The Wisconsin epidemiologic study of diabetic retinopathy: XVII - The 14-year incidence and progression of diabetic retinopathy and associated risk factors in type 1 diabetes
The Wisconsin epidemiologic study of diabetic retinopathy: XVII - The 14-year incidence and progression of diabetic retinopathy and associated risk factors in type 1 diabetes
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DOI：
10.1016/s0161-6420(98)91020-x
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发表时间：
1998-10-01
期刊：
影响因子：
13.7
通讯作者：
Cruickshanks, KJ
中科院分区：
文献类型：
--
作者：
Klein, R;Klein, BEK;Cruickshanks, KJ
目的：探讨糖尿病视网膜病变及黄斑水肿14年的发病率、进展及其与各种危险因素的关系。设计：基于人群的发病率研究。环境：该研究在威斯康星州南部的一个二县地区进行。参与者：634名30岁前诊断为糖尿病的胰岛素服用者参加了基线、4年、10年和14年的随访检查。主要观察指标：采用改进的Airlie House分类和早期治疗糖尿病视网膜病变研究视网膜病变严重程度方案，通过对立体彩色眼底照片进行模糊分级，检测视网膜病变14年的进展情况、向增散性视网膜病变的进展情况和黄斑水肿的发生率。结果：14年视网膜病变进展率为86%，视网膜病变消退率为17%，进展为增殖性视网膜病变为37%，黄斑水肿发生率为26%，视网膜病变较轻，男性，基线时糖化血红蛋白或舒张压较高，糖化血红蛋白水平升高，从基线到4年随访时舒张压水平升高，视网膜病变进展的可能性更大。增殖性视网膜病变或黄斑水肿发生率的增加与更严重的基线视网膜病变、基线时更高的糖化血红蛋白以及基线和4年随访检查期间糖化血红蛋白的增加相关。增生性视网膜病变的风险增加与基线时高血压的存在有关，而黄斑水肿发展的风险增加与基线时总蛋白尿的存在有关。基线时较低的糖化血红蛋白与视网膜病变的改善有关。结论：这些数据表明，14年视网膜病变的进展率和黄斑水肿的发生率相对较高。这些数据还表明，降低高血糖和高血压可能有利于减少增殖性视网膜病变的进展。
Objective: To examine the 14-year incidence and progression of diabetic retinopathy and macular edema and its relation to various risk factors.Design: Population-based incidence study.Setting: The study was conducted in an Ii-county area in southern Wisconsin.Participants: Six hundred thirty-four insulin-taking persons with diabetes diagnosed before age 30 years participated in baseline, 4-year, 10-year, and 14-year follow-up examinations.Main Outcome Measures: The 14-year progression of retinopathy, progression to proliferative retinopathy, and incidence of macular edema were detected by masked grading of stereoscopic color fundus photographs using the modified Airlie House classification and the Early Treatment Diabetic Retinopathy Study retinopathy severity scheme.Results: The 14-year rate of progression of retinopathy was 86%, regression of retinopathy was 17%, progression to proliferative retinopathy was 37%, and incidence of macular edema was 26%, Progression of retinopathy was more likely with less severe retinopathy, being male, having higher glycosylated hemoglobin or diastolic blood pressure at baseline, an increase in the glycosylated hemoglobin level, and an increase in diastolic blood pressure level from the baseline to the 4-year follow-up. Increased risk of proliferative retinopathy or incidence of macular edema was associated with more severe baseline retinopathy, higher glycosylated hemoglobin at baseline, and an increase in the glycosylated hemoglobin between the baseline and 4-year follow-up examination. The increased risk of proliferative retinopathy was associated with the presence of hypertension at baseline, whereas the increased risk of a participant having macular edema develop was associated with the presence of gross proteinuria at baseline. Lower glycosylated hemoglobin at baseline was associated with improvement in retinopathy,Conclusions: These data suggest relatively high 14-year rates of progression of retinopathy and incidence of macular edema. These data also suggest that a reduction of hyperglycemia and hypertension may result in a beneficial decrease in the progression to proliferative retinopathy.