Kernell A, Dedorsson I, Johansson B, Wickström C P, Ludvigsson J, Tuvemo T, Neiderud J, Sjöström K, Malmgren K, Kanulf P, Mellvig L, Gjötterberg M, Sule J, Persson L A, Larsson L I, Aman J, Dahlquist G
Department of Paediatrics, University Hospital, Linköping, Sweden.
Diabetologia. 1997 Mar;40(3):307-10. doi: 10.1007/s001250050679.
Vision-threatening diabetic retinopathy can be prevented if it is diagnosed before becoming too advanced. Since diabetic retinopathy has been reported to occur only rarely before the end of pubertal development, children and adolescents are seldom included in screening programmes. We invited 780 children and adolescents with insulin-dependent diabetes mellitus diagnosed before the age of 15.0 years (disease duration of < 12 years) and who were older than 9.0 years at the time of examination from eight regions of Sweden. Retinal examination was performed with stereoscopic fundus photograph. The photograph were rated according to a modified Airlie House classification. The dropouts (223/780, 28.6%) were significantly older and with a longer duration of diabetes than the examined children (p < 0.001 and 0.001, respectively). Photographs from 557 patients aged (median [interquartile range]:14.6 [12.4-17.0]) years and with a diabetes duration of 8.0 (5.5-9.9) years were evaluated. Retinopathy was demonstrated in 81 patients (14.5%):66 with background retinopathy, 2 with microaneurysms and hard exudates, 12 with preproliferative retinopathy, 1 with proliferative retinopathy. Preproliferative retinopathy was diagnosed in a 12.8-year-old girl in pubertal stage 3 and an 11.8-year-old boy in pubertal stage 2, and proliferative retinopathy was found in a 21.5-year-old girl. Retinopathy was demonstrated in 6% and 18% of patients in pubertal stages 1 and 5, respectively. The overall prevalence of retinopathy in this population may even be higher since the dropouts were older and had a longer duration of diabetes. Since background and preproliferative retinopathy were found in children before puberty, we recommend including children and adolescents in screening programmes for diabetic retinopathy from the age of 10 years.
如果在威胁视力的糖尿病视网膜病变发展到晚期之前进行诊断，就可以预防这种疾病。由于据报道，糖尿病视网膜病变在青春期发育结束前很少发生，因此儿童和青少年很少被纳入筛查项目。我们邀请了来自瑞典八个地区的780名15.0岁之前被诊断为胰岛素依赖型糖尿病（病程<12年）且在检查时年龄大于9.0岁的儿童和青少年。通过立体眼底照相进行视网膜检查。照片根据改良的阿利屋分类法进行评分。失访者（223/780，28.6%）比接受检查的儿童年龄显著更大，糖尿病病程更长（分别为p<0.001和0.001）。对557例年龄（中位数[四分位间距]：14.6[12.4 - 17.0]）岁、糖尿病病程为8.0（5.5 - 9.9）年的患者的照片进行了评估。81例患者（14.5%）出现视网膜病变：66例为背景性视网膜病变，2例有微动脉瘤和硬性渗出物，12例为增殖前期视网膜病变，1例为增殖性视网膜病变。在青春期3期的一名12.8岁女孩和青春期2期的一名11.8岁男孩中诊断出增殖前期视网膜病变，在一名21.5岁女孩中发现增殖性视网膜病变。在青春期1期和5期的患者中，视网膜病变的发生率分别为6%和18%。由于失访者年龄更大、糖尿病病程更长，该人群中视网膜病变的总体患病率可能更高。由于在青春期前的儿童中发现了背景性和增殖前期视网膜病变，我们建议将10岁及以上的儿童和青少年纳入糖尿病视网膜病变筛查项目。
