Predicting development of proliferative diabetic retinopathy.
Predicting development of proliferative diabetic retinopathy.
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DOI：
10.2337/dc12-0790
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发表时间：
2013-06
期刊：
影响因子：
16.2
通讯作者：
Stein JD
中科院分区：
文献类型：
--
作者：
Harris Nwanyanwu K;Talwar N;Gardner TW;Wrobel JS;Herman WH;Stein JD
识别糖尿病视网膜病变进展风险最高的个体并及早干预可以限制视力丧失并降低与治疗更晚期疾病相关的成本。本研究的目的是确定与非增殖性糖尿病视网膜病变 (NPDR) 进展为增殖性糖尿病视网膜病变 (PDR) 相关的因素。这是一项回顾性队列分析，使用 2001 年至 2009 年间参加大型管理式护理网络的所有年龄≥30 岁的眼科护理接受者的理赔数据库。对新诊断的 NPDR 个体进行纵向随访。多变量 Cox 回归分析确定了与 PDR 进展相关的因素。确定了三年和五年视网膜病变进展的概率。在 4,617 名发生 NPDR 的参与者中，307 名 (6.6%) 发生了 PDR。调整混杂因素后，HbA1c 每增加 1 点，发生 PDR 的风险就会增加 14%（调整后的风险比 1.14 [95% CI 1.07–1.21]）。那些患有不愈合溃疡的人进展为 PDR 的风险增加了 54% (1.54 [1.15–2.07])，而患有肾病的参与者相对于没有这些情况的人来说，进展为 PDR 的风险略有显着增加 (1.29 [0.99–1.67])。 NPDR 低风险个体的 5 年进展概率为 5%（范围 2-8），高风险患者的 5 年进展概率为 38%（14-55）。除了血糖控制之外，糖尿病的非眼科表现（例如肾病和不愈合的溃疡）与糖尿病视网膜病变进展的风险增加相关。我们的视网膜病变进展风险评分可以帮助临床医生对最有疾病进展风险的患者进行分层。
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). 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. 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). 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.
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DOI：
10.1056/nejmoa1001288
发表时间：
2010-07-15
期刊：
The New England journal of medicine
影响因子：
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作者：
ACCORD Study Group;ACCORD Eye Study Group;Chew EY;Ambrosius WT;Davis MD;Danis RP;Gangaputra S;Greven CM;Hubbard L;Esser BA;Lovato JF;Perdue LH;Goff DC Jr;Cushman WC;Ginsberg HN;Elam MB;Genuth S;Gerstein HC;Schubart U;Fine LJ
通讯作者：
Fine LJ
影响因子：
13.7
作者：
Gordon, Mae O.
通讯作者：
Gordon, Mae O.
影响因子：
8.2
作者：
Aspelund, T.;Porisdottir, O.;Stefansson, E.
通讯作者：
Stefansson, E.
影响因子：
16.2
作者：
Mayfield, JA;Reiber, GE;Greene, T
通讯作者：
Greene, T
影响因子：
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作者：
Moss, SE;Klein, R;Wong, TY
通讯作者：
Wong, TY