Nagi D K, Pettitt D J, Bennett P H, Klein R, Knowler W C
Edna Coates Diabetes Centre, Pinderfields Hospital Trust, Wakefield, UK, England.
Diabet Med. 1997 Jun;14(6):449-56. doi: 10.1002/(SICI)1096-9136(199706)14:6<449::AID-DIA367>3.0.CO;2-D.
In a population-based epidemiological study, 991 Pima Indians with non-insulin-dependent (Type 2) diabetes mellitus (NIDDM) and 288 without diabetes aged > or =15 years were examined for retinopathy by fundus photography with a 45 degrees fundus camera after mydriasis. The photographs were graded using a modified Airlie-House classification scheme. The associations of several factors with retinopathy were studied by logistic regression. Non-proliferative retinopathy was present in 11.2 % (19/169) subjects at the time of diagnosis of diabetes and in 8.3% (4/48) in newly diagnosed subjects who had a documented non-diabetic oral glucose tolerance test within 4 years prior to diagnosis of diabetes. The prevalence of retinopathy in subjects with impaired glucose tolerance was 12% (8/68). Retinopathy at the time of diagnosis of diabetes was significantly associated with lower body mass index and higher systolic blood pressure but not glycaemia. Retinopathy was present in 375 (37.8 %) diabetic subjects and 14 (5.2 %) non-diabetic subjects. Among all subjects with diabetes (duration 0-37 years), stepwise multivariate analysis showed non-proliferative retinopathy to be associated with duration of diabetes, mean blood pressure, fasting plasma glucose, treatment with insulin and albuminuria. Proliferative retinopathy was seen in 34 (2.7%) of diabetic and none of the non-diabetic subjects, and was associated with 2 h post-load glucose concentrations, as well as albuminuria, insulin treatment, younger age, and diastolic blood pressure. These data confirm the need for fundus examination at the time of diagnosis of diabetes and during long-term follow-up. Albuminuria and blood pressure are potentially modifiable risk factors and the impact of treating these on incidence and progression of diabetic retinopathy need to be assessed.
在一项基于人群的流行病学研究中，对991名非胰岛素依赖型（2型）糖尿病（NIDDM）的皮马印第安人以及288名年龄≥15岁的非糖尿病患者进行了散瞳后使用45度眼底照相机进行眼底摄影检查视网膜病变。照片采用改良的艾利屋分类方案进行分级。通过逻辑回归研究了几个因素与视网膜病变的关联。糖尿病诊断时，11.2%（19/169）的受试者存在非增殖性视网膜病变，在诊断糖尿病前4年内有记录的非糖尿病口服葡萄糖耐量试验的新诊断受试者中，这一比例为8.3%（4/48）。糖耐量受损受试者中视网膜病变的患病率为12%（8/68）。糖尿病诊断时的视网膜病变与较低的体重指数和较高的收缩压显著相关，但与血糖无关。375名（37.8%）糖尿病受试者和14名（5.2%）非糖尿病受试者存在视网膜病变。在所有糖尿病患者（病程0 - 37年）中，逐步多变量分析显示非增殖性视网膜病变与糖尿病病程、平均血压、空腹血糖、胰岛素治疗和蛋白尿有关。34名（2.7%）糖尿病患者出现增殖性视网膜病变，非糖尿病患者均未出现，增殖性视网膜病变与负荷后2小时血糖浓度、蛋白尿、胰岛素治疗、较年轻的年龄和舒张压有关。这些数据证实了在糖尿病诊断时和长期随访期间进行眼底检查的必要性。蛋白尿和血压是潜在可改变的危险因素，需要评估治疗这些因素对糖尿病视网膜病变发生率和进展的影响。
