青少年发病的胰岛素依赖型糖尿病患者的血糖控制与视网膜病变的发展。一项12年纵向研究的结果。

Glycemic control and development of retinopathy in youth-onset insulin-dependent diabetes mellitus. Results of a 12-year longitudinal study.

作者信息

Goldstein D E, Blinder K J, Ide C H, Wilson R J, Wiedmeyer H M, Little R R, England J D, Eddy M, Hewett J E, Anderson S K

机构信息

Department of Child Health, University of Missouri School of Medicine, Columbia.

出版信息

Ophthalmology. 1993 Aug;100(8):1125-31; discussion 1131-2. doi: 10.1016/s0161-6420(93)31516-2.

DOI:10.1016/s0161-6420(93)31516-2

PMID:8341491

Abstract

BACKGROUND

In 1979, the authors began a prospective study of the natural history of retinopathy in youth-onset insulin-dependent diabetes mellitus (IDDM). Their major goal was to determine if there was an association between glycemic control and the development and progression of retinopathy.

METHODS

The study consisted of 420 individuals with IDDM (onset younger than 20 years of age) and no retinopathy at baseline. Study subjects were enrolled between 1979 and 1988. Stereo color fundus photographs were obtained annually. Two eye endpoints were recorded: duration when retinopathy was first detected, and when proliferative retinopathy was detected. Glycemic control was assessed by quarterly determinations of glycohemoglobin (GHb). Life-table analyses were performed relating duration of diabetes, sex, GHb, and age of diabetes onset to development of retinopathy.

RESULTS

Retinopathy did not develop before 2 years' duration or before puberty. The prevalence of retinopathy was 50% by 9 years' duration and 100% by 20 years' duration. Retinopathy developed in females approximately 2 years sooner than in males, but plotting duration as postpubertal years resulted in nearly identical rates. Retinopathy developed significantly earlier in subjects with prepubertal onset of diabetes than in subjects with postpubertal onset if duration was plotted as postpubertal years. When separated into three groups based on GHb levels (< 7.5%, 7.5%-9%, > 9%), retinopathy developed approximately 2 years later in subjects in the less than 7.5% GHb group than those in the higher GHb groups. Proliferative retinopathy developed in 11 subjects. Their mean GHb level was higher than the mean GHb for those without proliferative retinopathy (10.9 versus 8.6%; P < 0.01). The higher the level of GHb, the sooner proliferative changes were detected.

CONCLUSION

Long-term glycemic control is significantly related to both development and progression of retinopathy. Prepubertal duration of diabetes is a significant risk factor for the development of retinopathy.

摘要

背景

1979年，作者开始了一项关于青少年起病的胰岛素依赖型糖尿病（IDDM）视网膜病变自然史的前瞻性研究。他们的主要目标是确定血糖控制与视网膜病变的发生和进展之间是否存在关联。

方法

该研究包括420例IDDM患者（发病年龄小于20岁），基线时无视网膜病变。研究对象于1979年至1988年入组。每年拍摄立体彩色眼底照片。记录两个眼部终点：首次检测到视网膜病变的时间，以及检测到增殖性视网膜病变的时间。通过每季度测定糖化血红蛋白（GHb）来评估血糖控制情况。进行生命表分析，将糖尿病病程、性别、GHb和糖尿病发病年龄与视网膜病变的发生相关联。

结果

视网膜病变在病程2年之前或青春期之前不会发生。病程9年时视网膜病变患病率为50%，病程20年时为100%。女性视网膜病变的发生比男性早约2年，但以青春期后年限计算病程时，发生率几乎相同。如果以青春期后年限计算病程，青春期前发病的糖尿病患者比青春期后发病的患者视网膜病变发生明显更早。根据GHb水平（<7.5%、7.5%-9%、>9%）分为三组时，GHb水平低于7.5%组的患者视网膜病变发生时间比GHb水平较高组的患者晚约2年。11例患者发生了增殖性视网膜病变。他们的平均GHb水平高于无增殖性视网膜病变患者的平均GHb水平（10.9%对8.6%；P<0.01）。GHb水平越高，增殖性改变检测得越早。