Stram Douglas A, Jiang Xuejuan, Varma Rohit, Torres Mina, Burkemper Bruce S, Choudhury Farzana, Klein Ronald, Gauderman W James, McKean-Cowdin Roberta
USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, California, United States.
Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, California, United States.
Ophthalmol Retina. 2018 Feb;2(2):96-105. doi: 10.1016/j.oret.2017.05.014. Epub 2017 Aug 16.
To identify factors associated with prevalent diabetic retinopathy (DR) among Chinese American adults with type 2 diabetes mellitus (T2DM), and to compare these factors to ones previously described for a population-based sample of Latinos with a higher DR prevalence.
Population-based cross-sectional study.
4582 Chinese Americans aged 50 or older residing in Monterey Park, California.
Participants completed an in-home questionnaire on socio-demographic status and medical history, and a comprehensive clinical eye examination, using the same protocol implemented in the Los Angeles Latino Eye Study. Fundus photographs from 7 Early Treatment Diabetic Retinopathy fields were graded in a masked manner using a modified Airlie House grading system to assess presence and severity of DR. Logistic regression analyses based on a conceptual model of DR risk identified factors associated with prevalent DR.
Odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with DR and vision-threatening DR (VTDR).
In total, 238 participants were diagnosed with any DR; 27 of these were classified as having VTDR. Both, any DR and VTDR showed statistically significant positive associations with T2DM duration (OR = 1.24, OR = 2.07, OR = 3.99), glycosylated hemoglobin (HbA1c) (OR = 1.33, OR = 1.86, OR = 3.22), systolic blood pressure (SBP) (OR = 1.19), and insulin treatment (OR = 2.44). For VTDR, we also found novel associations with antihypertensive drugs (OR: 0.18; 95% CI: 0.06-0.61) and statins (OR: 4.96; 95% CI: 1.60-16.41). Chinese Americans and Latinos had a nearly identical DR probability based on HbA1c and SBP. However, Latinos had a higher DR probability at every year of duration of T2DM (≥ 5 years).
While we observed an overall lower DR prevalence in Chinese Americans than in Latinos (35.8% of individuals with TD2M in Chinese Americans versus 42.0% in Latinos), our data indicate that the impact of increasing HbA1c and SBP on DR probability is incrementally the same in both populations. However, increasing T2DM duration is associated with higher DR probability in Latinos than Chinese Americans, even after controlling for other known predictors. Novel factors associated with VTDR include antihypertensive drugs and statins. However, to determine if these drugs impact VTDR susceptibility, we need longitudinal data and more cases.
确定患有2型糖尿病（T2DM）的华裔美国成年人中与糖尿病视网膜病变（DR）患病率相关的因素，并将这些因素与先前针对糖尿病视网膜病变患病率较高的拉丁裔人群样本所描述的因素进行比较。
基于人群的横断面研究。
居住在加利福尼亚州蒙特利公园市的4582名50岁及以上的华裔美国人。
参与者完成了一份关于社会人口统计学状况和病史的家庭问卷，并进行了一次全面的临床眼科检查，采用了与洛杉矶拉丁裔眼病研究相同的方案。使用改良的艾利屋分级系统对来自7个糖尿病视网膜病变早期治疗区域的眼底照片进行盲法分级，以评估糖尿病视网膜病变的存在和严重程度。基于糖尿病视网膜病变风险概念模型的逻辑回归分析确定了与糖尿病视网膜病变患病率相关的因素。
与糖尿病视网膜病变和威胁视力的糖尿病视网膜病变（VTDR）相关因素的比值比（OR）和95%置信区间（CI）。
共有238名参与者被诊断患有任何糖尿病视网膜病变；其中27名被归类为患有威胁视力的糖尿病视网膜病变。任何糖尿病视网膜病变和威胁视力的糖尿病视网膜病变均与T2DM病程（OR = 1.24、OR = 2.07、OR = 3.99）、糖化血红蛋白（HbA1c）（OR = 1.33、OR = 1.86、OR = 3.22）、收缩压（SBP）（OR = 1.19）和胰岛素治疗（OR = 2.44）呈统计学显著正相关。对于威胁视力的糖尿病视网膜病变，我们还发现了与抗高血压药物（OR：0.18；95%CI：0.06 - 0.61）和他汀类药物（OR：4.96；95%CI：1.60 - 16.41）的新关联。基于HbA1c和SBP，华裔美国人和拉丁裔患糖尿病视网膜病变的概率几乎相同。然而，在T2DM病程的每一年（≥5年），拉丁裔患糖尿病视网膜病变的概率更高。
虽然我们观察到华裔美国人的糖尿病视网膜病变总体患病率低于拉丁裔（华裔美国人中患有T2DM的个体为35.8%，而拉丁裔为42.0%），但我们的数据表明，HbAic和SBP升高对糖尿病视网膜病变概率的影响在这两个人群中逐渐相同。然而，即使在控制了其他已知预测因素后，拉丁裔中T2DM病程延长与糖尿病视网膜病变概率升高的相关性仍高于华裔美国人。与威胁视力的糖尿病视网膜病变相关的新因素包括抗高血压药物和他汀类药物。然而，要确定这些药物是否影响威胁视力的糖尿病视网膜病变易感性，我们需要纵向数据和更多病例。
