非增生性糖尿病視網(wǎng)膜病和視網(wǎng)膜出血

　增生性糖尿病視網(wǎng)膜病和新血管

　　2012年12月28日在線發(fā)表于《糖尿病護(hù)理》的一項研究表明，血糖控制、眼部以外并發(fā)癥（腎病、未愈合潰瘍）與糖尿病視網(wǎng)膜病變風(fēng)險增高相關(guān)。視網(wǎng)膜病變進(jìn)展風(fēng)險評分可幫助臨床醫(yī)生對糖尿病眼底病變高風(fēng)險患者進(jìn)行分層。

　　該研究為一項回顧性隊列研究，旨在對非增生性視網(wǎng)膜病變（NPDR）進(jìn)展為增生性視網(wǎng)膜病變（PDR）的相關(guān)危險因素進(jìn)行鑒別。

　　研究者在2001-2009年納入到大型醫(yī)療管理網(wǎng)絡(luò)、年齡≥30歲的眼部疾病患者中選取索賠數(shù)據(jù)庫中的資料，對新診斷NPDR患者進(jìn)行縱向隨訪。采用多變量回歸分析鑒別NPDR進(jìn)展為PDR的危險因素，確定3年與5年視網(wǎng)膜病變進(jìn)展概率。

　　研究共納入4617名入NPDR患者，其中307例（6.6%）患者進(jìn)展為PDR。經(jīng)混雜校正，HbA1c每升高一個百分點，進(jìn)展為PDR的風(fēng)險上升14%(經(jīng)校正危害比1.14 [95%可信區(qū)間1.07–1.21])。存在未愈合潰瘍的患者進(jìn)展為PDR的風(fēng)險增加了54%，合并腎病的患者進(jìn)展為PDR的風(fēng)險顯著增加。低危患者5年預(yù)估NPDR進(jìn)展發(fā)生率為5%，高?；颊邉t為38%。

　　研究者提示，在糖尿病患者中鑒別那些進(jìn)展為糖尿病視網(wǎng)膜病變的高危患者，并通過早期干預(yù)措施，可將其視力損失降低到最低。

　　非增生性糖尿病視網(wǎng)膜病 (non-proliferative diabetic retinopathy)：特征為血管膨脹、微動脈瘤（血管變?nèi)酰?、視網(wǎng)膜出血，以及視網(wǎng)膜浮腫。增生性糖尿病視網(wǎng)膜病 (proliferative diabetic retinopathy) ：特征為新血管形成。

　　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.