Relationship of hyperglycemia to the long-term incidence and progression of diabetic retinopathy.
Relationship of hyperglycemia to the long-term incidence and progression of diabetic retinopathy.
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DOI：
10.1001/archinte.1994.00420190068008
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发表时间：
1994-10
影响因子：
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通讯作者：
R. Klein;B. Klein;S. Moss;K. Cruickshanks
中科院分区：
文献类型：
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作者：
R. Klein;B. Klein;S. Moss;K. Cruickshanks
背景 目的是检查 10 年内高血糖（通过糖化血红蛋白水平测量）与糖尿病视网膜病变的发病率和进展之间的关系。方法 糖尿病发病时年龄小于 30 岁（n = 682）和年龄大于 30 岁（n = 834）的患者参加了基于人群的队列研究的基线（1980-1982）和随访（1984-1986 和 1990-1992）检查。通过微柱测量糖化血红蛋白水平。通过立体眼底照片确定视网膜病变。结果 基线时糖化血红蛋白水平处于最高四分位数的人比糖化血红蛋白水平处于最低四分位数的人更有可能出现视网膜病变进展（年轻发病组：相对风险 [RR]，2.9；95% 置信区间 [CI]，2.3 至 3.5；服用胰岛素的老年发病组：RR，2.1；95% CI，1.6 至 2.8；以及未服用胰岛素的老年发病组：RR，4.3；95% CI，3.0 至 6.2）并且更有可能发生增殖性糖尿病视网膜病变（年轻发病组：RR，7.1；95% CI，4.6 至 11.1；服用胰岛素的老年发病组：RR，3.1；95% CI，1.5 至 6.1；老年发病组未服用胰岛素组：RR，13.8；95% CI，4.8 至 39.5）。即使在控制其他风险变量后，这些关系在所有检查组中均显着 (P < .005)。结论 这些数据与这样的假设相一致，即通过糖化血红蛋白水平测量的高血糖的长期控制是糖尿病视网膜病变长期进展的一个重要危险因素，并且较低水平的糖化血红蛋白，甚至在糖尿病病程后期，可能会改变年轻和老年糖尿病患者在病程早期较高水平所带来的风险。
BACKGROUND The object was to examine the relationship of hyperglycemia, as measured by glycosylated hemoglobin level, to the incidence and progression of diabetic retinopathy over a 10-year period. METHODS Patients who were younger (n = 682) and older (n = 834) than 30 years at onset of diabetes participated in baseline (1980-1982) and follow-up (1984-1986 and 1990-1992) examinations of a population-based cohort study. Glycosylated hemoglobin levels were measured by microcolumn. Retinopathy was determined from stereoscopic fundus photographs. RESULTS Persons with glycosylated hemoglobin levels in the highest quartile at baseline were more likely to have progression of retinopathy than persons with levels in the lowest quartile (younger-onset group: relative risk [RR], 2.9; 95% confidence interval [CI], 2.3 to 3.5; older-onset group taking insulin: RR, 2.1; 95% CI, 1.6 to 2.8; and older-onset group not taking insulin: RR, 4.3; 95% CI, 3.0 to 6.2) and were more likely to develop proliferative diabetic retinopathy (younger-onset group: RR, 7.1; 95% CI, 4.6 to 11.1; older-onset group taking insulin: RR, 3.1; 95% CI, 1.5 to 6.1; and older-onset group not taking insulin: RR, 13.8; 95% CI, 4.8 to 39.5). These relations were significant (P < .005) in all groups examined, even after controlling for other risk variables. CONCLUSIONS These data are compatible with the hypothesis that long-term control of hyperglycemia, as measured by glycosylated hemoglobin levels, is a significant risk factor for the long-term progression of diabetic retinopathy and that lower levels of glycosylated hemoglobin, even later in the course of diabetes, may modify the risk imposed by higher levels earlier in the course of disease in people with both younger- and older-onset diabetes.