Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Universidade Federal do RioGrande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
Diabetes Care. 2011 May;34(5):1238-44. doi: 10.2337/dc11-0079.
The prognostic significance of diabetic retinopathy (DR) for death and cardiovascular (CV) outcomes is debated. We investigated the association of DR with all-cause mortality and CV events in patients with diabetes by a systematic review and meta-analysis.
The electronic databases Medline and Embase were searched for cohort studies that evaluated DR in type 2 or type 1 diabetic patients and reported total mortality and/or fatal and nonfatal CV events, including myocardial infarction, angina pectoris, coronary artery bypass graft, ischemic changes on a conventional 12-lead electrocardiogram, transient ischemic attack, nonfatal stroke, or lower leg amputation. Data extraction was performed by two reviewers independently. Pooled effect estimates were obtained by using random-effects meta-analysis.
The analysis included 20 studies that fulfilled the inclusion criteria, providing data from 19,234 patients. In patients with type 2 diabetes (n = 14,896), the presence of any degree of DR increased the chance for all-cause mortality and/or CV events by 2.34 (95% CI 1.96-2.80) compared with patients without DR. In patients with type 1 diabetes (n = 4,438), the corresponding odds ratio was 4.10 (1.50-11.18). These associations remained after adjusting for traditional CV risk factors. DR was also predictive of all-cause mortality in type 2 diabetes (odds ratio 2.41 [1.87-3.10]) and type 1 diabetes (3.65 [1.05-12.66]).
The presence of DR was associated with an increased risk of all-cause mortality and CV events in both type 2 and type 1 diabetic patients.
糖尿病视网膜病变（DR）与死亡和心血管（CV）结局的预后意义存在争议。我们通过系统评价和荟萃分析研究了 DR 与糖尿病患者全因死亡率和 CV 事件的关系。
检索电子数据库 Medline 和 Embase，以评估 2 型或 1 型糖尿病患者中 DR 并报告总死亡率和/或致命和非致命 CV 事件的队列研究，包括心肌梗死、心绞痛、冠状动脉旁路移植术、常规 12 导联心电图上的缺血改变、短暂性脑缺血发作、非致命性中风或小腿截肢。由两名审阅者独立进行数据提取。使用随机效应荟萃分析获得汇总效应估计值。
分析纳入了 20 项符合纳入标准的研究，提供了 19234 名患者的数据。在 2 型糖尿病患者（n=14896）中，与无 DR 的患者相比，任何程度的 DR 使全因死亡率和/或 CV 事件的发生几率增加 2.34 倍（95%CI 1.96-2.80）。在 1 型糖尿病患者（n=4438）中，相应的优势比为 4.10（1.50-11.18）。在调整传统 CV 危险因素后，这些关联仍然存在。DR 也预测了 2 型糖尿病（优势比 2.41 [1.87-3.10]）和 1 型糖尿病（3.65 [1.05-12.66]）患者的全因死亡率。
DR 的存在与 2 型和 1 型糖尿病患者全因死亡率和 CV 事件风险增加相关。
