病情进展，72.3%病情消退/消失。病情进展与血压升高呈正相关（收缩压每升高10 mmHg，调整后比值比（OR）为1.3，95% CI 1.1 - 1.6），与空腹血糖水平呈负相关（每升高1 mmol/l，OR为0.36，CI 0.14 - 0.92）。使用阿司匹林与病情消退有弱相关性（OR为2.4，CI 1.0 - 6.0）。
5年间，10%的老年非糖尿病患者发生了视网膜病变，而72%的基线损害病情消退。年龄与这些病变的发生显著相关。
