本文選題：糖尿病 + 糖尿病視網(wǎng)膜病變��； 參考：《瀘州醫(yī)學院》2012年碩士論文

【摘要】：目的：了解四川省瀘州市40歲及其以上自然人群中糖尿病視網(wǎng)膜病變(diabetic retinopathy, DR)的患病率,并通過體格檢查和問卷調(diào)查來獲取被調(diào)查者的相關(guān)資料,然后運用統(tǒng)計學分析探討DR的相關(guān)影響因素,為我市DR的防治提供基本的流行病學依據(jù)。方法：2011年05月至2011年12月在四川省瀘州市采用多級分層整群隨機抽樣方法,先整群隨機抽取6個社區(qū),然后在每個社區(qū)內(nèi)采用單純隨機抽樣方法,共抽取8000名40歲及其以上的長住居民進行糖尿病及DR的橫斷面流行病學調(diào)查。參照1999年WHO推薦的糖尿病診斷標準,對篩查出的1374名糖尿病患者進行：①問卷調(diào)查：一般情況、既往糖尿病病史、DR病史、家族史、吸煙及飲酒情況,受教育程度等；②臨床體格檢查：身高、體重、腰圍、臀圍、血壓、心電圖等,計算體重指數(shù)(body mass index, BMI);③實驗室檢查：空腹血糖(fasting blood glucose, FPG)、餐后2小時血糖(2hour postprandial blood glucose,2hPPG)、糖化血紅蛋白(glycosylated hemoglobin Alc HbAlc)、總膽固醇(total cholesterol, TC)、甘油三醋(triglyceride, TG)、高密度脂蛋白膽固醇(high-density lipoprotein cholesterol, HDL-c)、低密度脂蛋白膽固醇(low-density lipoprotein cholesterol, LDL-c)、肝功、腎功等；④眼部檢查：日常生活視力、小孔鏡視力、眼底鏡檢查、部分患者采用裂隙燈檢查、免散瞳眼底照相機眼底照相和眼底熒光血管造影(fundus fluoresceine angiography, FFA)進行DR診斷。診斷標準參照1984年中華醫(yī)學會眼科學會眼底病學組制定的DR分期標準。采用統(tǒng)計軟件SPSS13.0對調(diào)查數(shù)據(jù)進行統(tǒng)計學分析。結(jié)果：實際接受檢查7478人,受檢率為93.48%,檢出1374例糖尿病患者,糖尿病患病率為18.37%。DR患者214例,在糖尿病患者中的患病率為15.57%,占所有受檢者比率為2.86%。其中男性76例,在所檢男性2.43%；女性138例,占所檢女性3.17%,經(jīng)過統(tǒng)計學處理,男女性別之間的DR的發(fā)病率無統(tǒng)計學意義(P0.05)。DR患病率在各年齡段有顯著差異(P0.001),其中70歲到79歲年齡段DR患病率最高,達到該年齡段人群的5.44%。214例DR患者中非增生性194例,占所有受檢DR患者的90.65%；增生性20例,占所有受檢DR患者的9.35%。214例DR患者中,低視力和盲的患病率隨著年齡的增長有增加的趨勢(P0.05),主要原因是眼底病變和白內(nèi)障。1374例糖尿病患者中,DR人群的平均HDL-c(1.26±0.32)mmol/L,與無糖尿病視網(wǎng)膜病變(no diabetic retinopathy, NDR)人群的HDL-c(1.09±0.26)mmol/L之間比較差異存在統(tǒng)計學意義(P0.05)；DR人群的平均HbAlc(8.67±1.78)%與NDR人群的(5.98+0.36)%之間比較差異存在統(tǒng)計學意義(P0.001)。對糖尿病病程與糖尿病患者發(fā)生DR關(guān)系進行統(tǒng)計學分析,差異有統(tǒng)計學意義(P0.001),進一步進行精確趨勢卡方檢驗,差異有統(tǒng)計學意義(P0.001)。多因素Logistic回歸分析顯示,糖尿病病程、HbAlc水平、高密度脂蛋白水平、高血壓與DR的患病率有密切關(guān)系(P0.05)。結(jié)論：四川省瀘州市糖尿病患者中DR患病率高；糖尿病病程、血糖水平及同時患有高血壓病都是影響DR病情發(fā)生發(fā)展的重要因素；HbAlc水平和HDL-c水平可作為監(jiān)測糖尿病患者DR發(fā)生、發(fā)展的重要指標。
[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.
【學位授予單位】：瀘州醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R774.1

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