2型糖尿病人群轻度视力损伤患者2年随访研究  

Two-year follow-up study in type 2 diabetic patients with mild visual impairment

作　　者：徐娴[1] 徐艺[2] 陆丽娜[2] 白雪林 张波[2] 贺江南[2] 何鲜桂[2] 朱剑锋[2] 邹海东[1] Xu Xian;Xu Yi;Lu Lina;Bai Xuelin;Zhang Bo;He Jiangnan;He Xiangui;Zhu Jianfeng;Zou Haidong(Department of Ophthalmology,Shanghai General Hospital,Shanghai Jiao Tong University Shanghai Key Laboratory of Eye Fundus Disease,Shanghai 200080,China;Shanghai Eye Hospital Shanghai Eye Disease Prevention and Treatment Center,Shanghai 200040,China;Xinjing Community Health Service Center,Shanghai 200335,China)

机构地区：[1]上海交通大学附属第一人民医院眼科中心,上海市眼底病重点实验室,200080 [2]上海市眼科医院上海市眼病防治中心,200040 [3]上海市新泾镇社区卫生服务中心,200335

出　　处：《中华眼科杂志》2021年第10期766-771,共6页Chinese Journal of Ophthalmology

基　　金：国家自然科学基金(81670898,81600778);上海市优秀学术带头人计划(16XD1402300);上海市第四轮公共卫生三年行动计划(GWTD2015S08,GWIV-3.3);上海市科委项目(17511107901);上海申康医院发展中心慢病防治项目(SHDC12015315);上海市卫生和计划生育委员会项目(20164Y0237)。

摘　　要：目的了解2型糖尿病人群中双眼轻度视力损伤患者随访2年后的视力变化及相关因素。方法以人群为基础的2年期队列研究。2016年10至12月对笔者2014年的前期研究中上海市新泾社区双眼轻度视力损伤的2型糖尿病人群650例进行再次随访,获得随访对象人群的基本特征、血生化检测结果和眼科检查结果。采用国际眼科理事会2002标准,将轻度视力损伤定义为最佳矫正视力<0.8且≥0.3,中重度损伤定为最佳矫正视力<0.3且≥0.05,盲定为最佳矫正视力<0.05。根据2年后的视力变化情况分为减轻组、加重组和不变组,采用卡方检验或者独立t检验,确定影响视力变化的相关因素及2年后视力损伤的主要原因。结果605例受访者完成了2年后的随访。其中,477例仍为双眼轻度视力损伤,占78.8%(477/605);49例单眼或双眼视力损伤程度减轻,占8.1%(49/605);79例单眼或双眼视力损伤程度加重,占13.1%(79/605)。年龄轻(t=2.7,P<0.05)、病程短(t=2.5,P<0.05)、血糖化血红蛋白浓度低(t=2.5,P<0.05)或血总胆固醇浓度低(t=2.8,P<0.05)是视力损伤程度减轻的相关因素。受教育程度低(t=5.2,P<0.05)、血糖化血红蛋白浓度高(t=2.4,P<0.05)或血总胆固醇浓度高(t=2.0,P<0.05)是视力损伤程度加重的相关因素。白内障、糖尿病视网膜病变为导致轻度、中重度视力损伤或盲的第1和第2位的视力损伤原因。结论2型糖尿病人群轻度视力损伤者在2年后视力发生下降者比例较高,加强对血糖化血红蛋白及血总胆固醇的监测和控制,可能有助于减缓视力损伤进展。Objective To determine the 2-year visual prognosis in Chinese type 2 diabetic patients with mild visual impairment and identify the predictors factors.Method This was a 2-year population-based cohort study.The study population consisted of 650 type 2 diabetic patients with bilateral mild visual impairment in 2014 who were followed up in 2016.The demographic information,systemic and ophthalmological examination results for each participant was collected.Mild visual impairment was defined as best-corrected visual acuity(BCVA)<20/25 to≥20/63,moderate and severe visual impairment was defined as BCVA<20/63 to≥20/400,blindness was defined as BCVA<20/400 following the International Council of Ophthalmology(ICO)2002 definition.The two-year visual prognosis was divided into three groups:visual impairment regression,progression,and stable.Using chi-square test or independent t-test,the predictor factors of visual prognosis and the leading causes of visual impairment were studied.Results 605 patients completed the follow-up in 2016.Among them,477 were still bilateral mild visual impairment,accounting for 78.8%(477/605).The level of unilateral or bilateral visual impairment regressed in 8.1%(49/605),while progressed in 13.1%(79/605).Young age(t=2.7,P<0.05),short duration of diabetes(t=2.5,P<0.05),low blood glycemic hemoglobin(t=2.5,P<0.05)and total cholesterol(t=2.8,P<0.05)were associated with regression of visual impairment.Low levels of education(t=5.2,P<0.05),high blood glycemic hemoglobin(t=2.4,P<0.05)and total cholesterol(t=2.4,P<0.05)were associated with progression of visual impairment.Cataracts and diabetic retinopathy were the first and second cause of mild,moderate severe visual impairment or blindness.Conclusions The percentage of 2-year visual acuity decline is relatively high in type 2 diabetic patients with mild visual impairment.We should strengthen blood glucose and cholesterol control to reduce the progress of visual impairment.

关 键 词：糖尿病 2型 视力损伤 最佳矫正视力 视力预后 

分 类 号：R587.2[医药卫生—内分泌] R771.3[医药卫生—内科学]