Department of Ophthalmology, Aarhus University Hospital, DK-8200, Aarhus N, Denmark.
Diabetologia. 2020 Nov;63(11):2462-2470. doi: 10.1007/s00125-020-05234-0. Epub 2020 Jul 21.
AIMS/HYPOTHESIS: The purpose of screening for diabetic retinopathy is to detect either of the two sight-threatening complications: proliferative diabetic retinopathy (PDR) or clinically significant diabetic macular oedema (DME). The aim of the study was to evaluate whether systemic risk factors affect the risk of developing these two complications differently.
Survival analysis with death as a competing risk was used to describe the effect of sex, age and time of onset of diabetes, systolic (SBP) and diastolic (DBP) BPs, and the weighted exposure and CV of HbA for the development of PDR and DME from all 2773 patients treated for diabetic retinopathy in a defined population from the Aarhus area, Denmark, between 1 July 1994 and 1 July 2019.
Increasing HbA above normal increased the risk of developing both PDR and DME (p < 0.04), and values below normal increased the risk of developing PDR (p < 0.013). Increasing DBP increased the risk of developing both PDR and DME (p < 0.0001), whereas increasing SBP increased the risk of developing DME (p < 0.0001), but not PDR (p > 0.08). The risk of developing PDR increased with decreasing age of onset of diabetes (p < 0.0001), whereas the risk of developing DME was maximal for a known onset of diabetes at about 30 years of age and decreased significantly for both lower and higher ages of onset (p < 0.0001). The risk of developing both PDR and DME was lower in women than in men (p < 0.004) and was reduced with lower variability of repeated HbA measurements (p < 0.0001).
CONCLUSIONS/INTERPRETATION: Systemic risk factors such as metabolic regulation, arterial BP and the age of onset of diabetes contribute differently to the development of PDR and DME. The overall risk of developing treatment-requiring diabetic retinopathy should be calculated from the risks of reaching each of the two complications separately.
目的/假设：筛查糖尿病性视网膜病变的目的是检测两种威胁视力的并发症之一：增生性糖尿病性视网膜病变（PDR）或临床显著糖尿病性黄斑水肿（DME）。本研究旨在评估系统危险因素是否以不同的方式影响这两种并发症的发生风险。
使用以死亡为竞争风险的生存分析来描述性别、年龄和糖尿病发病时间、收缩压（SBP）和舒张压（DBP）、HbA 的加权暴露和变异系数对 2773 例在丹麦奥胡斯地区定义人群中接受糖尿病性视网膜病变治疗的患者发生 PDR 和 DME 的影响，研究时间为 1994 年 7 月 1 日至 2019 年 7 月 1 日。
HbA 高于正常值会增加发生 PDR 和 DME 的风险（p<0.04），而低于正常值会增加发生 PDR 的风险（p<0.013）。DBP 升高会增加发生 PDR 和 DME 的风险（p<0.0001），而 SBP 升高会增加发生 DME 的风险（p<0.0001），但不会增加 PDR 的风险（p>0.08）。糖尿病发病年龄越小，发生 PDR 的风险越高（p<0.0001），而发生 DME 的风险在已知发病年龄约 30 岁时达到最大值，并随着发病年龄的降低和升高而显著降低（p<0.0001）。与男性相比，女性发生 PDR 和 DME 的风险较低（p<0.004），且 HbA 重复测量的变异系数较低时风险也会降低（p<0.0001）。
结论/解释：代谢调节、动脉血压和糖尿病发病年龄等系统危险因素对 PDR 和 DME 的发生发展有不同的影响。治疗相关糖尿病性视网膜病变的总体风险应根据分别达到两种并发症的风险来计算。
