四川省泸州市糖尿病视网膜病变的流行病学调查及相关因素分析

发布时间：2018-06-19 21:41

本文选题：糖尿病 + 糖尿病视网膜病变　；参考：《泸州医学院》2012年硕士论文

【摘要】：目的：了解四川省泸州市40岁及其以上自然人群中糖尿病视网膜病变(diabetic retinopathy, DR)的患病率,并通过体格检查和问卷调查来获取被调查者的相关资料,然后运用统计学分析探讨DR的相关影响因素,为我市DR的防治提供基本的流行病学依据。方法：2011年05月至2011年12月在四川省泸州市采用多级分层整群随机抽样方法,先整群随机抽取6个社区,然后在每个社区内采用单纯随机抽样方法,共抽取8000名40岁及其以上的长住居民进行糖尿病及DR的横断面流行病学调查。参照1999年WHO推荐的糖尿病诊断标准,对筛查出的1374名糖尿病患者进行：①问卷调查：一般情况、既往糖尿病病史、DR病史、家族史、吸烟及饮酒情况,受教育程度等；②临床体格检查：身高、体重、腰围、臀围、血压、心电图等,计算体重指数(body mass index, BMI);③实验室检查：空腹血糖(fasting blood glucose, FPG)、餐后2小时血糖(2hour postprandial blood glucose,2hPPG)、糖化血红蛋白(glycosylated hemoglobin Alc HbAlc)、总胆固醇(total cholesterol, TC)、甘油三醋(triglyceride, TG)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol, HDL-c)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol, LDL-c)、肝功、肾功等；④眼部检查：日常生活视力、小孔镜视力、眼底镜检查、部分患者采用裂隙灯检查、免散瞳眼底照相机眼底照相和眼底荧光血管造影(fundus fluoresceine angiography, FFA)进行DR诊断。诊断标准参照1984年中华医学会眼科学会眼底病学组制定的DR分期标准。采用统计软件SPSS13.0对调查数据进行统计学分析。结果：实际接受检查7478人,受检率为93.48%,检出1374例糖尿病患者,糖尿病患病率为18.37%。DR患者214例,在糖尿病患者中的患病率为15.57%,占所有受检者比率为2.86%。其中男性76例,在所检男性2.43%；女性138例,占所检女性3.17%,经过统计学处理,男女性别之间的DR的发病率无统计学意义(P0.05)。DR患病率在各年龄段有显著差异(P0.001),其中70岁到79岁年龄段DR患病率最高,达到该年龄段人群的5.44%。214例DR患者中非增生性194例,占所有受检DR患者的90.65%；增生性20例,占所有受检DR患者的9.35%。214例DR患者中,低视力和盲的患病率随着年龄的增长有增加的趋势(P0.05),主要原因是眼底病变和白内障。1374例糖尿病患者中,DR人群的平均HDL-c(1.26±0.32)mmol/L,与无糖尿病视网膜病变(no diabetic retinopathy, NDR)人群的HDL-c(1.09±0.26)mmol/L之间比较差异存在统计学意义(P0.05)；DR人群的平均HbAlc(8.67±1.78)%与NDR人群的(5.98+0.36)%之间比较差异存在统计学意义(P0.001)。对糖尿病病程与糖尿病患者发生DR关系进行统计学分析,差异有统计学意义(P0.001),进一步进行精确趋势卡方检验,差异有统计学意义(P0.001)。多因素Logistic回归分析显示,糖尿病病程、HbAlc水平、高密度脂蛋白水平、高血压与DR的患病率有密切关系(P0.05)。结论：四川省泸州市糖尿病患者中DR患病率高；糖尿病病程、血糖水平及同时患有高血压病都是影响DR病情发生发展的重要因素；HbAlc水平和HDL-c水平可作为监测糖尿病患者DR发生、发展的重要指标。
[Abstract]:Objective: to understand the prevalence of diabetic retinopathy (diabetic retinopathy, DR) in the natural population of 40 years old and over in Luzhou of Sichuan Province, and to obtain the related data of the respondents through physical examination and questionnaire survey, and then to explore the related factors of DR by statistical analysis, and provide the basic epidemic for the prevention and control of DR in our city. Methods: a multilevel stratified cluster random sampling method was used from 05 months to December 2011 2011 in Luzhou, Sichuan province. A group of 6 communities were sampled randomly, and a random sampling method was used in each community. A total of 8000 residents aged 40 and above were selected for a cross-sectional epidemiological survey of diabetes and DR. According to the diabetes diagnostic criteria recommended by WHO in 1999, 1374 diabetic patients were screened: (1) questionnaire survey: general situation, history of previous diabetes, history of DR, family history, smoking and drinking, education, etc.; (2) clinical physical examination: height, weight, waist circumference, hip circumference, blood pressure, electrocardiogram and so on, and calculate body mass index (BMI) Body mass index, BMI); (3) laboratory examination: fasting blood glucose (FPG), 2 hours postprandial blood glucose (2hour postprandial blood glucose), glycosylated hemoglobin, glycerol three vinegar, high density lipoprotein cholesterol (high-density lipoprotein cholesterol) Ensity lipoprotein cholesterol, HDL-c), low density lipoprotein cholesterol (low-density lipoprotein cholesterol, LDL-c), liver function, kidney function, etc. (4) eye examination: daily life vision, small aperture vision, ocular fundus examination, slit lamp examination in some patients, fundus photography and fundus fluorescein angiography (Fu) Ndus fluoresceine angiography, FFA) for DR diagnosis. The diagnostic criteria refer to the standard of DR staging established by the ophthalmology group of the Chinese Medical Association in 1984. Statistical software SPSS13.0 was used to analyze the data. Results: 7478 people were tested and the rate of examination was 93.48%. 1374 diabetics, diabetes patients were detected. The rate of disease was 214 cases of 18.37%.DR patients, and the prevalence rate in diabetic patients was 15.57%, accounting for 76 cases in men, 2.43% in males, 138 in women and 3.17% in women. The incidence of DR between men and women was not statistically significant (P0.05) the incidence of.DR was significant in all ages. The difference (P0.001), among which the prevalence rate of DR was the highest in the age group of 70 to 79 years, 194 cases of non proliferative 5.44%.214 in the DR patients of this age group, 90.65% of all DR patients, 20 cases of proliferative sex, which accounted for the 9.35%.214 cases of DR in all DR patients, the prevalence of low vision and blindness increased with the increase of age. (P0.05), the main reason was that the average HDL-c (1.26 + 0.32) mmol/L of the DR population was HDL-c (1.26 + 0.32) in the patients with ocular fundus and cataract, and the difference was statistically significant between the HDL-c (1.09 + 0.26) mmol/L of the no diabetic retinopathy (NDR) population (1.09 + 0.26) mmol/L. There was a statistically significant difference between the group (5.98+0.36)% of the population (P0.001). The statistical analysis of the relationship between the course of diabetes and the occurrence of DR in diabetic patients was statistically significant (P0.001). The difference was statistically significant (P0.001). The multifactor Logistic regression analysis showed the course of diabetes, HbAlc level, high density lipoprotein level and hypertension are closely related to the prevalence of DR (P0.05). Conclusion: the prevalence of DR in diabetic patients in Sichuan province is high; the course of diabetes, blood glucose level and simultaneously suffering from hypertension are all important factors affecting the development of DR, and the level of HbAlc and HDL-c can be used as monitoring diabetes. The occurrence of DR in patients with disease is an important indicator of development.
【学位授予单位】：泸州医学院
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R774.1

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