Klein Ronald, Knudtson Michael D, Lee Kristine E, Gangnon Ronald, Klein Barbara E K
Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53726-2336, USA.
Ophthalmology. 2009 Mar;116(3):497-503. doi: 10.1016/j.ophtha.2008.10.016. Epub 2009 Jan 22.
To examine the 25-year cumulative incidence of macular edema (ME) and its relation to various risk factors.
Population-based study.
A total of 955 insulin-taking persons living in an 11-county area in southern Wisconsin with type 1 diabetes diagnosed before age 30 years who participated in baseline examinations (1980-1982) and at least 1 of 4 follow-up (4-, 10-, 14-, and 25-year) examinations (n=891) or died before the first follow-up examination (n=64).
Stereoscopic color fundus photographs were graded using the modified Airlie House classification and the Early Treatment Diabetic Retinopathy Study retinopathy severity scheme. Competing risk of death was included in statistical models.
Incidence of ME and clinically significant ME (CSME).
The 25-year cumulative incidence was 29% for ME and 17% for CSME. Annualized incidences of ME were 2.3%, 2.1%, 2.3%, and 0.9% in the first, second, third, and fourth follow-up periods of the study, respectively. In univariate analyses, the incidence of ME was associated with male sex, more severe diabetic retinopathy, higher glycosylated hemoglobin, proteinuria, higher systolic and diastolic blood pressure, and more pack-years of smoking. Multivariate analyses showed that the incidence of ME was related to higher baseline glycosylated hemoglobin (hazard ratio [HR] per 1% 1.17; 95% confidence interval [CI], 1.10-1.25; P<0.001) and higher systolic blood pressure (HR per 10 mmHg 1.15; 95% CI, 1.04-1.26; P=0.004) and marginally to proteinuria (HR 1.43; 95% CI, 0.99-2.08; P=0.06).
These data show that relatively high 25-year cumulative rates of incidence of ME were related to glycemia and blood pressure. The lower risk of incident ME in the last period of the study may reflect recent improvement in care.
研究黄斑水肿（ME）的25年累积发病率及其与各种危险因素的关系。
基于人群的研究。
共有955名在威斯康星州南部11县地区服用胰岛素的1型糖尿病患者，这些患者在30岁之前被诊断出患有糖尿病，并参加了基线检查（1980 - 1982年）以及4次随访检查（4年、10年、14年和25年）中的至少1次检查（n = 891），或在首次随访检查前死亡（n = 64）。
使用改良的艾利屋分类法和早期糖尿病性视网膜病变研究视网膜病变严重程度方案对立体彩色眼底照片进行分级。统计模型中纳入了死亡的竞争风险。
ME和临床显著性ME（CSME）的发病率。
ME的25年累积发病率为29%，CSME为17%。在研究的第一个、第二个、第三个和第四个随访期，ME的年化发病率分别为2.3%、2.1%、2.3%和0.9%。在单变量分析中，ME的发病率与男性、更严重的糖尿病视网膜病变、更高的糖化血红蛋白、蛋白尿、更高的收缩压和舒张压以及更多的吸烟包年数有关。多变量分析显示，ME的发病率与更高的基线糖化血红蛋白（每增加1%的风险比[HR]为1.17；95%置信区间[CI]，1.10 - 1.25；P < 0.001）、更高的收缩压（每增加10 mmHg的HR为1.15；95% CI, 1.04 - 1.26；P = 0.004）以及与蛋白尿有微弱关联（HR为1.43；95% CI, 0.99 - 2.08；P = 0.06）。
这些数据表明，ME相对较高的25年累积发病率与血糖和血压有关。研究最后阶段ME发病风险较低可能反映了近期护理方面的改善。
