高密度脂蛋白胆固醇是 1 型糖尿病视网膜病变发展和进展的保护性预测指标：一项 15 年随访研究。
HDL cholesterol is a protective predictor in the development and progression of retinopathy in type 1 diabetes: A 15-year follow-up study.
机构信息
Department of Ophthalmology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Dugi dol 4a, Zagreb, Croatia.
Department of Ophthalmology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Dugi dol 4a, Zagreb, Croatia.
出版信息
Diabetes Res Clin Pract. 2022 Apr;186:109814. doi: 10.1016/j.diabres.2022.109814. Epub 2022 Mar 3.
AIMS
To evaluate the 15-year incidence of development and progression of diabetic retinopathy (DR) in type 1 diabetic patients (T1DM) and determine the associated risk factors.
METHODS
123 T1DM were included in this prospective cohort study and followed for 15 years. Demographic, clinical, laboratory parameters, and retinal photographs were collected and analyzed. Risk factors for DR development and progression were identified using Cox regression analysis.
RESULTS
At baseline, 87 (71%) patients had no DR, and 36 (29%) had nonproliferative DR (NPDR). After 15 years, 54 patients (43.9%; 29.3/1000 person-years) developed NPDR or progressed to proliferative DR (PDR); 24 (27.6%) developed new NPDR, and 30 (83.3%) progressed to PDR. HbAc (HR = 1.48, p = 0.008) and urinary albumin excretion rate (AER) (HR = 1.58, p = 0.045) were associated with the risk of DR development and progression, and a protective association was found for HDL cholesterol (HR = 0.17, p = 0.021). The presence of DR at baseline (HR = 2.95, p = 0.023) was associated with the risk of its progression to PDR.
CONCLUSIONS
The 15-year incidence of DR development and progression in T1DM is still very high, which points to the need for close monitoring of T1DM, especially those with higher HbAc, higher AER, the initial presence of DR, and lower HDL cholesterol.
目的
评估 15 年内 1 型糖尿病患者（T1DM）糖尿病视网膜病变（DR）的发展和进展情况，并确定相关的危险因素。
方法
本前瞻性队列研究纳入了 123 例 T1DM 患者，随访 15 年。收集并分析了人口统计学、临床、实验室参数和视网膜照片。使用 Cox 回归分析确定 DR 发展和进展的危险因素。
结果
基线时，87 例（71%）患者无 DR，36 例（29%）患者为非增生性 DR（NPDR）。15 年后，54 例患者（43.9%；29.3/1000 人年）发生 NPDR 或进展为增生性 DR（PDR）；24 例（27.6%）新发生 NPDR，30 例（83.3%）进展为 PDR。糖化血红蛋白（HbAc）（HR=1.48，p=0.008）和尿白蛋白排泄率（AER）（HR=1.58，p=0.045）与 DR 发展和进展的风险相关，而高密度脂蛋白胆固醇（HDL-C）与风险呈负相关（HR=0.17，p=0.021）。基线时存在 DR（HR=2.95，p=0.023）与进展为 PDR 的风险相关。
结论
T1DM 患者 DR 的发展和进展在 15 年内仍很高，这表明需要密切监测 T1DM，特别是那些 HbAc 较高、AER 较高、初始存在 DR 和 HDL-C 较低的患者。
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