Hirai Flavio E, Knudtson Michael D, Klein Barbara E K, Klein Ronald
Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Madison, Wisconsin 53726, USA.
Am J Ophthalmol. 2008 Apr;145(4):700-6. doi: 10.1016/j.ajo.2007.11.019. Epub 2008 Jan 28.
To investigate the association of clinically significant macular edema (CSME) and long-term survival in individuals with type 1 and type 2 diabetes.
Population-based cohort study.
The Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) is an ongoing prospective population-based cohort study initiated from August 21, 1980 through July 30, 1982 of individuals with diabetes diagnosed at either younger than 30 years of age (younger-onset group; n = 996) or 30 years of age or older (older-onset group; n = 1,370). Stereoscopic color retinal photographs were graded for retinopathy using the modified Airlie House classification scheme. CSME was defined by the Early Treatment Diabetic Retinopathy Study criteria.
Prevalence of CSME was 5.9% and 7.5% for the younger- and older-onset groups, respectively. After 20 years of follow-up, 276 younger-onset and 1,197 older-onset persons died. When adjusting for age and gender, CSME was not significantly associated with all-cause mortality (hazard ratio [HR], 1.41; 95% confidence interval [CI], 0.96 to 2.07; P = .08) or ischemic heart disease mortality (HR, 1.14; 95% CI, 0.61 to 2.12; P = .68) in the younger-onset group. In the older-onset group, there was increased all-cause and ischemic heart disease mortality when CSME was present (HR, 1.55; 95% CI, 1.25 to 1.92; P < .01; and HR, 1.56; 95% CI, 1.15 to 2.13; P < .01, respectively), when adjusting for age and gender. After controlling for other risk factors, the association remained significant for ischemic heart disease (HR, 1.58; 95% CI, 1.07 to 2.35; P = .02) among those taking insulin. CSME was not significantly associated with stroke mortality in either group.
CSME seems to be a risk indicator for decreased survival in persons with older-onset diabetes mellitus. The presence of CSME may identify individuals who should be receiving care for detection and treatment of cardiovascular disease.
研究1型和2型糖尿病患者中具有临床意义的黄斑水肿（CSME）与长期生存之间的关联。
基于人群的队列研究。
威斯康星糖尿病视网膜病变流行病学研究（WESDR）是一项正在进行的前瞻性基于人群的队列研究，始于1980年8月21日至1982年7月30日，研究对象为30岁以下被诊断为糖尿病的个体（早发型组；n = 996）或30岁及以上的个体（晚发型组；n = 1370）。使用改良的艾利屋分类方案对立体彩色视网膜照片进行视网膜病变分级。CSME根据早期糖尿病性视网膜病变研究标准定义。
早发型组和晚发型组的CSME患病率分别为5.9%和7.5%。经过20年的随访，276例早发型患者和1197例晚发型患者死亡。在调整年龄和性别后，早发型组中CSME与全因死亡率（风险比[HR]，1.41；95%置信区间[CI]，0.
