血清脂质对糖尿病视网膜病变和黄斑水肿发病和进展的影响：Sankara Nethralaya 糖尿病视网膜病变流行病学和分子遗传学研究 II。

Influence of serum lipids on the incidence and progression of diabetic retinopathy and macular oedema: Sankara Nethralaya Diabetic Retinopathy Epidemiology And Molecular genetics Study-II.

机构信息

Shri Bhagwan Mahavir Vitreoretinal Services, Chennai, India.

出版信息

Clin Exp Ophthalmol. 2017 Dec;45(9):894-900. doi: 10.1111/ceo.12990. Epub 2017 Jun 22.

DOI:10.1111/ceo.12990

PMID:28512919

Abstract

IMPORTANCE

The importance of lipids on incidence and progression of diabetic retinopathy has not been studied in the Indian population.

BACKGROUND

To elucidate the influence of serum lipid control on the incidence and progression of diabetic retinopathy and diabetic macular oedema in subjects with type 2 diabetes.

DESIGN

Population-based longitudinal observational study in a hospital setting.

PARTICIPANTS

Eight hundred ninety subjects were examined at baseline and follow-up.

METHODS

Diabetic retinopathy was graded per Modified Early Treatment Diabetic Retinopathy Study scales; 45°, 4-field dilated stereoscopic digital photography was performed with an additional 30°, 7-field for those who had retinopathy. Macular oedema was evaluated per Proposed International Clinical Diabetic Retinopathy and Diabetic Macular Oedema Disease Severity Scales.

MAIN OUTCOME MEASURES

Association of serum lipids and incidence and progression of diabetic retinopathy.

RESULTS

Poor control of total cholesterol was associated with the incidence of sight-threatening retinopathy (odds ratio = 7.2 [95% confidence interval: 1.5-34.3], P = 0.012) and macular oedema (odds ratio = 5.5 [95% confidence interval: 1.4-27.4], P = 0.037) after adjusting for potential confounders. Poor control of triglycerides was associated with progression to proliferative diabetic retinopathy (odds ratio = 3.2 [95% confidence interval: 1.1-10.5], P = 0.048). Risk for incident macular oedema (P = 0.041) and progression to proliferative diabetic retinopathy (P = 0.028) was greater when all lipid types were abnormal.

CONCLUSIONS AND RELEVANCE

Poor control of lipids is a risk factor for incidence of and progression to late stages of retinopathy. Abnormal levels of all lipid types are associated with risk of incident macular oedema and progression to proliferative diabetic retinopathy.

摘要

重要性

脂质对印度人群中糖尿病视网膜病变的发生和进展的影响尚未得到研究。

背景

阐明血清脂质控制对 2 型糖尿病患者糖尿病视网膜病变和糖尿病黄斑水肿发生和进展的影响。

设计

在医院环境中进行的基于人群的纵向观察性研究。

参与者

890 名受试者在基线和随访时接受检查。

方法

根据改良早期糖尿病视网膜病变研究量表对糖尿病视网膜病变进行分级；对有视网膜病变的患者进行 45°、4 野散瞳立体数字摄影，并额外进行 30°、7 野检查。黄斑水肿根据建议的国际临床糖尿病视网膜病变和糖尿病黄斑水肿疾病严重程度量表进行评估。

主要观察指标

血清脂质与糖尿病视网膜病变发生和进展的关系。

结果

总胆固醇控制不佳与威胁视力的视网膜病变（比值比=7.2[95%置信区间：1.5-34.3]，P=0.012）和黄斑水肿（比值比=5.5[95%置信区间：1.4-27.4]，P=0.037）的发生相关，在调整了潜在混杂因素后。三酰甘油控制不佳与进展为增殖性糖尿病视网膜病变相关（比值比=3.2[95%置信区间：1.1-10.5]，P=0.048）。当所有脂质类型异常时，发生黄斑水肿的风险（P=0.041）和进展为增殖性糖尿病视网膜病变的风险（P=0.028）更大。