Chen Xue, Rong Shi Song, Xu Qihua, Tang Fang Yao, Liu Yuan, Gu Hong, Tam Pancy O S, Chen Li Jia, Brelén Mårten E, Pang Chi Pui, Zhao Chen
Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University and State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China; Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.
Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.
PLoS One. 2014 Sep 19;9(9):e108196. doi: 10.1371/journal.pone.0108196. eCollection 2014.
Age-related macular degeneration (AMD) is a major cause of severe vision loss in elderly people. Diabetes mellitus is a common endocrine disorder with serious consequences, and diabetic retinopathy (DR) is the main ophthalmic complication. DR and AMD are different diseases and we seek to explore the relationship between diabetes and AMD. MEDLINE, EMBASE, and the Cochrane Library were searched for potentially eligible studies. Studies based on longitudinal cohort, cross-sectional, and case-control associations, reporting evaluation data of diabetes as an independent factor for AMD were included. Reports of relative risks (RRs), hazard ratios (HRs), odds ratio (ORs), or evaluation data of diabetes as an independent factor for AMD were included. Review Manager and STATA were used for the meta-analysis. Twenty four articles involving 27 study populations were included for meta-analysis. In 7 cohort studies, diabetes was shown to be a risk factor for AMD (OR, 1.05; 95% CI, 1.00-1.14). Results of 9 cross-sectional studies revealed consistent association of diabetes with AMD (OR, 1.21; 95% CI, 1.00-1.45), especially for late AMD (OR, 1.48; 95% CI, 1.44-1.51). Similar association was also detected for AMD (OR, 1.29; 95% CI, 1.13-1.49) and late AMD (OR, 1.16; 95% CI, 1.11-1.21) in 11 case-control studies. The pooled ORs for risk of neovascular AMD (nAMD) were 1.10 (95% CI, 0.96-1.26), 1.48 (95% CI, 1.44-1.51), and 1.15 (95% CI, 1.11-1.21) from cohort, cross-sectional and case-control studies, respectively. No obvious divergence existed among different ethnic groups. Therefore, we find diabetes a risk factor for AMD, stronger for late AMD than earlier stages. However, most of the included studies only adjusted for age and sex; we thus cannot rule out confounding as a potential explanation for the association. More well-designed prospective cohort studies are still warranted to further examine the association.
年龄相关性黄斑变性(AMD)是老年人严重视力丧失的主要原因。糖尿病是一种常见的内分泌疾病,后果严重,而糖尿病视网膜病变(DR)是主要的眼科并发症。DR和AMD是不同的疾病,我们试图探讨糖尿病与AMD之间的关系。检索了MEDLINE、EMBASE和Cochrane图书馆,查找可能符合条件的研究。纳入基于纵向队列、横断面和病例对照关联的研究,报告将糖尿病作为AMD独立因素的评估数据。纳入相对风险(RRs)、风险比(HRs)、比值比(ORs)的报告,或糖尿病作为AMD独立因素的评估数据。使用Review Manager和STATA进行荟萃分析。纳入24篇涉及27个研究人群的文章进行荟萃分析。在7项队列研究中,糖尿病被证明是AMD的一个危险因素(OR,1.05;95%CI,1.00-1.14)。9项横断面研究的结果显示糖尿病与AMD之间存在一致关联(OR,1.21;95%CI,1.00-1.45),尤其是晚期AMD(OR,1.48;95%CI,1.44-1.51)。在11项病例对照研究中,也检测到AMD(OR,1.29;95%CI,1.13-1.49)和晚期AMD(OR,1.16;95%CI,1.11-1.21)的类似关联。来自队列、横断面和病例对照研究的新生血管性AMD(nAMD)风险的合并OR分别为1.10(95%CI,0.96-1.26)、1.48(95%CI,1.44-1.51)和1.15(95%CI,1.11-1.21)。不同种族群体之间不存在明显差异。因此,我们发现糖尿病是AMD的一个危险因素,对晚期AMD的影响比对早期阶段更强。然而,大多数纳入研究仅对年龄和性别进行了调整;因此,我们不能排除混杂因素作为这种关联的潜在解释。仍然需要更多设计良好的前瞻性队列研究来进一步检验这种关联。