糖尿病视网膜病变患者视觉相关生活质量调查研究  

The impact of diabetic retinopathy on vision-related quality of life

作　　者：臧博 荣世松 丁晓霞 邹博 臧冬晓 王禹 许艳芳 冯克谜 李冬 Zang Bo;Rong Shisong;Ding Xiaoxia;Zou Bo;Zang Dongxiao;Wang Yu;Xu Yanfang;Feng Kemi;Li Dong(Fushun Eye Hospital,Fushun 113006,China;Department of Ophthalmology,Harvard Medical School,Massachusetts Eye and Ear,Mass General Brigham,Boston 02101-02117,USA;Eye Hospital,Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]抚顺市眼病医院,抚顺113006 [2]Department of Ophthalmology,Harvard Medical School,Massachusetts Eye and Ear,Mass General Brigham,Boston 02101-02117,USA [3]温州医科大学附属眼视光医院,温州325000

出　　处：《中华眼科杂志》2022年第10期760-768,共9页Chinese Journal of Ophthalmology

基　　金：辽宁省自然科学基金(20170540328)。

摘　　要：目的了解2型糖尿病伴糖尿病视网膜病变(DR)患者的视觉相关生活质量(VRQoL)。方法横断面研究。纳入2012年7月至2013年5月辽宁省抚顺市将军街道15个社区已确诊为2型糖尿病的居民1537例,男性623例,女性914例,年龄(61.1±8.4)岁。采用美国国立眼科研究院视功能量表(NEI-VFQ-25)中文版来评估受检者的VRQoL。受检者分别按年龄、性别、有无视力损伤、受累眼进行分析。不同人群间量表分数的比较采用Wilcoxon秩和检验或Kruskal-Wallis H检验。将每只眼分为无DR、轻度非增生期糖尿病性视网膜病变(NPDR)、中度NPDR、重度NPDR和增生性糖尿病视网膜病变(PDR)。判断受检者双眼DR严重程度,按7级DR综合等级进行分级。采用广义线性模型评估DR严重程度与量表分数的线性关系;采用局部加权回归来评估DR综合严重程度与量表分数之间可能存在的非线性关系。结果1537例受检者中无DR者836例(54.4%),轻度NPDR 479例(31.2%),中度NPDR 90例(5.9%),重度NPDR 72例(4.7%),PDR 60例(3.8%)。与单眼受累患者相比,双眼受累患者总体视力[70.2(66.5,72.5)分和68.9(63.9,71.6)分,Z=90.222,P=0.038]、近距离活动[90.5(85.8,94.0)分和88.8(84.5,92.5)分,Z=114.942,P=0.005]、依赖性[91.1(85.6,96.5)分和89.3(83.8,94.5)分,Z=91.934,P=0.033]、心理健康[80.0(73.4,84.9)分和77.5(70.8,82.0)分,Z=118.388,P=0.003]、社会角色限制[76.8(70.1,82.4)分和74.5(67.6,80.6)分,Z=90.791,P=0.036]和总分[88.3(84.2,91.0)分和86.9(82.8,90.1)分,Z=96.207,P=0.024]的分数均低于单眼DR者,差异有统计学意义。随着DR严重程度的增加,总体视力(χ^(2)=85.665)、近距离活动(χ^(2)=78.462)、远距离活动(χ^(2)=145.489)、社会功能(χ^(2)=53.629)、依赖性(χ^(2)=86.710)、心理健康(χ^(2)=68.281)、社会角色限制(χ^(2)=45.357)、色觉(χ^(2)=68.176)、周边视野(χ^(2)=116.179)、NEI-VFQ-25总分(χ^(2)=133.291)分数逐渐降低(均P<0.001)。局部加权回归曲线显示社会角色限�Objective To assess the effect of diabetic retinopathy(DR)on vision-related quality of life(VRQoL)in patients with type 2 diabetes.Methods In this cross-sectional study,patients with type 2 diabetes residing in 15 residency communities in Fushun,Liaoning province were enrolled from July 2012 to May 2013.We measured the VRQoL by the 25-item National Eye Institute Visual Function Questionnaire(NEI-VFQ-25).Patients were grouped according to their age,gender,presence of visual impairment,and affected eyes.NEI-VFQ-25 scores were compared between/among groups using the Wilcoxon rank-sum test or Kruskal-Wallis H test.The severity of DR in the eyes was graded into no DR,mild non-proliferative diabetic retinopathy(NPDR),moderate NPDR,severe NPDR,and proliferative diabetic retinopathy(PDR).Severity scores from both eyes were then summarized to create a single per-person grade ranging from 1(no DR in either eye)to 7(bilateral PDR).Generalized linear models were used to assess the linear relationship between NEI-VFQ-25 scores and DR severity.Locally weighted scatterplot smoothing plots were generated to evaluate the possible nonlinear associations between concatenated severity of DR and VRQoL.Results A total of 1537 patients were recruited,including 836(54.4%)with no DR,479(31.2%)with mild NPDR,90(5.9%)with moderate NPDR,72(4.7%)with severe NPDR and 60(3.9%)with PDR.Compared with patients with unilateral DR,bilaterally involved subjects were statistically significantly compromised in general vision[70.2(66.5,72.5)vs.68.9(63.9,71.6),Z=90.222,P=0.038],near activities[90.5(85.8,94.0)vs.88.8(84.5,92.5),Z=114.942,P=0.005],dependency[91.1(85.6,96.5)vs.89.3(83.8,94.5),Z=91.934,P=0.033],mental health[80.0(73.4,84.9)vs.77.5(70.8,82.0),Z=118.388,P=0.003],role difficulties[76.8(70.1,82.4)vs.74.5(67.6,80.6),Z=90.791,P=0.036]and NEI-VFQ-25 composite[88.3(84.2,91.0)vs.86.9(82.8,90.1),Z=96.207,P=0.024].Scores on general vision(χ^(2)=85.665),near activities(χ^(2)=78.462),distance activities(χ^(2)=145.489),social function(χ^(2)=53.629),d

关 键 词：糖尿病视网膜病变 视敏度 生活质量 心理测定学 调查和问卷 疾病严重程度指数 

分 类 号：R587.2[医药卫生—内分泌] R774.1[医药卫生—内科学]