Background Long-term study on type 2 diabetes discovered that some patients with diabetic retinopathy (DR) or diabetic macular edema (DME) appear regression of lesions without invasive ocular intervention but only systemic medication.These mechanisms remain unclear.Objective This study was to survey the regression rate and relevant factors of DR and DME in type 2 diabetic patients.Methods A prospectively observational study was performed.Totally 778 patients who met the inclusion criteria participated in this consecutive 5-year survey.The demographic information of the patients was collected,and the systemic and ophthalmological examinations were carried out,and the fundus photography was identified by 2 doctors by blind method.DR was graded into non-,mild-,moderate-,severe-nonproliferation DR and proliferative DR based on international clinical classification,and DME was graded into non-,mild-,moderate-and severe-DME.DR improvement and DME regression were served as the outcome variables and defined as the grading of DR or DME in lateral eyes lowering by at least 1 grade and without development of DR or DME in fellow eyes.The influences of age,gender,education level,diabetes onset age,diabetes course,obesity and serum creatinine,triacylglycerol,total cholesterol and glycosylated hemoglobin levels were evaluated by Logistic regression analysis.Results Four hundred and fifty-six patients appeared DR in the initial examination,of which 139 patients appeared regression of DR severity with the regression rate of 30.48％.Both low blood glucose level and low serum creatinine level at initial examination were independent risk factors associated with DR regression (blood glucose level:odds ratio(OR) =0.53,95％ confidence interval [CI]:0.45-0.63,P＜0.01;serum creatinine level:OR =0.98,95％ CI:0.97-0.99,P＜0.01).One hundred and fifty-eight patients were found to have DME at the initial examination,of which 20 had a regression of DME severity throughout the follow-up duration,with the regression rate 12.66％.High baseline blood glucose level was found to be the only independent risk factor associated with DME regression (OR =1.47,95％ CI:1.14-1.91,P ＜ 0.01).Conclusions Effective control of blood glucose and serum creatinine levels is a favorable factor for the regression of DR,and the rapid drop of blood glucose level is beneficial to the regression of DME.%背景 对2型糖尿病患者的长期随访过程中发现,部分糖尿病视网膜病变(DR)和糖尿病黄斑水肿(DME)患者未经眼底激光光凝、内眼手术或眼内药物治疗眼底病变可好转,但其影响因素尚不清楚.目的 探讨中国2型糖尿病患者DR和DME自行好转的发生率及促好转影响因素. 方法 采用前瞻性观察研究方法,于2007-2012年对上海市新泾社区中符合纳入标准的778例2型糖尿病患者进行连续5年的流行病学调查和随访,收集患者一般资料,对患者行全身体格检查、实验室血生化指标检查、眼部检查和眼底照相,眼底照片读片采用盲法.采用国际临床分类方法和视网膜玻璃体增生情况将DR分为无明显DR和轻、中、重度非增生性DR及增生性DR;并将DME分为无、轻度、中度和重度DME.将DR好转和DME好转作为2个结局变量,好转为仅接受全身用药者至少一眼终末DR或DME分级较基线时下降至少1级且对侧眼DR无进展.采用Logistic多元回归分析判断年龄、性别、受教育程度、糖尿病发病年龄、糖尿病病程、肥胖及血肌酐、三酰甘油、总胆固醇和糖化血红蛋白(HbA1c)水平对结局变量的影响.结果 2007年基线调查时发现DR患者456例,其中139例患者5年后至少1眼DR好转,好转率为30.48％.基线检查低HbA1c水平和低血肌酐水平是DR好转的促进因素[HbA1c:优势比(OR)=0.53,95％可信区间(CI)]:0.45 ～0.63,P＜0.01;血肌酐:OR=0.98,95％ CI:0.97 ～0.99,P＜0.01).基线调查时发现DME 158例,其中20例5年后至少1眼好转,好转率为12.66％.高基线血糖水平是DME好转的唯一、独立影响因素(OR=1.47,95％ CI:1.14～1.91,P＜0.01).结论 降低2型糖尿病DR患者的血糖和血肌酐水平有助于DR好转,快速降低血糖水平有助于DME的好转.
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