Rand L I, Krolewski A S, Aiello L M, Warram J H, Baker R S, Maki T
N Engl J Med. 1985 Dec 5;313(23):1433-8. doi: 10.1056/NEJM198512053132302.
To identify risk factors for the development of proliferative diabetic retinopathy, we compared 111 patients with longstanding insulin-dependent diabetes who had proliferative retinopathy (cases) with 81 patients with diabetes of similar duration (an average of 26 years) who did not have proliferative diabetic retinopathy (controls). The cases had diabetes that was more difficult to manage, as evidenced by their more frequent blood sugar levels above 200 mg per deciliter (11 mmol per liter) on routine clinic visits (odds ratio, 1.6 for each increment of 10 per cent in the relative frequency), and they expended less effort in managing their diabetes, as indicated by their less frequent testing of urine for sugar (odds ratio, 0.3). Among those who did not have myopia, the cases also had an excess of the HLA-DR phenotypes 4/0, 3/0, or X/X (odds ratio, 10.0). Among those with myopia, these phenotypes did not carry an increased risk of proliferative retinopathy. These results support a multifactorial model for the development of proliferative diabetic retinopathy; however, the mechanisms of action of the identified factors remain unknown.
为了确定增殖性糖尿病视网膜病变发生的危险因素，我们将111例患有长期胰岛素依赖型糖尿病且伴有增殖性视网膜病变的患者（病例组）与81例病程相似（平均26年）但无增殖性糖尿病视网膜病变的糖尿病患者（对照组）进行了比较。病例组的糖尿病更难控制，这在常规门诊就诊时血糖水平高于200毫克每分升（11毫摩尔每升）的频率更高上得到了证明（优势比，相对频率每增加10%为1.6），并且他们在糖尿病管理上付出的努力较少，这体现在他们检测尿糖的频率较低（优势比，0.3）。在没有近视的患者中，病例组中HLA - DR表型4/0、3/0或X/X的比例也过高（优势比，10.0）。在有近视的患者中，这些表型并未增加增殖性视网膜病变的风险。这些结果支持增殖性糖尿病视网膜病变发生的多因素模型；然而，所确定因素的作用机制仍不清楚。
