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随着人口老龄化的加剧,常见慢病糖尿病(diabetic mellitus,DM)已经成为全球公共卫生疾病。据估计,2040年全球约有6.42亿DM病人[1]。糖尿病视网膜病变(diabetic retinopathy,DR)作为DM的常见眼部并发症[2],是成年劳动人口失明和视力损害的主要原因[3]。上海市地处长江三角洲,经济发达,既往有关该市DR的流行病学研究多针对上海市区,上海市郊则较少。本研究采用横断面研究方法,获取上海市郊白鹤镇DM病人DR数据,为调查我国经济发达地区城镇化农村人口DR患病情况提供资料。现作报道。
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本研究选取上海市郊白鹤镇889名居民健康档案中登记的DM居民作为研究对象进行DR筛查,实际受检822人,应答率92.46%,其中眼底照片可判读者743例,占90.4%。743名眼底照片可判读者中:男321人(43.2%),女422人(56.8%);年龄(61.5±6.5)岁,其中60岁及以上者495人(66.6%),60岁以下者248人(33.4%);身高(160.8±8.2)cm;体质量(62.6±9.1)kg;BMI(24.2±2.7)kg/m2,其中0.4%的DM居民BMI < 18.5 kg/m2,51.8%的DM居民18.5 kg/m2≤BMI < 24 kg/m2,47.8%的DM居民BMI≥24 kg/m2;人群文化程度:接受小学及以下教育者589人(79.3%),接受初中、中职及普高教育者150人(20.2%),接受大专及以上教育者4人(0.5%)。
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743名DM病人中共检出DR病人115例,总患病率15.5%,其中轻度NPDR 30例占26.09%, 中度NPDR 60例占52.17%, 重度NPDR 17例占14.78%, PDR 8例占6.96%。
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单因素分析显示FPG、HbA1c、BUN、uCr是DR的相关因素(P < 0.05~P < 0.01)(见表 1);以上述4个相关因素为自变量(赋值为实际检测值),DR为因变量(1=是,0=否)进行多元logistic回归分析显示,DR发生率与FPG、HbA1c呈正相关(P < 0.05和P < 0.01),与uCr呈负相关(P < 0.01)(见表 2)。
暴露因素 全样本(n=743) NDR(n=628) NPDR PDR(n=8) Z P 轻度(n=30) 中度(n=60) 重度(n=17) FPG/(mmol/L) 8.86±2.48 8.60±2.24 10.35±3.67 9.88±3.13 11.54±2.34 10.41±2.56 42.59 < 0.0 HbA1c/(mmol/L) 6.98±1.28 6.84±1.16 7.73±1.44 7.75±1.81 8.05±1.38 7.36±1.35 41.97 < 0.01 TC/(mmol/L) 5.37±1.04 5.40±1.02 4.96±0.95 5.32±1.17 5.47±1.06 4.97±0.98 6.13 >0.05 TG/(mmol/L) 1.67±1.38 1.71±1.44 1.30±0.75 1.61±1.20 1.26±0.77 1.57±0.80 3.90 >0.05 LDL/(mmol/L) 3.26±0.93 3.28±0.92 3.06±0.83 3.24±1.03 3.42±0.91 2.89±0.95 3.46 >0.05 HDL/(mmol/L) 1.37±0.30 1.37±0.29 1.27±0.31 1.35±0.38 1.45±0.35 1.43±0.36 5.86 >0.05 BUN/(mmol/L) 6.09±1.72 6.07±1.65 6.07±1.41 6.26±2.56 6.86±0.88 5.40±1.25 11.13 < 0.05 sCr/(μmol/L) 59.81±20.07 59.50±20.43 60.77±10.15 61.83±22.59 63.18±8.89 58.38±17.92 6.09 >0.05 uCr/(μmol/L) 7.87±4.09 8.07±4.12 6.87±2.81 6.92±4.16 7.41±3.52 3.38±1.51 21.77 < 0.01 uALB/(mg/L) 8.30(3.10-23.90) 8.25(3.10-23.45) 5.55(1.93-13.28) 9.65(2.95-56.98) 10.60(7.15-24.15) 8.60(4.23-21.40) 4.02 >0.05 UACR/(mg/g) 9.20(3.90-24.90) 8.75(3.80-24.18) 6.90(2.68-16.75) 14.55(4.43-68.08) 11.40(6.95-35.95) 19.15(15.08-42.70) 9.41 >0.05 表 1 DR暴露因素在不同等级DR中分布情况及单因素分析
暴露因素 B OR 95%CI Waldχ2 P FPG/(mmol/L) 0.107 1.113 1.003~1.235 4.043 < 0.05 HbA1c/(mmol/L) 0.335 1.398 1.145~1.708 10.805 < 0.01 BUN/(mmol/L) 0.049 1.050 0.944~1.168 0.797 >0.05 uCr/(μmol/L) -0.084 0.919 0.868~0.973 8.373 < 0.01 表 2 DR患病的多因素有序logistic回归分析
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743名DM病人中检出糖尿病黄斑水肿(diabetic macular edema, DME)DME病人19例,患病率2.56%。1 450眼可判读眼底照片中27眼睛患有DME。探究该1 450只眼睛DME分布与DR分级情况发现:DME出现频率随DR严重程度发展有增加趋势(P < 0.01)(见表 3)。
DME NDR 轻度NPDR 中度NPDR 重度NPDR PDR 合计 Z P 有 6(0.41) 0(0.00) 8(0.55) 4(0.28) 9(0.62) 27(1.82) 10.86 < 0.01 无 1 253(86.41) 44(3.03) 99(6.83) 25(1.72) 2(0.14) 1 423(98.18) 合计 1 259(86.82) 44(3.03) 107(7.38) 29(2.00) 11(0.76) 1 450(100.00) 表 3 DR与DME之间的关系[眼;百分率(%)]
上海市郊白鹤镇糖尿病病人视网膜病变患病率及危险因素分析
Analysis of the prevalence and risk factors of retinopathy in diabetic patients in a suburb of Shanghai
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摘要:
目的调查上海市郊白鹤镇糖尿病(diabetic mellitus,DM)病人糖尿病视网膜病变(diabetic retinopathy,DR)的患病情况,并进行患病率及危险因素分析。 方法采用以人群为基础的横断面研究。于2017年7月,从白鹤镇疾控中心居民健康档案中获取889名DM居民登记信息,收集该人群血液、尿液样本,同时进行眼底照相获取DR信息。以2002年DR国际临床分级标准对眼底照片进行判读。 结果实际受检822人,应答率92.46%,其中眼底照片可判读者743例,占90.4%。共检出DR病人115例,患病率15.5%,其中轻度非增殖性DR(nonproliferative DR,NPDR)、中度NPDR、重度NPDR以及增殖性DR分别占26.09%、52.17%、14.78%、6.96%;多变量logistic回归分析显示空腹血糖高、糖化血红蛋白高、尿肌酐低是DR的独立危险因素(P < 0.05~P < 0.01);糖尿病黄斑水肿(diabetic macular edema,DME)病人19例,患病率2.56%。DME分布与DR分级存在关联,DME出现频率随DR严重程度发展增加(P < 0.01)。 结论上海市郊白鹤镇DM病人DR患病率为15.5%,以NPDR为主,即尚处病程前期,故应及时采取相应诊断和干预,防控DR发展。 Abstract:ObjectiveTo investigate the prevalence and risk factors of diabetic retinopathy (DR) in patients with diabetic mellitus (DM) in a suburb of Shanghai. MethodsA population-based cross-sectional study was used.In July 2017, the registration information of 889 DM residents were obtained from the resident health archives of Baihe Center for Disease Prevention and Control.The information of blood and urine samples were analyzed, and the DR information was collected using the fundus images in all cases.The fundus images were analyzed according to the 2002 DR international clinical grading standard. ResultsThe response rate in 698 residents was 92.46%, and 743 cases (90.4%) were diagnosed by fundus images.A total of 115 DR patients were diagnosed, and the prevalence of DR was 15.5%.Among them, the mild nonproliferative DR (NPDR), moderate NPDR, severe NPDR and proliferative DR accounted for 26.09%, 52.17%, 14.78% and 6.96%, respectively.The results of multivariate logistic regression analysis showed that the high fasting blood glucose, high glycosylated hemoglobin, and low urine creatinine were the independent risk factors of DR (P < 0.05 to P < 0.01).The diabetic macular edema (DME) in 19 patients was found, and the prevalence of which was 2.56%.The DME distribution was associated with the DR grading, and the frequency of DME increased with the increasing of DR severity (P < 0.01). ConclusionsThe prevalence of DR in DM patients in Baihe town, a suburb of Shanghai, is 15.5%.The NPDR is the main, and still in the early stage of the disease.Therefore, the diagnosis and intervention should timely be taken to prevent and control the development of DR. -
Key words:
- diabetic retinopathy /
- epidemiology /
- Shanghai suburb /
- macular edema /
- prevalence /
- risk factor
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表 1 DR暴露因素在不同等级DR中分布情况及单因素分析
暴露因素 全样本(n=743) NDR(n=628) NPDR PDR(n=8) Z P 轻度(n=30) 中度(n=60) 重度(n=17) FPG/(mmol/L) 8.86±2.48 8.60±2.24 10.35±3.67 9.88±3.13 11.54±2.34 10.41±2.56 42.59 < 0.0 HbA1c/(mmol/L) 6.98±1.28 6.84±1.16 7.73±1.44 7.75±1.81 8.05±1.38 7.36±1.35 41.97 < 0.01 TC/(mmol/L) 5.37±1.04 5.40±1.02 4.96±0.95 5.32±1.17 5.47±1.06 4.97±0.98 6.13 >0.05 TG/(mmol/L) 1.67±1.38 1.71±1.44 1.30±0.75 1.61±1.20 1.26±0.77 1.57±0.80 3.90 >0.05 LDL/(mmol/L) 3.26±0.93 3.28±0.92 3.06±0.83 3.24±1.03 3.42±0.91 2.89±0.95 3.46 >0.05 HDL/(mmol/L) 1.37±0.30 1.37±0.29 1.27±0.31 1.35±0.38 1.45±0.35 1.43±0.36 5.86 >0.05 BUN/(mmol/L) 6.09±1.72 6.07±1.65 6.07±1.41 6.26±2.56 6.86±0.88 5.40±1.25 11.13 < 0.05 sCr/(μmol/L) 59.81±20.07 59.50±20.43 60.77±10.15 61.83±22.59 63.18±8.89 58.38±17.92 6.09 >0.05 uCr/(μmol/L) 7.87±4.09 8.07±4.12 6.87±2.81 6.92±4.16 7.41±3.52 3.38±1.51 21.77 < 0.01 uALB/(mg/L) 8.30(3.10-23.90) 8.25(3.10-23.45) 5.55(1.93-13.28) 9.65(2.95-56.98) 10.60(7.15-24.15) 8.60(4.23-21.40) 4.02 >0.05 UACR/(mg/g) 9.20(3.90-24.90) 8.75(3.80-24.18) 6.90(2.68-16.75) 14.55(4.43-68.08) 11.40(6.95-35.95) 19.15(15.08-42.70) 9.41 >0.05 表 2 DR患病的多因素有序logistic回归分析
暴露因素 B OR 95%CI Waldχ2 P FPG/(mmol/L) 0.107 1.113 1.003~1.235 4.043 < 0.05 HbA1c/(mmol/L) 0.335 1.398 1.145~1.708 10.805 < 0.01 BUN/(mmol/L) 0.049 1.050 0.944~1.168 0.797 >0.05 uCr/(μmol/L) -0.084 0.919 0.868~0.973 8.373 < 0.01 表 3 DR与DME之间的关系[眼;百分率(%)]
DME NDR 轻度NPDR 中度NPDR 重度NPDR PDR 合计 Z P 有 6(0.41) 0(0.00) 8(0.55) 4(0.28) 9(0.62) 27(1.82) 10.86 < 0.01 无 1 253(86.41) 44(3.03) 99(6.83) 25(1.72) 2(0.14) 1 423(98.18) 合计 1 259(86.82) 44(3.03) 107(7.38) 29(2.00) 11(0.76) 1 450(100.00) -
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