北京市顺义区40岁及以上人群糖尿病视网膜病变的流行病学调查

摘要

Background There are no noticeable symptoms in early stages of diabetic retinopathy(DR)and the detection of presymptomatic DR remains challenging. Therefore, data on the prevalence and progress of DR will help in prevention and treatment programs in China. Objective This study was to survey the prevalence and risk factors of diabetic retinopathy( DR ) in a population aged 40 years or older in the Shunyi district of Beijing city.Methods A cross-sectional study was designed. Cluster sampling was used to randomly select 4167 (91.6%)individuals aged ≥40 years in 24 clusters in the Shunyi district of Beijing city in China. The Questionnaire data,including general information, living habits, present history, past history, family history, education level etc., were obtained from each subjects. The height, body weight and blood pressure were examined, and slit-lamp examination, direct ophthalmoscopy,indirect ophthalmoscopy and nonmydriatic fundus photography were performed during the study duration. Diabetic mellitus (DM)was diagnosed and graded according to the criteria of Early Treatment Diabetic Retinopathy Study Research Group(ETDRS). The associated factors with DR were analyzed byx2 test,trend x2 test,and multivariate Logistic regression analysis. This protocol was approved by the Ethic Committee of Peking University. Informed consent was obtained from each individual prior to the survey. Results A total of 4167 ( 91.6% )individuals were examined from the 4549 samples with a response rate of 86. 4%. This study showed a prevalence of 29. 2% for DR, 5.4% for sight-threatening diabetic retinopathy ( STDR), and 1.3% for prolifrative retinopathy (PDR) in type 2 DM subjects. Of the type 2 DM subjects,0. 4% (4/445)had social blindness( VA＜0. 1 ) ,and 6. 3% (28/445) presented with visual impairment (VA ＜ 0. 3 )in bilateral eyes. Univariate Logistic regression analysis indicated that insulin therapy ( P = 0.011 ) and lower body mass index ( BMI, kg/m2 ) ( P = 0. 022 ) appeared to be significantly associated with DR, and the multivariate Logistic regression analysis demonstrated that longer duration of diabetes( P＜ 0. 01 ) , increased fasting glucose ( P ＜ 0.01 ) and lower education level ( P = 0. 031 ) were significant independent predictors of DR. Conclusion The prevalence of DR is lower among diabetic Chinese aged ≥ 40 years than those of matched population in Western countries. Lower BMI and insulin therapy were the significantly associated factors of DR, and a longer duration of disease and higher fasting glucose level are independent risk factors of DR. Education attainment is important for the DM patients as a protective factor of DR.%背景 糖尿病视网膜病变(DR)发病早期隐匿,为DR的早期干预带来了一定的困难.了解人群中DR的发生和进展状况对于中国DR的防治具有重要意义.目的 调查北京市顺义区≥40岁的2型糖尿病(DM)患者中DR患病率,探讨DR发生的影响因素.方法 采用整群随机抽样方法在顺义区共抽取24个调查点,对≥40岁人群进行问卷调查,并进行身高、体重、血压、血糖测量以及裂隙灯、检眼镜及免散瞳眼底照相等眼部检查.将所得数据进行t检验、x2检验及Logistic回归分析,评价与DR相关的影响因素.结果 抽样所得≥40岁人群4549位中,共有4167(91.6%)位受检者接受筛查.根据早期治疗DR研究组(ETDRS)诊断标准,DR患病率为29.2%,严重的非增生型糖尿病视网膜病变(PDR)为2.5%(n=11),PDR为1.3%(n=6),威胁视力的DR为5.4%(n=24).2型DM患者中,0.4%(4/445)为社会性盲(VA＜0.1),6.3%(28/445)为双眼的视力损害(VA＜0.3).单因素分析显示低体质量指数(BMI)(P=0.022)、胰岛素治疗史(P=0.011)与DR的发生有明显相关.较长的DM病程(P＜0.01)及增高的空腹血糖水平(P＜0.01)是DR发生的独立危险因素.而文化程度的提高是预防DR发生的保护性因素(P=0.031).结论 北京市顺义区≥40岁人群DR患病率低于国外同年龄人群的调查结果,胰岛素治疗史及低BMI是影响DR发生的相关因素,而DM病程及空腹血糖水平是DR发生的独立危险因素.加强相关知识的宣传教育对预防DR的发生至关重要.