柳州市糖尿病患者视网膜病变的患病率调查及其影响因素

刘金纪; 王欢; 龙陟罡; 阳桥生; 莫雄钧; 黄丽; 韦所苏; 陈秋菊

doi:10.16462/j.cnki.zhjbkz.2021.06.010

柳州市糖尿病患者视网膜病变的患病率调查及其影响因素

doi: 10.16462/j.cnki.zhjbkz.2021.06.010

1.
545001 柳州，柳州市红十字会医院眼科
2.
530000 南宁，广西壮族自治区人民医院预防保健科

基金项目:

2019年广西医药卫生自筹经费计划课题 Z20190697

2020年广西医药卫生自筹经费计划课题 Z20201302

详细信息

通讯作者:
韦所苏，E-mail: 40222503@qq.com

陈秋菊，E-mail：375383754@qq.com

中图分类号: R181.22
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- 被引次数: 0
出版历程
- 收稿日期: 2021-02-23
- 修回日期: 2021-04-27
- 刊出日期: 2021-06-10

Prevalence and related factors of diabetic retinopathy in Liuzhou

1.
Department of Ophthalmology, Liuzhou Red Cross Hospital, Liuzhou 545001, China
2.
Prevention and Health Care Department, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530000, China

Funds:

2019 Guangxi Medical and Health Self-financing Plan Project Z20190697

2020 Guangxi Medical and Health Self-financing Plan Project Z20201302

More Information

Corresponding author: WEI Suo-su, E-mail: 40222503@qq.com; CHEN Qiu-ju, E-mail: 375383754@qq.com

摘要

摘要: 目的了解广西壮族自治区柳州市糖尿病(diabetes mellitus, DM)患者糖尿病视网膜病变(diabetic retinopathy, DR)的患病率及其影响因素。方法采用整群抽样的方法抽取柳州市辖区内的12个社区卫生服务中心、乡镇卫生院中确诊为DM的患者作为研究对象，对研究对象进行问卷调查、常规体检、实验室检测及眼底检查。采用非条件二分类Logistic逐步回归分析模型分析影响DM患者发生DR的危险因素。结果共调查DM患者3 017例，其中有898例患者诊断为DR，占比29.8%，其中736例为轻度非增生型DR、103例为中度非增生型DR、23例为重度非增生型DR、36例为增生型DR，占比分别为82.0%、11.5%、2.5%和4.0%。二分类非条件Logistic逐步回归分析模型分析结果显示，年龄较小(OR=0.628, 95% CI: 0.531~0.744)、有全身疾病史(OR=0.812, 95% CI: 0.684~0.963)是DR的保护因素；有眼部手术史(OR=2.096, 95% CI: 1.632~2.693)、FPG较高(OR=1.103, 95% CI: 1.071~1.135)、尿白蛋白较高(OR=1.001, 95% CI: 1.000~1.001)、SBP较高(OR=1.011, 95% CI: 1.006~1.016)、心率较快(OR=1.009, 95% CI: 1.001~1.017)、职业为农民和自由职业(OR=1.207, 95% CI: 1.002~1.453)是DR的独立危险因素。结论广西壮族自治区柳州市DM患者DR患病率处于中等水平，主要以轻度非增生型DR为主。年龄、全身疾病史、眼部手术史、尿白蛋白、FPG、血压、心率、职业是DM患者发生DR的影响因素。应对DM患者加强DR的宣传教育以及筛查力度。
- 糖尿病视网膜病变 /
- 患病率 /
- 影响因素
Abstract: Objective To estimate the prevalence and related factors of diabetic retinopathy(DR) in patients with diabetes mellitus (DM) in Liuzhou, Guangxi Zhuang Autonomous Region. Methods A stratified cluster random sampling method was used to select patients who diagnosed with DM from 12 community health service centers and township health centers in Liuzhou as the research objects. Questionnaire survey, physical examination, laboratory tests and fundus examination were performed to them. Unconditional two classification Logistic stepwise regression analysis model was used to analyze the relationship between DR and various factors. Results A total of 3 017 DM were included, and 898 of them presented with DR at a morbidity rate of 29.8%. Among DR patients, the number of mild, moderate, severe non-proliferative DR patients and proliferative DR patients were 736(82.0%), 103(11.5%), 23(2.5%) and 36(4.0%), respectively. The unconditional two classification Logistic stepwise regression analysis demonstrated, the younger people (OR=0.628, 95% CI: 0.531-0.744), history of systemic disease (OR=0.812, 95% CI: 0.684-0.963) were protective factors for DR. The history of eye surgery (OR=2.096, 95% CI: 1.632-2.693), higher fasting glucose (OR=1.103, 95% CI: 1.071-1.135), higher urinary albumin (OR=1.001, 95% CI: 1.000-1.001), higher systolic pressure (OR=1.011, 95% CI: 1.006-1.016), faster heart rate (OR=1.009, 95% CI: 1.001-1.017), farmer and freelance occupation (OR=1.207, 95% CI: 1.002-1.453) were the independent risk factors for DR occurrence. Conclusions The prevalence of DR is medium in the DM patients in Liuzhou, Guangxi Zhuang Autonomous Region, mainly with mild non-proliferative DR patients. Ages, history of systemic disease, eye surgery, urinary albumin, fasting glucose, blood pressure, heart rate and occupation are the independent risk factors for DR occurrence.The publicity and education of DR and disease screening for DM patients should be strengthened.
- Diabetic retinopathy /
- Prevalence /
- Related factors

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表 1 糖尿病视网膜病变有无的影响因素比较[n(%)]

Table 1. Comparison of Influencing factors with or without diabetic retinopathy [n(%)]

变量	有糖尿病视网膜病变(n=898)	无糖尿病视网膜病变(n=2 119)	χ²/t′/t/Z值	P值
性别			0.994	0.319
男	382(30.8)	860(69.2)
女	516(29.1)	1 259(70.9)
居住地			2.459	0.117
城市	708(29.1)	1 723(70.9)
农村	190(32.4)	396(67.6)
职业			14.593	＜0.001
农民	147(33.3)	295(66.7)
企事业单位工作人员	54(32.0)	115(68.0)
退休	574(27.7)	1 496(72.3)
自由职业者	123(36.6)	213(63.4)
文化程度			12.614	0.006
小学及以下	219(28.9)	540(71.1)
初中	352(32.4)	736(67.6)
高中或中专	271(29.8)	637(70.2)
大学及以上	56(21.4)	206(78.6)
糖尿病家族史			4.285	0.038
有	234(32.9)	478(67.1)
无	664(28.8)	1 641(71.2)
医保类型			29.395	＜0.001
新农合	165(32.9)	336(67.1)
居民医保	118(42.4)	160(57.6)
职工医保	587(27.5)	1 551(72.5)
无	28(28.0)	72(72.0)
糖尿病类型			0.525	0.469
Ⅰ型	5(22.7)	17(77.3)
Ⅱ型	893(29.8)	2 102(70.2)
眼部手术史			26.269	＜0.001
有	131(42.4)	178(57.6)
无	767(28.3)	1 941(71.7)
吸烟史			6.741	0.009
有	115(36.1)	204(63.9)
无	783(29.0)	1 915(71.0)
饮酒史			0.575	0.448
有	106(31.5)	230(68.5)
无	792(29.5)	1 889(70.5)
全身疾病史			9.792	0.002
有	496(27.6)	1 300(72.4)
无	402(32.9)	819(67.1)
其他眼部疾病史			0.558	0.455
有	247(30.8)	555(69.2)
无	651(29.4)	1 564(70.6)
中心性肥胖			1.620	0.203
是	241(31.6)	522(68.4)
否	657(29.1)	1 597(70.9)
年龄(x±s, 岁)	63.43±9.19	65.66±9.70	-5.859	＜0.001
BMI(x±s, kg/m²)	18.95±5.13	18.95±5.12	-0.015	0.988
糖尿病病程[M(P₂₅, P₇₅), 年]	9.00(5.00, 15.00)	6.00(3.00, 10.00)	-8.571	＜0.001
FPG(x±s, mmol/L)	8.12±3.27	7.22±2.41	7.396	＜0.001
糖化血红蛋白[M(P₂₅, P₇₅), %]	6.81(6.30, 8.00)	6.40(5.80, 7.40)	-8.955	＜0.001
尿素氮[M(P₂₅, P₇₅), mmol/L]	5.20(4.40, 6.30)	5.10(4.30, 5.90)	-3.106	0.002
肌酐(x±s, μmol/L)	83.18±47.74	79.80±46.79	1.789	0.074
尿白蛋白[M(P₂₅, P₇₅), μg/min]	16.55(13.25, 28.70)	16.55(11.00, 21.00)	-4.603	＜0.00
胆固醇[M(P₂₅, P₇₅), mmol/L]	5.16(4.35, 5.98)	5.13(4.36, 5.84)	-1.209	0.227
TG[M(P₂₅, P₇₅), mmol/L]	1.56(1.11, 2.20)	1.61(1.14, 2.39)	-1.610	0.107
HDL[M(P₂₅, P₇₅), mmol/L]	2.90(2.23, 3.56)	2.90(2.24, 3.58)	-1.058	0.290
LDL(x±s, mmol/L)	2.96±1.04	2.95±1.09	0.217	0.828
SBP(x±s, mm Hg)	139.54±17.36	136.97±16.05	3.799	＜0.001
DBP(x±s, mm Hg)	79.91±10.79	80.32±26.88	-0.447	0.655
心率(x±s, 次/min)	82.38±10.69	80.97±10.34	3.398	0.001
注：1 mm Hg=0.133 kPa。

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表 2 糖尿病视网膜病变影响因素的多因素分析

Table 2. Multivariate analysis of the influencing factors of diabetic retinopathy

变量	β值	s_x值	Wald χ²值	OR(95% CI)值	P值
年龄	-0.465	0.087	28.800	0.628(0.531~0.744)	＜0.001
眼部手术史	0.740	0.128	33.510	2.096(1.632~2.693)	＜0.001
全身疾病史	-0.209	0.088	5.689	0.812(0.684~0.963)	0.017
FPG	0.098	0.015	44.180	1.103(1.071~1.135)	＜0.001
尿白蛋白	0.001	0.000	15.119	1.001(1.000~1.001)	＜0.001
SBP	0.011	0.003	18.023	1.011(1.006~1.016)	＜0.001
心率	0.009	0.004	5.418	1.009(1.001~1.017)	0.020
职业^a	0.188	0.095	3.931	1.207(1.002~1.453)	0.047
常量	-3.310	0.494	44.963	0.037	＜0.001
注：^a将职业分为2类，其中企事业单位工作人员与退休为一类，并作为对照组，农民与自由职业者划为另一类；表中仅列出P＜0.05的变量。

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变量	有糖尿病视网膜病变(n=898)	无糖尿病视网膜病变(n=2 119)	χ²/t′/t/Z值	P值
性别			0.994	0.319
男	382(30.8)	860(69.2)
女	516(29.1)	1 259(70.9)
居住地			2.459	0.117
城市	708(29.1)	1 723(70.9)
农村	190(32.4)	396(67.6)
职业			14.593	＜0.001
农民	147(33.3)	295(66.7)
企事业单位工作人员	54(32.0)	115(68.0)
退休	574(27.7)	1 496(72.3)
自由职业者	123(36.6)	213(63.4)
文化程度			12.614	0.006
小学及以下	219(28.9)	540(71.1)
初中	352(32.4)	736(67.6)
高中或中专	271(29.8)	637(70.2)
大学及以上	56(21.4)	206(78.6)
糖尿病家族史			4.285	0.038
有	234(32.9)	478(67.1)
无	664(28.8)	1 641(71.2)
医保类型			29.395	＜0.001
新农合	165(32.9)	336(67.1)
居民医保	118(42.4)	160(57.6)
职工医保	587(27.5)	1 551(72.5)
无	28(28.0)	72(72.0)
糖尿病类型			0.525	0.469
Ⅰ型	5(22.7)	17(77.3)
Ⅱ型	893(29.8)	2 102(70.2)
眼部手术史			26.269	＜0.001
有	131(42.4)	178(57.6)
无	767(28.3)	1 941(71.7)
吸烟史			6.741	0.009
有	115(36.1)	204(63.9)
无	783(29.0)	1 915(71.0)
饮酒史			0.575	0.448
有	106(31.5)	230(68.5)
无	792(29.5)	1 889(70.5)
全身疾病史			9.792	0.002
有	496(27.6)	1 300(72.4)
无	402(32.9)	819(67.1)
其他眼部疾病史			0.558	0.455
有	247(30.8)	555(69.2)
无	651(29.4)	1 564(70.6)
中心性肥胖			1.620	0.203
是	241(31.6)	522(68.4)
否	657(29.1)	1 597(70.9)
年龄(x±s, 岁)	63.43±9.19	65.66±9.70	-5.859	＜0.001
BMI(x±s, kg/m²)	18.95±5.13	18.95±5.12	-0.015	0.988
糖尿病病程[M(P₂₅, P₇₅), 年]	9.00(5.00, 15.00)	6.00(3.00, 10.00)	-8.571	＜0.001
FPG(x±s, mmol/L)	8.12±3.27	7.22±2.41	7.396	＜0.001
糖化血红蛋白[M(P₂₅, P₇₅), %]	6.81(6.30, 8.00)	6.40(5.80, 7.40)	-8.955	＜0.001
尿素氮[M(P₂₅, P₇₅), mmol/L]	5.20(4.40, 6.30)	5.10(4.30, 5.90)	-3.106	0.002
肌酐(x±s, μmol/L)	83.18±47.74	79.80±46.79	1.789	0.074
尿白蛋白[M(P₂₅, P₇₅), μg/min]	16.55(13.25, 28.70)	16.55(11.00, 21.00)	-4.603	＜0.00
胆固醇[M(P₂₅, P₇₅), mmol/L]	5.16(4.35, 5.98)	5.13(4.36, 5.84)	-1.209	0.227
TG[M(P₂₅, P₇₅), mmol/L]	1.56(1.11, 2.20)	1.61(1.14, 2.39)	-1.610	0.107
HDL[M(P₂₅, P₇₅), mmol/L]	2.90(2.23, 3.56)	2.90(2.24, 3.58)	-1.058	0.290
LDL(x±s, mmol/L)	2.96±1.04	2.95±1.09	0.217	0.828
SBP(x±s, mm Hg)	139.54±17.36	136.97±16.05	3.799	＜0.001
DBP(x±s, mm Hg)	79.91±10.79	80.32±26.88	-0.447	0.655
心率(x±s, 次/min)	82.38±10.69	80.97±10.34	3.398	0.001
注：1 mm Hg=0.133 kPa。

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柳州市糖尿病患者视网膜病变的患病率调查及其影响因素

doi: 10.16462/j.cnki.zhjbkz.2021.06.010

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韦所苏，E-mail: 40222503@qq.com

陈秋菊，E-mail：375383754@qq.com

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Prevalence and related factors of diabetic retinopathy in Liuzhou

Corresponding author: WEI Suo-su, E-mail: 40222503@qq.com; CHEN Qiu-ju, E-mail: 375383754@qq.com

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柳州市糖尿病患者视网膜病变的患病率调查及其影响因素

doi: 10.16462/j.cnki.zhjbkz.2021.06.010

通讯作者: 韦所苏，E-mail: 40222503@qq.com 陈秋菊，E-mail：375383754@qq.com

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Prevalence and related factors of diabetic retinopathy in Liuzhou

Corresponding author: WEI Suo-su, E-mail: 40222503@qq.com; CHEN Qiu-ju, E-mail: 375383754@qq.com

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通讯作者:
韦所苏，E-mail: 40222503@qq.com

陈秋菊，E-mail：375383754@qq.com