Stolk Ronald P, van Schooneveld Mary J, Cruickshank J Kennedy, Hughes Alun D, Stanton Alice, Lu Juming, Patel Anushka, Thom Simon A McG, Grobbee Diederick E, Vingerling Johannes R
Department of Epidemiology, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands.
Diabetes Care. 2008 Apr;31(4):708-13. doi: 10.2337/dc07-1657. Epub 2008 Jan 9.
The objective of this study was to describe prevalent vascular retinal lesions among patients with type 2 diabetes enrolled in the ADVANCE Retinal Measurements (AdRem) study, a substudy of the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial.
Seven-field stereoscopic photographs of both eyes were obtained at the baseline assessment of the ADVANCE trial. All photographs were graded in a central reading center. Gradable retinal images were received from 1,605 patients.
The number of patients with any retinopathy (Early Treatment of Diabetic Retinopathy Study [ETDRS] score > or = 20) was 645 (40.2% [95% CI 37.8-42.6]); of these, 35 (2.2% [1.6-3.0]) had severe diabetic retinopathy (ETDRS score > or = 50). Focal arterial narrowing, venous beading, and arteriovenous nicking were present in 3.8, 5.1, and 9.8% of participants, respectively. Among participants included in this study, Chinese and South-Asian patients had more retinopathy than Caucasians, as defined both by ETDRS score (49.4, 46.0, and 31.3%, respectively; P < 0.001, adjusted for age, sex, A1C, systolic blood pressure, and duration of diabetes) and specific vascular lesions (e.g., arteriovenous nicking 12.3, 8.5, and 7.5%, respectively; adjusted P < 0.005). A1C, duration of diabetes, and systolic blood pressure were similarly associated with increased retinal lesions in Chinese, South-Asian, and Caucasian patients.
Using a sensitive diagnostic procedure, more than one-third of patients with type 2 diabetes enrolled in the AdRem study had retinal lesions at baseline. Despite differences in prevalence and severity of retinopathy among Chinese, South-Asian, and Caucasian patients included in this study, the cross-sectional associations among established risk factors for retinopathy and retinal lesions were similar across ethnic groups.
本研究的目的是描述参与糖尿病视网膜病变进展研究（AdRem）的2型糖尿病患者中普遍存在的视网膜血管病变情况，AdRem研究是糖尿病与血管疾病行动：培哚普利吲达帕胺片与美吡达缓释片对照评估（ADVANCE）试验的一项子研究。
在ADVANCE试验的基线评估时获取双眼的七视野立体照片。所有照片均在中央阅片中心进行分级。共收到1605例患者的可分级视网膜图像。
患有任何视网膜病变（糖尿病视网膜病变早期治疗研究[ETDRS]评分≥20）的患者有645例（40.2%[95%CI 37.8 - 42.6]）；其中，35例（2.2%[1.6 - 3.0]）患有重度糖尿病视网膜病变（ETDRS评分≥50）。分别有3.8%、5.1%和9.8%的参与者存在局灶性动脉狭窄、静脉串珠样改变和动静脉交叉压迹。在本研究纳入的参与者中，按照ETDRS评分（分别为49.4%、46.0%和31.3%；P<0.001，经年龄、性别、糖化血红蛋白、收缩压和糖尿病病程校正）以及特定血管病变（如动静脉交叉压迹分别为12.3%、8.5%和7.5%；校正P<0.005）定义，中国和南亚患者的视网膜病变比白种人更多。糖化血红蛋白、糖尿病病程和收缩压与中国、南亚和白种人患者视网膜病变增加的关联相似。
采用敏感的诊断程序，参与AdRem研究的2型糖尿病患者中超过三分之一在基线时存在视网膜病变。尽管本研究纳入的中国、南亚和白种人患者在视网膜病变的患病率和严重程度上存在差异，但视网膜病变既定危险因素与视网膜病变之间的横断面关联在不同种族群体中相似。
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