Liu Yiyuan, Wang Minghui, Morris Andrew D, Doney Alex S F, Leese Graham P, Pearson Ewan R, Palmer Colin N A
Corresponding author: Colin N.A. Palmer,
Diabetes Care. 2013 Dec;36(12):3979-84. doi: 10.2337/dc12-2392. Epub 2013 Oct 29.
This study sought to investigate the progression and regression of diabetic retinopathy (DR) and the effects of population risk factors on the rates of transition across retinopathy stages.
The study cohort consisted of 44,871 observed DR events between the calendar years 1990 and 2011 for 4,758 diabetic patients who were diagnosed at 35 years of age or older. The first retinal observation was recorded within a year from diagnosis, and the result was recorded as free of retinopathy. A multistate Markov model was applied for analyzing the development of DR and its relation to the patterns of changes in risk factors.
We observed a consistent risk effect of HbA1c on the progression (no retinopathy to mild background DR [BDR] hazard ratio per SD of HbA1c [HR] 1.42 [95% CI 1.32-1.52], mild BDR to observable BDR HR 1.32 [95% CI 1.08-1.60], and observable BDR to severe nonproliferative/proliferative DR HR 2.23 [95% CI 1.16-4.29]). Similarly, systolic blood pressure (SBP) and diastolic blood pressure increased the risk for the transition from the asymptomatic phase to mild BDR (HR 1.20 [95% CI 1.11-1.30]) and the mild BDR to observable BDR (HR 1.87 [95% CI 1.46-2.40]), respectively. Regression from mild BDR to no DR was associated with lower SBP (HR 0.79 [95% CI 0.64-0.97]) and lower HbA1c (HR 0.76 [95% CI 0.64-0.89]).
Progression and regression of DR were strongly associated with blood pressure and glycemic exposure.
本研究旨在调查糖尿病视网膜病变（DR）的进展和逆转情况，以及人群风险因素对视网膜病变各阶段转变率的影响。
研究队列包括1990年至2011年期间4758例35岁及以上糖尿病患者的44871次观察到的DR事件。首次视网膜观察在诊断后一年内记录，结果记录为无视网膜病变。采用多状态马尔可夫模型分析DR的发展及其与风险因素变化模式的关系。
我们观察到糖化血红蛋白（HbA1c）对进展具有一致的风险影响（从无视网膜病变到轻度背景性DR [BDR]，HbA1c每标准差的风险比[HR]为1.42 [95% CI 1.32 - 1.52]；从轻度BDR到可观察到的BDR，HR为1.32 [95% CI 1.08 - 1.60]；从可观察到的BDR到重度非增殖性/增殖性DR，HR为2.23 [95% CI 1.16 - 4.29]）。同样，收缩压（SBP）和舒张压分别增加了从无症状阶段到轻度BDR转变的风险（HR 1.20 [95% CI 1.11 - 1.30]）以及从轻度BDR到可观察到的BDR转变的风险（HR 1.87 [95% CI 1.46 - 2.40]）。从轻度BDR逆转至无DR与较低的SBP（HR 0.79 [95% CI 0.64 - 0.97]）和较低的HbA1c（HR 0.76 [95% CI 0.64 - 0.89]）相关。
DR的进展和逆转与血压及血糖暴露密切相关。
