Diabetes Care;肾病增高糖尿病视网膜病变风险

　　非增生性糖尿病视网膜病和视网膜出血 

　　增生性糖尿病视网膜病和新血管 

　　2012年12月28日在线发表于《糖尿病护理》的一项研究表明，血糖控制、眼部以外并发症（肾病、未愈合溃疡）与糖尿病视网膜病变风险增高相关。视网膜病变进展风险评分可帮助临床医生对糖尿病眼底病变高风险患者进行分层。

　　该研究为一项回顾性队列研究，旨在对非增生性视网膜病变（NPDR）进展为增生性视网膜病变（PDR）的相关危险因素进行鉴别。

　　研究者在2001-2009年纳入到大型医疗管理网络、年龄≥30岁的眼部疾病患者中选取索赔数据库中的资料，对新诊断NPDR患者进行纵向随访。采用多变量回归分析鉴别NPDR进展为PDR的危险因素，确定3年与5年视网膜病变进展概率。

　　研究共纳入4617名入NPDR患者，其中307例（6.6%）患者进展为PDR。经混杂校正，HbA1c每升高一个百分点，进展为PDR的风险上升14%(经校正危害比1.14 [95%可信区间1.07–1.21])。存在未愈合溃疡的患者进展为PDR的风险增加了54%，合并肾病的患者进展为PDR的风险显著增加。低危患者5年预估NPDR进展发生率为5%，高危患者则为38%。

　　研究者提示，在糖尿病患者中鉴别那些进展为糖尿病视网膜病变的高危患者，并通过早期干预措施，可将其视力损失降低到最低。

　　非增生性糖尿病视网膜病 (non-proliferative diabetic retinopathy)：特征为血管膨胀、微动脉瘤（血管变弱）、视网膜出血，以及视网膜浮肿。增生性糖尿病视网膜病 (proliferative diabetic retinopathy) ：特征为新血管形成。  

与视网膜病变相关的拓展阅读：

• Neurology：视网膜病变或可揭示多发性硬化进展
• JDC:糖尿病视网膜病变为显性肾病显著危险因素
• Diabetes Care：T2DM视网膜病变筛查或可2年一次
• Diabetes Care：终末糖基化产物（AGE）水平升高与视网膜病变进展相关
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Predicting Development of Proliferative Diabetic Retinopathy

OBJECTIVE 

Identifying individuals most at risk for diabetic retinopathy progression and intervening early can limit vision loss and reduce the costs associated with managing more advanced disease. The purpose of this study was to identify factors associated with progression from nonproliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR).

RESEARCH DESIGN AND METHODS 

This was a retrospective cohort analysis using a claims database of all eye care recipients age ≥30 years enrolled in a large managed-care network from 2001 to 2009. Individuals with newly diagnosed NPDR were followed longitudinally. Multivariable Cox regression analyses identified factors associated with progression to PDR. Three- and five-year probabilities of retinopathy progression were determined.

RESULTS 

Among the 4,617 enrollees with incident NPDR, 307 (6.6%) developed PDR. After adjustment for confounders, every 1-point increase in HbA1c was associated with a 14% (adjusted hazard ratio 1.14 [95% CI 1.07–1.21]) increased hazard of developing PDR. Those with nonhealing ulcers had a 54% (1.54 [1.15–2.07]) increased hazard of progressing to PDR, and enrollees with nephropathy had a marginally significant increased hazard of progressing to PDR (1.29 [0.99–1.67]) relative to those without these conditions. The 5-year probability of progression for low-risk individuals with NPDR was 5% (range 2–8) and for high-risk patients was 38% (14–55).

CONCLUSIONS 

Along with glycemic control, nonophthalmologic manifestations of diabetes mellitus (e.g., nephropathy and nonhealing ulcers) are associated with an increased risk of diabetic retinopathy progression. Our retinopathy progression risk score can help clinicians stratify patients who are most at risk for disease progression.