Kuiv R, Tein P, Algvere P V, Bäcklund L B, Holm O
Department of Ophthalmology, University of Tartu, Republic of Estonia.
Acta Ophthalmol Scand. 1997 Aug;75(4):447-56. doi: 10.1111/j.1600-0420.1997.tb00412.x.
To perform a cross-sectional baseline investigation of diabetic retinopathy prevalence and metabolic control.
Using a register of insulin-dependent diabetes mellitus in Tartu (pop. 104,791), 175 patients were invited to fundus photography; 149 (89%) participated, 99 of them diagnosed with diabetes before the age of thirty. Four Kodachrome 64 photographs per eye were taken with a Canon CR4 - 45NM camera through tropicamide-dilated pupils; slides were projected and systematically graded. Capillary blood samples (n = 132) for HbA1c determination were mailed on filter paper. Following cysteine buffer elution, Mono S ion exchange chromatography was performed (reference range 3.7 to 5.3%).
Any diabetic retinopathy was found in 114 patients (76.5%; 95% confidence interval, CI, 70 to 83%); mild to moderate non-proliferative retinopathy in 59 (40%; 95% CI 32 to 48%); severe non-proliferative retinopathy in 29 (19.5%; 95% CI 13 to 26%); proliferative retinopathy in 26 (17%; 95% CI 11 to 24%); 47 patients (32%) needed laser photocoagulation. Vitreous haemorrhage was observed in 9 (6%) of subjects. In patients diagnosed with diabetes before the age of 30 years, prevalence of any retinopathy was 82% (95% CI 73 to 89%) and of proliferative retinopathy 23% (95% CI 15 to 33%). Median HbA1c was 9.7% for women and 8.6% for men (95% CI for difference 0.7 to 2.1%).
Retinopathy prevalences (76-82%) are the highest reported from population-based studies. Glycaemia levels were very high and should be gradually lowered. Methods capable of validation can be successfully introduced for population-based assessment of hyperglycaemia and retinopathy prevalences.
对糖尿病视网膜病变患病率及代谢控制情况进行横断面基线调查。
利用塔尔图（人口104,791）胰岛素依赖型糖尿病登记册，邀请175名患者进行眼底照相；149名（89%）患者参与，其中99名在30岁之前被诊断为糖尿病。使用佳能CR4 - 45NM相机通过托吡卡胺散瞳后，每只眼睛拍摄四张柯达克罗姆64照片；幻灯片放映后进行系统分级。用于测定糖化血红蛋白（HbA1c）的毛细血管血样（n = 132）通过滤纸邮寄。经过半胱氨酸缓冲液洗脱后，进行单磺酸离子交换色谱分析（参考范围3.7%至5.3%）。
114名患者（76.5%；95%置信区间，CI，70%至83%）发现有任何糖尿病视网膜病变；59名（40%；95%CI 32%至48%）有轻度至中度非增殖性视网膜病变；29名（19.5%；95%CI 13%至26%）有重度非增殖性视网膜病变；26名（17%；95%CI 11%至24%）有增殖性视网膜病变；47名患者（32%）需要激光光凝治疗。9名（6%）受试者观察到玻璃体出血。在30岁之前被诊断为糖尿病的患者中，任何视网膜病变的患病率为82%（95%CI 73%至89%），增殖性视网膜病变的患病率为23%（95%CI 15%至33%）。女性糖化血红蛋白中位数为9.7%，男性为8.6%（差异的95%CI为0.7%至2.1%）。
视网膜病变患病率（76% - 82%）是基于人群研究报道中最高的。血糖水平非常高，应逐步降低。能够进行验证的方法可成功用于基于人群的高血糖和视网膜病变患病率评估。
