Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, FinlandDepartment of Ophthalmology, Helsinki University Central Hospital, Helsinki, FinlandDivision of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, FinlandThe Baker IDI Heart and Diabetes Institute, Melbourne, Vic., Australia.
Acta Ophthalmol. 2013 Dec;91(8):709-15. doi: 10.1111/j.1755-3768.2012.02522.x. Epub 2012 Sep 13.
To investigate whether age at onset of type 1 diabetes is a risk factor for clinically significant macular oedema (CSME).
A sample of 1354 patients with a mean duration of diabetes 24.6 ± 11.6 years was drawn from the FinnDiane Study population and divided into age at onset groups 0-4 (n = 184), 5-14 (n = 662) and 15-40 years (n = 508). Type 1 diabetes was defined as age at onset ≤40 years, C-peptide negativity and insulin treatment initiated within 1 year of diagnosis. Retinopathy status was assessed from fundus photographs and stereoscopic fundus examinations and graded with the ETDRS scale.
After 30 years of diabetes, the estimated cumulative incidences of CSME were 17% (95% CI 11-26) in age at onset group 0-4 years, 27% (95% CI 23-32) in age at onset group 5-14 years and 34% (95% CI 27-41) in age at onset group 15-40 years (p = 0.002, Gray's test). In a competing risks regression model, adjusted for covariates selected with Bayesian information criteria, age at onset 5-14 years (HR 1.89 [95% CI 1.22-2.91], p = 0.004), and age at onset 15-40 years (HR 3.72 [95% CI 2.35-5.89], p < 0.0001), were significant overall risk factors for CSME (p < 0.0001). Higher ETDRS score (HR 1.04 ([95% CI 1.03-1.05], p < 0.0001), HbA1c (HR 1.12 [95% CI 1.02-1.23], p = 0.016), and total cholesterol (HR 1.19 [95% CI 1.04-1.37], p = 0.013) also increased the risk of CSME.
Higher age at onset of type 1 diabetes is a significant risk factor for macular oedema. This suggests that ageing may modify the risk of retinopathy in type 1 diabetes.
研究 1 型糖尿病发病年龄是否为临床显著黄斑水肿（CSME）的危险因素。
从 FinnDiane 研究人群中抽取了 1354 名平均病程为 24.6±11.6 年的患者作为样本，将其分为发病年龄组 0-4 岁（n=184）、5-14 岁（n=662）和 15-40 岁（n=508）。1 型糖尿病的定义为发病年龄≤40 岁、C 肽阴性和诊断后 1 年内开始胰岛素治疗。通过眼底照片和立体眼底检查评估视网膜病变情况，并使用 ETDRS 量表进行分级。
在 30 年的糖尿病病程后，发病年龄组 0-4 岁的患者 CSME 的累积发生率为 17%（95%CI 11-26），发病年龄组 5-14 岁的患者 CSME 的累积发生率为 27%（95%CI 23-32），发病年龄组 15-40 岁的患者 CSME 的累积发生率为 34%（95%CI 27-41）（p=0.002，Gray 检验）。在基于贝叶斯信息准则选择协变量的竞争风险回归模型中，发病年龄 5-14 岁（HR 1.89[95%CI 1.22-2.91]，p=0.004）和发病年龄 15-40 岁（HR 3.72[95%CI 2.35-5.89]，p<0.0001）是 CSME 的总体显著危险因素（p<0.0001）。较高的 ETDRS 评分（HR 1.04[95%CI 1.03-1.05]，p<0.0001）、HbA1c（HR 1.12[95%CI 1.02-1.23]，p=0.016）和总胆固醇（HR 1.19[95%CI 1.04-1.37]，p=0.013）也增加了 CSME 的风险。
1 型糖尿病发病年龄较高是黄斑水肿的显著危险因素。这表明年龄增长可能改变 1 型糖尿病患者的视网膜病变风险。
