首页|福建省龙岩市糖尿病视网膜病变流行病学特征及影响因素分析

福建省龙岩市糖尿病视网膜病变流行病学特征及影响因素分析

Prevalence and associated factors of diabetic retinopathy among diabetic residents in Longyan of Fujian Province

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目的 了解福建省龙岩市糖尿病居民中糖尿病视网膜病变(DR)的患病情况及其相关因素.方法 调查研究.2022年1月至2023年12月在福建省龙岩市7个县市区的112个镇街中纳入社区慢性病随访管理系统的糖尿病患者10 061例作为目标调查人群.对其进行问卷调查、常规全身检查及视力和免散瞳眼底数码照相检查.剔除身高、体重、血压、空腹血糖(FPG)、糖尿病病程均缺失者762例,不能窥清眼底者507例,最终纳入统计分析8 792例.DR诊断及分型参照2019年DR国际临床分级标准;单眼或双眼DR者均作为1例纳入DR患病率统计;双眼DR以程度较重眼进行DR分级.按有、无DR对受检者进行分组;以平均年龄67岁为界分为年龄≤67岁组、>67岁组进行统计分析.采用x2检验统计分析与患病相关的影响因素;通过二分类多因素logistic回归分析,筛选DR的影响因素.结果 8 792例受检者中,检出DR 888例(10.1%,888/8 792)(DR组);无DR 7 904例(89.0%,7 904/8 792)(无DR组).与无DR组比较,DR组患者FPG(Z=-12.448)、糖尿病病程(Z=-18.936)、收缩压(Z=-4.237)、舒张压(Z=-2.881)、体重指数(BMI)≥24 kg/m2者均升高,差异有统计学意义(P<0.001);两组高血压(x2=11.450)、高血脂(x2=5.100)、肾脏疾病(x2=7.039)、糖尿病家族史(x2=5.0.25)以及是否规律用药(x2=66.034)比较,差异均有统计学意义(P<0.05).年龄≤67岁组、>67岁组分别为4 688、4 104例.年龄≤67岁组中,不同FPG水平(x2=111.754)、糖尿病病程(x2=231.658)、BMI(x2=12.404)、收缩压(x2=17.912)、是否规律用药(x2=40.727)以及有无高血脂病史(x2=6.816)、高血压病史(x2=6.775)者DR患病率比较,差异均有统计学意义(P<0.05);年龄>67岁组中,不同FPG水平(x2=59.916)、糖尿病病程(x2=128.362)、收缩压(x2=5.183)、是否规律用药(x2=22.097)以及有无肾脏疾病(x2=6.251)、糖尿病家族史(x2=4.967)者DR患病率比较,差异均有统计学意义(P<0.05).不同性别、不同文化程度、有无吸烟史、有无饮酒史、有无运动习惯、有无心脏病史、有无其他疾病家族史的糖尿病患者间DR患病率差异无统计学意义(P>0.05).Logistics回归分析结果显示,年龄>67岁者,FPG[比值比(OR)=1.074,95%可信区间(CI)1.046~1.102]、糖尿病病程(OR=1.088,95%CI 1.071~1.106)、收缩压(OR=1.007,95%CI 1.001~1.013)、肾脏疾病(OR=3.617,95%CI1.268~10.320)为DR发生的危险因素(P<0.05);年龄≤67岁者,FPG(OR=1.088,95%CI1.067~1.110)、糖尿病病程(OR=1.108,95%CI 1.091~1.125)、收缩压(OR=1.008,95%CI 1.003~1.013)是DR发生的独立危险因素(P<0.05),BMI≥24 kg/m2(OR=0.934,95%CI0.908~0.965)是DR的保护因素(P<0.05).年龄、是否规律用药、高血压、高血脂均为DR发生的可疑混杂因素.结论 福建省龙岩地区糖尿病患者DR患病率为10.1%;FPG、糖尿病病程、收缩压为DR发生的独立危险因素,年龄、是否规律用药、高血压、高血脂为DR发生的可疑混杂因素.
Objective To investigate the prevalence and associated factors of diabetic retinopathy(DR)among diabetic residents in Longyan of Fujian Province.Methods A investigative research.From January 2022 to December 2023,a total of 10 061 diabetic patients enrolled in the chronic disease follow-up management system from 112 towns and sub-districts in 7 counties and districts of Longyan of Fujian Province were selected as the target population.A questionnaire survey,routine physical examination,vision test,and non-mydriatic fundus photography were conducted.A total of 762 cases with missing height,weight,blood pressure,fasting plasma glucose(FPG),and diabetes duration,and 507 cases with unclear fundus photography were excluded,resulting in 8 792 cases included in the final statistical analysis.DR diagnosis and classification were based on the 2019 International Clinical Classification of DR.The prevalence of DR was calculated for single-eye or double-eye DR cases as 1 case;the more severe eye was used for DR grading in double-eye DR cases.Statistical analysis was performed by grouping based on the presence or absence of DR and dividing into age groups ≤67 years and>67 years.x2 test was used to analyze factors associated with prevalence;binary multivariate logistic regression analysis was employed to identify influencing factors of DR.Results Among the 8 792 cases,888(10.1%,888/8 792)were diagnosed with DR(DR group),and 7 904(89.9%,7 904/8 792)had no DR(non-DR group).Compared to the non-DR group,the DR group showed significant increases in FPG(Z=-12.448),diabetes duration(Z=-18.936),systolic blood pressure(Z=-4.237),diastolic blood pressure(Z=-2.881),and body mass index(BMI)≥24 kg/m2(P<0.001).Significant differences were also found between the two groups in hypertension(x2=11.450),hyperlipidemia(x2=5.100),kidney disease(x2=7.039),family history of diabetes(x2=5.025),and regular medication use(x2=66.034)(P<0.05).There were 4 688 cases in the ≤67 years group and 4 104 in the>67 years group.In the ≤67 years group,significant differences in DR prevalence were found for FPG levels(x2=1 11.754),diabetes duration(x2=231.658),BMI(x2=12.404),systolic blood pressure(x2=17.912),regular medication use(x2=40.727),hyperlipidemia(x2=6.816),and hypertension history(x2=6.775)(P<0.05).In the>67 years group,significant differences in DR prevalence were found for FPG levels(x2=59.916),diabetes duration(x2=128.362),systolic blood pressure(x2=5.183),regular medication use(x2=22.097),kidney disease(x2=6.251),and family history of diabetes duration(x2=4.967)(P<0.05).No significant differences in DR prevalence were found based on sex,education level,smoking history,alcohol consumption,exercise habits,heart disease history,or other family disease history(P>0.05).Logistics regression analysis results show that patients aged>67 years,FPG[odds ratio(OR)=1.074,95%confidence interval(CI)1.046-1.102],diabetes duration(OR=1.088,95%CI 1.071-1.106),systolic blood pressure(OR=1.007,95%CI 1.001-1.013),and kidney disease(OR=3.617,95%CI 1.268-10.320)were identified as risk factors for DR(P<0.05).In patients aged ≤67 years,FPG(OR=1.088,95%CI 1.067-1.110),diabetes duration(OR=1.108,95%CI 1.091-1.125),and systolic blood pressure(OR=1.008,95%CI 1.003-1.013)were identified as independent risk factors for DR(P<0.05),while BMI ≥24 kg/m2(OR=0.934,95%CI 0.908-0.965)was a protective factor for DR(P<0.05).Age,regular medication use,hypertension,and hyperlipidemia were identified as potential confounding factors for DR occurrence.Conclusions The prevalence of DR among diabetes patients in Longyan of Fujian Province,is 10.1%.FPG,diabete duration,and systolic blood pressure are independent risk factors for DR,while age,regular medication use,hypertension,and hyperlipidemia are potential confounding factors for DR occurrence.

DiabetesDiabetic retinopathyQuestionnaire surveyInfluencing factors

麻少卿、吴建宁、曹德华、陈燕、邱品生

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福建省龙岩市第二医院眼耳鼻喉科,龙岩 364000

福建省龙岩市新罗区疾病预防控制中心,龙岩 364000

糖尿病 糖尿病视网膜病变 问卷调查 影响因素

龙岩市科技创新联合资金卫生项目

2022LYF17054

2024

中华眼底病杂志
中华医学会

中华眼底病杂志

CSTPCD北大核心
影响因子:0.928
ISSN:1005-1015
年,卷(期):2024.40(8)
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