上海市社区2型糖尿病视网膜病变患者一年随访调查  

One-year follow-up for patients with diabetic retinopathy in Shanghai communities

作　　者：秦飞[1] 施榕 贾丽丽[3] 江华[4] 冯易[1] 张胜冰 宋道平 蒋玉立 顾文娟 彭云 程慧琴 娄洁琼 龙雯[1] Qin Fei;Shi Rong;Jia Lili;Jiang Hua;Feng Yi;Zhang Shengbing;Song Daoping;Jiang Yuli;Gu Wenjuan;Peng Yun;Cheng Huiqin;Lou Jieqiong;Long Wen(School of Public Health,Shanghai Jiao Tong University,Shanghai 200025,China;Daqiao Community Health Service Center,Shanghai 200433,China;School of Public Health,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Department of Ophthalmology,Shanghai Sixth People′s Hospital,Shanghai 200233,China;Department of Geriatrics Medicine,Shanghai East Hospital,Shanghai 200120,China;Huamu Community Health Service Center,Shanghai 201204,China;Jinyang Community Health Service Center,Shanghai 200120,China;Yinhang Community Health Service Center,Shanghai 200433,China;Siping Community Health Service Center,Shanghai 200433,China;Sanlin Community Health Service Center,Shanghai 200120,China)

机构地区：[1]上海交通大学公共卫生学院,200025 [10]上海市大桥社区卫生服务中心,200433 [2]上海中医药大学公共健康学院,201203 [3]上海市第六人民医院眼科,200233 [4]上海市东方医院老年医学科,200120 [5]上海市花木社区卫生服务中心,201204 [6]上海市金杨社区卫生服务中心,200120 [7]上海市殷行社区卫生服务中心,200433 [8]上海市四平社区卫生服务中心,200433 [9]上海市三林社区卫生服务中心,200120

出　　处：《中华全科医师杂志》2019年第6期529-534,共6页Chinese Journal of General Practitioners

基　　金：上海市公共卫生重点学科(全科医学)建设项目(15GWZK1002).

摘　　要：目的探索上海市社区2型糖尿病视网膜病变(DR)患者不同转归结局及其影响因素。方法2015年10月至2016年4月,用目标抽样与整群随机抽样结合的方法,抽取上海市花木、金杨、三林、殷行、四平、大桥6家社区卫生服务中心管理的533例2型糖尿病DR患者进行随访,收集患者的人口学信息、体格检查、实验室检测及眼底检查结果,进行DR诊断分级,分析患者的DR不同转归结局,采用有序logistic回归模型探索DR的影响因素。结果1年后,478例患者完成随访,女性占58.6%(280/478),男性占41.4%(198/478)。患者年龄(64±7)岁,病程(8.85±4.20)年。35例病情减轻,好转率为7.3%(35/478);29例病情加重,进展率为6.1%(29/478)。有序logistic回归分析发现,年龄(OR=0.197,95%CI:0.056~0.699)、BMI(OR=0.383,95%CI:0.171~0.856)、糖化血红蛋白(HbA1c)(OR=0.287,95%CI:0.102~0.803)、TG(OR=0.541,95%CI:0.295~0.991)、尿微量清蛋白与尿肌酐比值(ACR)(OR=0.218,95%CI:0.066~0.720)是患者DR病情发生不同转归结局的影响因素(均P<0.05)。结论DR患者的转归结局与年龄、BMI、血糖、血脂以及肾脏功能密切相关,降低BMI、控制血糖、血脂以及维持正常肾脏功能对防止DR病情加重以及促进DR病情好转具有重要意义。Objective To investigate the outcomes of patients with diabetic retinopathy (DR) in Shanghai communities and the influencing factors. Methods From October 2015 to April 2016,533 type 2 diabetic patients with DR were selected by target sampling and cluster random sampling method from six community health service centers in Shanghai. Patients were followed up for 1 year. The demographic information,physical examination,laboratory tests and eye fundus exam results were documented and the DR was graded.The factors associated with the regression of DR were analyzed. Results Total 478 patients, including 280 females (58.6%) and 198 males (41.4%),were followed up for 1 year. The mean age of patients was (64±7) years and the mean disease duration was (8.85±4.20) years. The original DR lesion was remitted in 35 patients with an improvement rate of 7.3%;while the original DR lesion was aggravated in 29 patients with a progression rate of 6.1%. Ordinal logistic regression analysis revealed that age (OR=0.197, 95%CI: 0.056-0.699), body mass index (BMI)(OR=0.383, 95%CI: 0.171-0.856), glycosylated hemoglobin (HbA1c)(OR=0.287, 95%CI: 0.102-0.803), triglycerides (TG)(OR=0.541, 95%CI: 0.295-0.991), urinary albumin to creatinine ratio (ACR)(OR=0.218,95%CI:0.066-0.720) were associated with DR in type 2 diabetic patients. Conclusion The regression of DR is closely related to age,BMI,glucose,serum lipids and renal function,so it is suggested that lowering BMI,controlling glucose and serum lipids and maintaining normal kidney function are necessary for preventing the progression and promoting the improvement of DR in diabetic patients.

关 键 词：糖尿病 2型 糖尿病视网膜病变 随访研究 转归 影响因素 

分 类 号：R587.2[医药卫生—内分泌]