2型糖尿病患者中与严格控制血压相关的视网膜病变进展和视力损失的危险因素:UKPDS69  

Risks of progression of retinopathy and vision loss related to tight blood pressure control in type 2 diabetes mellitus: UKPDS 69

作　　者：MatthewsD.R. Stratton I.M. Aldington S.J. 张自峰 

机构地区：[1]Oxford Ctr. Diabet., Endocrinol., M., Churchill Hospital, Old Road, Oxford OX3 7LJ, United Kingdom

出　　处：《世界核心医学期刊文摘（眼科学分册）》2005年第4期24-26,共3页Digest of the World Core Medical Journals:Ophthalmology

摘　　要：Objective: To determine the relationship between tight blood pressure (BP) control and the different aspects of diabetic retinopathy in patients with type 2 diabetes mellitus (DM). Setting: Nineteen hospital- based clinics in England, Scotland, and Northern Ireland. Design: Outcome of retinopathy status assessed by 4- field retinal photography related to allocation within a randomized controlled trial comparing a tight BP control policy aiming for a BP less than 150/85 mm Hg with a less tight BP control policy aiming for a BP less than 180/105 mm Hg. Subjects: One thousand one hundred forty- eight hypertensive patients with type 2 DM were studied. These patients had type 2 DM for a mean duration of 2.6 years at the inception of the Hypertension in Diabetes Study, had a mean age of 56 years; and had a mean BP of 160/94 mm Hg. Seven hundred fifty- eight patients were allocated to a tight BP control policy with angiotensin- converting enzyme inhibitor or β - blockers as the main therapy; 390 were allocated to a less tight BP control policy. Main Outcome Measures: Deterioration of retinopathy (≥ 2- step change on a modified Early Treatment Diabetic Retinopathy Study [ETDRSAbstractfinal scale), together with end points (photocoagulation, vitreous hemorrhage, and cataract extraction) and analysis of specific lesions (microaneurysms, hard exudates, and cotton- wool spots). Visual acuity was assessed at 3- year intervals using ETDRS logarithm of the minimum angle of resolution charts. Blindness was monitored as an end point with the criterion of Snellen chart assessment at 6/60 or worse. Results: By 4.5 years after randomization, there was a highly significant difference in microaneurysm count with 23.3% in the tight BP control group and 33.5% in the less tight BP control group having 5 or more microaneurysms (relative risk [RRAbstract, 0.70; P=.003). The effect continued to 7.5 years (RR, 0.66; P < .001). Hard exudates increased from a prevalence of 11.2% to 18.3% at 7.5 years after randomization with fewer lesions fObjective: To determine the relationship between tight blood pressure (BP) control and the different aspects of diabetic retinopathy in patients with type 2 diabetes mellitus (DM). Setting: Nineteen hospital- based clinics in England, Scotland, and Northern Ireland. Design: Outcome of retinopathy status assessed by 4- field retinal photography related to allocation within a randomized controlled trial comparing a tight BP control policy aiming for a BP less than 150/85 mm Hg with a less tight BP control policy aiming for a BP less than 180/105 mm Hg. Subjects: One thousand one hundred forty- eight hypertensive patients with type 2 DM were studied. These patients had type 2 DM for a mean duration of 2.6 years at the inception of the Hypertension in Diabetes Study, had a mean age of 56 years; and had a mean BP of 160/94 mm Hg. Seven hundred fifty- eight patients were allocated to a tight BP control policy with angiotensin- converting enzyme inhibitor or β - blockers as the main therapy; 390 were allocated to a less tight BP control policy. Main Outcome Measures: Deterioration of retinopathy (≥ 2- step change on a modified Early Treatment Diabetic Retinopathy Study [ETDRSAbstractfinal scale), together with end points (photocoagulation, vitreous hemorrhage, and cataract extraction) and analysis of specific lesions (microaneurysms, hard exudates, and cotton- wool spots). Visual acuity was assessed at 3- year intervals using ETDRS logarithm of the minimum angle of resolution charts. Blindness was monitored as an end point with the criterion of Snellen chart assessment at 6/60 or worse. Results: By 4.5 years after randomization, there was a highly significant difference in microaneurysm count with 23.3% in the tight BP control group and 33.5% in the less tight BP control group having 5 or more microaneurysms (relative risk [RRAbstract, 0.70; P=.003). The effect continued to 7.5 years (RR, 0.66; P < .001). Hard exudates increased from a prevalence of 11.2% to 18.3% at 7.5 years after randomization with fewer lesions f

关 键 词：视网膜病变 UKPDS69 光凝固 硬性渗出 微动脉瘤 对数视力表 控制组 随机治疗 病变发展 累积发病率 

分 类 号：R587.2[医药卫生—内分泌]