Morisaki N, Watanabe S, Kobayashi J, Kanzaki T, Takahashi K, Yokote K, Tezuka M, Tashiro J, Inadera H, Saito Y
Second Department of Internal Medicine, School of Medicine, Chiba University, Japan.
J Am Geriatr Soc. 1994 Feb;42(2):142-5. doi: 10.1111/j.1532-5415.1994.tb04941.x.
To assess whether control of diabetes mellitus is as important in the elderly as in young and middle-aged diabetic patients in terms of progression of retinopathy.
A 5-year longitudinal cohort study.
Outpatient diabetic clinic.
One hundred fourteen non-insulin-dependent diabetic patients (30 males, 84 females) > or = 60 years of age.
Retinopathy was checked at the beginning and end of the follow-up period. During the 5-year follow-up period, demographic variables, body mass index, HbA1c, blood pressure, and plasma lipids were monitored. Retinopathy was classified as follows: grade 0, no lesion; grade 1, non-proliferative retinopathy; grade 2, pre-proliferative retinopathy; grade 3, proliferative retinopathy. Progression of retinopathy during the 5-year follow-up was defined as an increase in its grade.
At the start of the study, 13% of the patients already had retinopathy, all of grade 1. The 5-year follow-up study showed that progression of retinopathy was 23.6% in all cases, 22.2% in those with grade 0 initially, and 33.3% in those with grade 1 initially. The progression rates of retinopathy as a function of the mean HbA1c during the follow-up were as follows: lower than 7%, 2%; 7-8%, 20%; 8-9%, 40%; more than 9%, 61%. Multiple logistic regression analysis showed that, of the parameters examined, only HbA1c was a significant risk factor for progression of retinopathy.
Control of diabetes mellitus is the most important factor associated with prevention of progression of retinopathy in elderly patients.
评估在视网膜病变进展方面，糖尿病控制对于老年糖尿病患者是否与中青年糖尿病患者同样重要。
一项为期5年的纵向队列研究。
门诊糖尿病诊所。
114例年龄≥60岁的非胰岛素依赖型糖尿病患者（男性30例，女性84例）。
在随访期开始和结束时检查视网膜病变情况。在5年随访期内，监测人口统计学变量、体重指数、糖化血红蛋白（HbA1c）、血压和血脂。视网膜病变分类如下：0级，无病变；1级，非增殖性视网膜病变；2级，增殖前期视网膜病变；3级，增殖性视网膜病变。5年随访期内视网膜病变的进展定义为病变等级升高。
研究开始时，13%的患者已有视网膜病变，均为1级。5年随访研究显示，总体视网膜病变进展率为23.6%，初始为0级的患者中进展率为22.2%，初始为1级的患者中进展率为33.3%。随访期间视网膜病变进展率与平均HbA1c的关系如下：低于7%，2%；7 - 8%，20%；8 - 9%，40%；高于9%，61%。多因素逻辑回归分析显示，在所检查的参数中，只有HbA1c是视网膜病变进展的显著危险因素。
糖尿病控制是老年患者预防视网膜病变进展的最重要因素。
