Burgess Philip I, Harding Simon P, García-Fiñana Marta, Beare Nicholas A V, Msukwa Gerald, Allain Theresa J
Malawi-Liverpool-Wellcome Trust Clinical Research Programme, and Department of Eye and Vision Science, University of Liverpool, Liverpool, England.
Department of Eye and Vision Science, University of Liverpool, and St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, England.
Ophthalmology. 2016 Sep;123(9):1919-25. doi: 10.1016/j.ophtha.2016.05.042. Epub 2016 Jul 9.
To describe the prevalence, incidence, and progression of retinopathy and to report associations with demographic, clinical, and biochemical variables in people with diabetes in Southern Malawi.
Prospective cohort study.
Subjects were systematically sampled from 2 primary care diabetes clinics.
We performed the first prospective cohort study of diabetic retinopathy from Sub-Saharan Africa over 24 months. Visual acuity, glycemic control, blood pressure, human immunodeficiency virus (HIV) status, urine albumin-to-creatinine ratio, hemoglobin, and lipids were assessed. Retinopathy was graded at an accredited reading center using modified Wisconsin grading of 4-field mydriatic photographs.
Incidence of sight-threatening retinopathy and progression of retinopathy by 2 steps on the Liverpool Diabetic Eye Study Scale.
A total of 357 subjects were recruited to the 24-month cohort study. At baseline, 13.4% of subjects were HIV positive and 15.1% were anemic. The 2-year incidence of sight-threatening diabetic retinopathy (STDR) for subjects with level 10 (no retinopathy), level 20 (background), and level 30 (preproliferative) retinopathy at baseline was 2.7% (95% confidence interval [CI], 0.1-5.3), 27.3% (95% CI, 16.4-38.2), and 25.0% (95% CI, 0-67.4), respectively. In a multivariate logistic analysis, 2-step progression of diabetic retinopathy was associated with glycosylated hemoglobin (odds ratio [OR], 1.27; 95% CI, 1.12-1.45), baseline grade of retinopathy (OR, 1.39; 95% CI, 1.02-1.91), and HIV infection (OR, 0.16; 95% CI, 0.03-0.78). At 2 years, 17 subjects (5.8%) lost ≥15 letters.
Incidence of STDR was approximately 3 times that reported in recent European studies. The negative association of HIV infection with retinopathy progression is a new finding.
描述马拉维南部糖尿病患者视网膜病变的患病率、发病率和进展情况，并报告其与人口统计学、临床和生化变量之间的关联。
前瞻性队列研究。
从2家基层医疗糖尿病诊所系统抽样选取研究对象。
我们进行了一项为期24个月的撒哈拉以南非洲地区糖尿病视网膜病变的首次前瞻性队列研究。评估了视力、血糖控制、血压、人类免疫缺陷病毒（HIV）感染状况、尿白蛋白与肌酐比值、血红蛋白和血脂。视网膜病变在一家认可的阅片中心使用改良的威斯康星4视野散瞳眼底照片分级法进行分级。
利物浦糖尿病眼病研究量表中威胁视力的视网膜病变的发病率以及视网膜病变进展2级情况。
共有357名研究对象被纳入为期24个月的队列研究。基线时，13.4%的研究对象HIV呈阳性，15.1%的研究对象贫血。基线时视网膜病变为10级（无视网膜病变）、20级（背景性视网膜病变）和30级（增殖前期视网膜病变）的研究对象，其2年威胁视力的糖尿病视网膜病变（STDR）发病率分别为2.7%（95%置信区间[CI]，0.1 - 5.3）、27.3%（95% CI，16.4 - 38.2）和25.0%（95% CI，0 - 67.4）。在多因素逻辑回归分析中，糖尿病视网膜病变进展2级与糖化血红蛋白（比值比[OR]，1.27；95% CI，1.12 - 1.45）、视网膜病变基线分级（OR，1.39；95% CI，1.02 - 1.91）和HIV感染（OR，0.16；95% CI，0.03 - 0.78）有关。2年时，17名研究对象（5.8%）视力下降≥15个字母。
STDR的发病率约为近期欧洲研究报道的3倍。HIV感染与视网膜病变进展呈负相关是一项新发现。
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