Porta Massimo, Schellino Francesca, Montanaro Marcello, Baltatescu Anatolie, Borio Lorenzo, Lopatina Tatiana, Trento Marina, Dalmasso Paola, Cavallo Franco
Diabetic Retinopathy Centre, Department of Medical Sciences, University of Turin, Corso AM Dogliotti 14, I-10126, Turin, Italy,
Acta Diabetol. 2014 Dec;51(6):1049-54. doi: 10.1007/s00592-014-0671-2. Epub 2014 Oct 28.
There is conflicting evidence to support the concept that the years with diabetes preceding puberty may not contribute to the development of vascular complications. In this paper, duration-related prevalence of retinopathy was compared in patients who developed type 1 diabetes before and after pubertal age.
Retrospective analysis of prospectively collected data of 1,483 patients was screened for retinopathy in 1991-2010, with diabetes onset at age ≤29, who were on insulin treatment and aged ≤60. Prepubertal age was defined as 0-12 in males and 0-11 in females.
A total of 647 patients had developed diabetes before and 836 after puberty. Cumulative prevalence of retinopathy was initially lower among those with prepubertal onset diabetes but rates became superimposable after 20-year duration. Patients with prepubertal onset diabetes had higher lifetime HbA1c and lower blood pressure than those who became diabetic after puberty.
CONCLUSIONS/INTERPRETATION: Retinopathy is infrequent during childhood and develops later than in patients with post-pubertal onset diabetes. After 20-year duration, however, retinopathy becomes just as prevalent suggesting that, in the long term, prepubertal years do contribute to the development of retinopathy. In this series, higher blood pressure may have played a role in the earlier appearance of retinopathy in patients with diabetes onset after puberty, whereas worse metabolic control may have contributed to the late "catch-up" effect in those with prepubertal onset disease.
关于青春期前患糖尿病的年限可能不会导致血管并发症发生这一概念，证据存在冲突。本文比较了青春期前和青春期后患1型糖尿病患者视网膜病变与病程相关的患病率。
对1991年至2010年前瞻性收集的1483例患者的数据进行回顾性分析，这些患者年龄≤29岁开始患糖尿病，接受胰岛素治疗且年龄≤60岁。青春期前年龄定义为男性0至12岁，女性0至11岁。
共有647例患者在青春期前患糖尿病，836例在青春期后患糖尿病。青春期前发病的糖尿病患者视网膜病变的累积患病率最初较低，但病程20年后发生率变得相同。青春期前发病的糖尿病患者终生糖化血红蛋白水平较高，血压低于青春期后患糖尿病的患者。
结论/解读：视网膜病变在儿童期很少见，且比青春期后发病的糖尿病患者出现得晚。然而，病程20年后，视网膜病变变得同样普遍，这表明从长期来看，青春期前的年限确实会导致视网膜病变的发生。在本系列研究中，较高的血压可能在青春期后发病的糖尿病患者视网膜病变较早出现中起了作用，而较差的代谢控制可能导致了青春期前发病患者后期的“追赶”效应。
