无糖尿病者视网膜病变与糖尿病和高血压15年发病率的关系：比弗迪姆眼研究
The relationship of retinopathy in persons without diabetes to the 15-year incidence of diabetes and hypertension: Beaver Dam Eye Study.
作者信息
Klein Ronald, Klein Barbara E K, Moss Scot E, Wong Tien Y
机构信息
Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA.
出版信息
Trans Am Ophthalmol Soc. 2006;104:98-107.
PURPOSE
To examine the relationship of retinopathy in persons without diabetes mellitus to the 15-year cumulative incidence of diabetes mellitus and hypertension.
METHODS
A total of 3,402 persons 43 to 86 years of age without diabetes mellitus (1,879 without diabetes or hypertension) at the time of a baseline examination in 1988-1990 had follow-up examinations in 1993-1995, 1998-2000, and/or 2003-2005. Diabetes mellitus was defined by a combination of history, serum glucose levels, and glycosylated hemoglobin levels, and hypertension was defined as systolic blood pressure >/=140 mm Hg or diastolic blood pressure >/=90 mm Hg and/or use of antihypertensive medications. Retinopathy at baseline was determined by masked gradings of stereoscopic fundus photographs using standardized protocols.
RESULTS
Retinopathy was present in 7.3% of the nondiabetic persons in the cohort and 5.4% of the nondiabetic, nonhypertensive cohort at baseline. The 15-year cumulative incidence of diabetes was 12.5% and of hypertension 54.1%. While controlling for age, persons with retinopathy were more likely to develop diabetes mellitus (odds ratio, 95% confidence interval, P value: 1.70, 1.17-2.48, P = .005) and hypertension (1.62, 1.18-2.23, P = .003) than persons without retinopathy. While controlling for other risk factors (eg, blood pressure, glucose level, cardiovascular disease history), the associations of retinopathy with incident diabetes mellitus (1.35, 0.90-2.03, P = .15) and hypertension (1.48, 1.05-2.07, P = .02) became attenuated but remained statistically significant for hypertension. In stratified analyses, retinopathy was associated with incident diabetes in persons younger than 65 years (1.80, 1.12-2.89, P = .02)
CONCLUSIONS
While controlling for other risk factors, retinopathy in nondiabetic individuals is associated with the incidence of hypertension and, in younger persons, with the incidence of diabetes mellitus.
目的
研究无糖尿病患者的视网膜病变与糖尿病和高血压15年累积发病率之间的关系。
方法
1988 - 1990年基线检查时，共有3402名年龄在43至86岁之间且无糖尿病的人（其中1879人无糖尿病或高血压）在1993 - 1995年、1998 - 2000年和/或2003 - 2005年接受了随访检查。糖尿病通过病史、血糖水平和糖化血红蛋白水平综合定义，高血压定义为收缩压≥140 mmHg或舒张压≥90 mmHg和/或使用抗高血压药物。基线时的视网膜病变通过使用标准化方案对立体眼底照片进行盲法分级来确定。
结果
队列中7.3%的非糖尿病患者和基线时5.4%的非糖尿病、非高血压患者存在视网膜病变。糖尿病的15年累积发病率为12.5%，高血压为54.1%。在控制年龄后，有视网膜病变的人比没有视网膜病变的人更易患糖尿病（优势比，95%置信区间，P值：1.70，1.17 - 2.48，P = 0.005）和高血压（1.62，1.18 - 2.23，P = 0.003）。在控制其他危险因素（如血压、血糖水平、心血管疾病史）后，视网膜病变与新发糖尿病（1.35，0.90 - 2.03，P = 0.15）和高血压（1.48，1.05 - 2.07，P = 0.02）的关联虽有所减弱，但对高血压仍具有统计学意义。在分层分析中，视网膜病变与65岁以下人群的新发糖尿病相关（1.80，1.12 - 2.89，P = 0.02）
结论
在控制其他危险因素的情况下，非糖尿病个体的视网膜病变与高血压发病率相关，在年轻人中与糖尿病发病率相关。
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