【作者】 刘巨平；

【导师】 李筱荣；

【作者基本信息】 天津医科大学 ， 眼科学， 2006， 硕士

【摘要】 近年来随着人民生活水平的快速提高,糖尿病的发病率也在不断上升。糖尿病视网膜病变(Diabetic Retinopathy,DR)是糖尿病患者的常见并发症,也是四大致盲性眼病之一,其发病率和致盲率也呈逐年升高的趋势。目前,糖尿病视网膜病变尚无有效的治疗方法,早期诊断并积极治疗以防止或延缓其进展至关重要,可以为绝大多数患者保存有用的视力。美国1992年流行病学调查显示糖尿病视网膜病变的患病率为25%,同期北京301医院一项调查则为18.96%。糖尿病视网膜病变的流行病学调查可以提供患病率、地区差异和种族差异等流行病学数据,同时可以确定糖尿病视网膜病变的流行病学相关危险因素,为防盲治盲工作提供支持和依据。我国糖尿病视网膜病变的流行病学调查资料已显陈旧,大多数集中于90年代且多以糖尿病住院患者为调查对象,缺乏新近的以人群为基础的糖尿病视网膜病变的流行病学调查。 本文目的在于调查天津市六城区15岁以上2型糖尿病患者的DR患病率,并通过社区筛检和问卷调查,获取相关信息,运用统计学分析探讨糖尿病视网膜病变的相关危险因素。 调查对象为天津市河北区、南开区、红桥区、汉沽区、津南区和武清区的常住居民21600人,经社区初步筛检对空腹血糖大于5.6mmol/L的居民做进一步确诊和眼部检查。在正式试验前,于2005年5月进行了1周的预试验,参考大量文献制定了统一的诊断标准和问卷调查表,并进行了工作人员的培训。糖尿病调查严格遵循WHO制定的方案和诊断标准,糖尿病视网膜病变的诊断标准采用国际临床糖尿病性视网膜病变严重程度分级标准,分为非增殖期和增殖期。 现场工作于2005年6～7月开展,每一位受检者接受如下检查:社区现场更多还原

【Abstract】 With the rapid development of living level in recent years, the prevalence of diabetes is increasing. Diabetic retinopathy (DR) is the most common cause of visual impairment and blindness in diabetics. The incidence of DR has an increasing trend recently. Early detection and treatment of DR can effectively prevent or delay vision loss in diabetics. Because high-risk patients may be asymptomatic, screening for diabetic retinopathy is recommended as an essential part of the management of diabetes. The prevalence of DR differs from regions or countries among the world. The collected screening data shows invalid in China, so a new screening is needed mostly.This survey intends to detect the prevalence of type 2 diabetes aged over 15 years old in six districts of Tian Jin. Collecting related information, we will confirmed the risk factors causing onset or development of diabetic retinopathy.21600 subjects were all residents of six districts in Tian Jin. Subjects with FPG >5.6mmol /L were recruited to further confirm and ocular examination. The survey was preceded by a pilot study to train medical practitioners, unify the procedures and diagnostic criteria for one week in May 2005. The identification for type 2 diabetes was based on the WHO definition in 1985. The diagnostic criteria for DR is the edition of Proposed International Clinical Diabetic Retinopathy Disease Severity Scale.The survey was conducted from June to July, 2005. The screening procedure as following: subjects with FPG>5.6mmol /L went to metabolic disease hospital toperform biochemical tests and ECQ and then to eye centre for ocular examination. The ocular examination included best corrected visual acuity, slit-lamp biomicroscopy, non-contact tonometry and also detailed flindus examination by both indirect ophthalmoscopy and contactlens biomicroscopy (with pupils dilated) conducted by a retinal specialist.A questionnaire was administered to patients after screening for retinopathy. The questionnaire contained demographic status, history of ocular diseases, history of administration, history of ocular trauma and surgery, awareness of DM and DR and so on.Of thel 107 subjects who responded to the survey, 650 had diabetes mellitus and 106 patients with DR. The overall prevalence of DR was 16.3%: 15.3% for males and 17.1% for females. Only 4(0.62%) patients presented with proliferative diabetic retinopathy.Using univariate analyses, our study demonstrated that no statistically significant association was observed between DR and sex, age, high dense lipoprotein, low dense lipoprotein, very low dense lipoprotein, serum cholesterol, triglycerides, FIB, proteinuria, changes of ECG and high myopia (x2=0.374, P=0.541;jf^l.063, P=0.9;t=1.85, 1.82, 0.28, 1.65, 0.98, 0.52> 1.59, P=0.065, 0.069, 0.783, 0.1, 0.327, 0.604, 0.115;^=0.269, P=0.604;x2=0.034, P=0.854). The prevalence of DR tended, however, to be high(9.2%) at diabetics lived in countryside (x2=4.464, P=0.035). The same tendency was found for long duration of diabetes and the 2 h postprandial levels: the prevalence of DR was 40% among patients with duration of diabetes over 10 years (.’￡=6539, P=0.000;t=3.34, P=0.001) . Mutivariate analyses revealed that duration of diabetes, intraocular surgeries and education degree were independent of risk factors (OR=0.989, 95%CI: 0.986-0.993, P=0.002;OR= 1.886, 95%CI: 1.143-3.113, P= 0.013;OR=1.167, 95%CI: 1.102-1.236, P=0.000) .In addition to screening for retinopathy, we obtained the awareness of DM and DR by the questionnaire. These items included the awareness of DM and DR, the ways of getting, intervals of visiting internist and ophthalmologist and so on. The results revealed that the awareness was poor and be treated lately.更多还原