Henricsson M, Groop L, Heijl A
Department of Ophthalmology, Helsingborg Hospital Helsingborg, Sweden.
Acta Ophthalmol Scand. 1996 Dec;74(6):528-32. doi: 10.1111/j.1600-0420.1996.tb00728.x.
To study the progression of retinopathy in patients with mild diabetes mellitus, we examined, in a cohort study, 347 patients treated with diet alone at baseline. The patients participated in an ophthalmological screening and control programme, and diet-treated patients who were examined between January 1990 and July 1992 were included in the study and followed until October 1995. Mean follow-up was 3.4 +/- 1.1 years. The alternative classification of the Wisconsin study was used to classify retinopathy, and the mean HbA1c values for the study period, to estimate the level of glycaemic control. At baseline, 314 of the patients (90.5%) had no retinopathy, and 33 (9.5%) had mild non-proliferative diabetic retinopathy. In 296 patients there was no retinopathy progression, in 27 patients there was progression by 1 level in the retinopathy scale, and in 24 patients by 2 levels or more. In 2 patients there was progression to proliferative diabetic retinopathy. The mean HbA1c (%) was 6.5 +/- 1.3. Higher HbA1c correlated to increased progression (r = 0.16; p = 0.005), and in a multivariate analysis, HbA1c remained associated with a progression of retinopathy by 2 levels or more, with a relative risk of 1.4 per percent increase in HbA1c (95% CI 1.1-2.0; p = 0.02). Furthermore, the presence of any retinopathy at baseline was associated with progression with a relative risk of 1.7 (95% confidence interval 1.1-2.8; (p = 0.02). These data indicate that even slightly elevated levels of HbA1c might be associated with a risk of retinopathy progression.
为研究轻度糖尿病患者视网膜病变的进展情况，我们在一项队列研究中对347例基线时仅接受饮食治疗的患者进行了检查。这些患者参与了眼科筛查和控制项目，1990年1月至1992年7月期间接受检查的饮食治疗患者被纳入研究，并随访至1995年10月。平均随访时间为3.4±1.1年。采用威斯康星研究的分类方法对视网膜病变进行分类，并计算研究期间的平均糖化血红蛋白（HbA1c）值，以评估血糖控制水平。基线时，314例患者（90.5%）无视网膜病变，33例（9.5%）有轻度非增殖性糖尿病视网膜病变。296例患者视网膜病变无进展，27例患者视网膜病变程度进展1级，24例患者进展2级或更高级别。2例患者进展为增殖性糖尿病视网膜病变。平均HbA1c（%）为6.5±1.3。较高的HbA1c与病变进展增加相关（r = 0.16；p = 0.005），多变量分析显示，HbA1c每增加1%，视网膜病变进展2级或更高级别的相对风险为1.4（95%CI 1.1 - 2.0；p = 0.02）。此外，基线时存在任何视网膜病变与病变进展相关，相对风险为1.7（95%置信区间1.1 - 2.8；p = 0.02）。这些数据表明，即使HbA1c水平略有升高也可能与视网膜病变进展风险相关。
