2型糖尿病患者视网膜病变对视觉功能影响的研究  

Effects of retinopathy on visual function in type 2 diabetes mellitus

作　　者：张畑霖 胡宗莉 王惠群[1] 赵否曦 潘七英 詹清清 安芹彧 张福艳 刘涛[1,3] 胡远东[3] Zhang Tianlin;Hu Zongli;Wang Huiqun;Zhao Fouxi;Pan Qiying;Zhan Qingqing;An Qinyu;Zhang Fuyan;Liu Tao;Hu Yuandong(School of Public Health,the Key Laboratory of Environmental Pollution Monitoring and Disease Control,Ministry of Education,Guizhou Medical University,Guiyang 550025,China;Department of Ophthalmology,Army Specialty Medical Center of PLA,Chongqing 400042,China;Institute of Chronic Disease Prevention and Control,Guizhou Center for Disease Control and Prevention,Guiyang 550004,China;School of Medicine of Guizhou University,Guiyang 550025,China)

机构地区：[1]贵州医科大学公共卫生与健康学院,环境污染与疾病监控教育部重点实验室,贵阳550025 [2]中国人民解放军陆军特色医学中心眼科,重庆400042 [3]贵州省疾病预防控制中心,贵阳550004 [4]贵州大学医学院,贵阳550025

出　　处：《中华预防医学杂志》2024年第9期1331-1340,共10页Chinese Journal of Preventive Medicine

基　　金：基于医防融合的健康管理中心大数据平台研究与示范(黔科合支撑[2021]一般447);贵州省农村地区糖尿病视网膜病变人工智能筛查技术应用研究(黔科合支撑[2020]4Y135);贵州省卫生健康委省级重点建设学科项目。

摘　　要：目的研究糖尿病视网膜病变(diabetic retinopathy,DR)及其严重程度对2型糖尿病患者视觉功能的影响,为预防DR对2型糖尿病患者的视觉功能损害提供科学依据。方法本研究为横断面设计,于2022年2月至2023年9月在贵州省4个社区卫生服务中心招募已经确诊的2型糖尿病患者。使用中文版视觉功能指数量表(visual function index-14,VF-14)调查受试者的近视力、视觉适应、主观视觉及立体视觉等视觉功能状况,量表得分越高者视觉功能越差。将每只眼的受损程度分为无DR、轻度非增生期糖尿病性视网膜病变(non-proliferative diabetic retinopathy,NPDR)、中度NPDR、重度NPDR和增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR),并用5级DR综合等级判断受检者双眼DR的综合严重程度。采用线性回归模型分析DR与视觉功能指数的线性关系。局部加权回归评估DR综合等级与视觉功能各项得分之间可能存在的非线性关系,斜率变化越大表示该等级视觉功能越差。结果共调查542例2型糖尿病患者,其中男性244例(45.02%),女性298例(54.98%),DR患者162例(29.89%)。在调整混杂因素后,与无DR人群相比,双眼DR患者的总体得分(β=0.136,P=0.003)、近视力(β=0.163,P<0.001)、视觉适应(β=0.092,P=0.042)、主观视觉(β=0.120,P=0.009)以及立体视觉(β=0.094,P=0.044)等得分均高于无DR;但各项视觉功能在无DR和单眼DR间的差异无统计学意义。局部加权回归曲线显示,在DR综合等级中,近视力(斜率:23.78)与总体得分(斜率:58.37)在双眼轻度NPDR到中度NPDR急剧上升;视觉适应(斜率:5.37、7.72)、主观视觉(斜率:6.53、7.93)、立体视觉(斜率:0.74、0.91)在双眼轻度NPDR到中度NPDR和在双眼中度NPDR到双眼重度NPDR/PDR均为缓慢上升。结论双眼DR与视觉功能受损相关,但单眼DR与无DR的视觉功能没有差异,DR对视觉功能的早期损害主要表现在近视力方面,在DR的预防控制中应更Objective To study the influence of the severity of diabetic retinopathy(DR)on the visual function of patients with type 2 diabetes,to provide scientific basis for the early prevention and control of DR.Methods This study was designed as a cross-sectional study,recruiting already-diagnosed type 2 diabetes patients in four community health service centers in Guizhou Province between February and September 2022.Employing the Chinese version of the Visual Function Index-14(VF-14),assess the participants′near vision,visual adaptation,subjective visual perception,and stereo vision,with higher scores indicating poorer visual function.Categorize the severity of each eye′s damage into no diabetic retinopathy(DR),mild non-proliferative diabetic retinopathy(NPDR),moderate NPDR,severe NPDR,and proliferative diabetic retinopathy(PDR),and use a 5-level DR grading system to evaluate the overall severity of diabetic retinopathy in both eyes.Employing linear regression analysis to investigate the linear relationship between DR and visual function index.Local weighted regression evaluates the nonlinear relationship between the DR composite score and the scores of visual function,with a steeper slope indicating poorer visual function for that level.Results A total of 542 patients with type 2 diabetes were investigated,including 244(45.02%)males,298(54.98%)females,and 162(29.89%)patients with DR.After adjusting for confounders,compared with those without DR,patients with binocular DR Had overall scores(β=0.136,P=0.003),near vision(β=0.163,P<0.001),visual adaptation(β=0.092,P=0.042),subjective vision(β=0.120,P=0.009)and stereo vision(β=0.094,P=0.044)were higher than those without DR.There were no differences in visual functions between DR And monocular DR.The local weighted regression curve showed that near vision(slope:23.78)and overall score(slope:58.37)increased sharply from mild to moderate NPDR in both eyes.Visual adaptation(slope:5.37,7.72),subjective vision(slope:6.53,7.93),stereovision(slope:0.74,0.91)increased slow

关 键 词：2型糖尿病 视觉功能指数(VF-14) 糖尿病视网膜病变 病变程度 

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