目的：调查和分析青岛地区糖尿病视网膜病变的发病率及其严重程度的危险因素。

方法：该调查研究分两部分：调查青岛地区2859名60岁以上的社区居民和4275名30岁以上的2型糖尿病住院患者。对所有研究对象进行眼科检查，血压及糖化血红蛋白测定，并通过调查问卷获得其年龄，性别，糖尿病病程，血糖控制情况及他们对糖尿病视网膜病变的了解情况。对所有的糖尿病视网膜病变(DR)患者进行眼底检查并照相，按EDTR标准对DR严重程度分级。重度非增殖期及增殖期DR，有临床意义的糖尿病黄斑水肿患者均归为需治疗组； 而轻中度非增殖期DR及无临床意义的糖尿病黄斑水肿均归为需观察组。对所得数据进行相关和回归分析以确定糖尿病视网膜病变的需治疗率和危险因素。Logistic回归模型用于估计调整患者年龄，性别，病程后的优势比(OR)和95%可信区间(CI)。

结果：2859名60岁以上居民中有334例(11.68%)患有糖尿病视网膜病变，其中48(14.81%)名居民需治疗； 4275名住院2型糖尿病患者中，1097例(25.66%)患有糖尿病视网膜病变，172(15.68%)例住院患者需要接受眼底激光或手术治疗。单变量和多变量回归分析显示，以下因素与糖尿病视网膜病变的需治疗率明显相关，包括：年龄(51～60岁：OR， 1.68； 95%CI： 1.21～1.72； 61～70岁：OR， 1.55； 95%CI： 1.38～1.76)； 病程(11～15年： OR， 2.61； 95% CI：1.51～4.72； 超过15年病程：OR， 4.15； 95%CI： 2.32～5.77)； 血糖控制情况：(血糖控制一般：OR， 2.51； 95%CI： 1.98～3.92； 血糖控制差：OR， 4.69； 95%CI： 3.39～6.95)； 对糖尿病视网膜病变的了解情况(完全不了解：OR， 1.45； 95%CI： 1.21～1.95)。而性别，31～50岁及70岁以上年龄，<10年的糖尿病病程，高血压和胰岛素治疗均与DR的需治疗率无关。

结论：青岛地区糖尿病视网膜病变的发病率和需治疗率较高。51～70岁年龄，超过10年的糖尿病病程，血糖控制欠佳，对糖尿病视网膜病变不了解是DR患者视网膜病变需治疗率的潜在危险因素。加强对51～70岁的2型糖尿病患者关于糖尿病视网膜病变的宣传教育，建立规范的社区糖尿病筛查系统，对早期防控DR的高发病率和致盲率至关重要。

METHODS: This survey consisted of the 2 following parts: 2859 community residents aged >60 years old and 4275 patients with T2DM who were older than 30 years old in Qingdao. Ophthalmic examinations were performed on all patients. A questionnaire was used to obtain the patient's age and gender, the duration of diabetes mellitus(DM), glycaemic control and their knowledge of diabetic retinopathy(DR). Blood pressure and haemoglobin levels were recorded. All included patients underwent a comprehensive ophthalmic examination that included a fundus examination and retinal photographs and that assigned a grade for the severity of retinopathy according to the Early Treatment Diabetic Retinopathy Study(ETDRS)severity scale. Patients with severe non-proliferative or proliferative diabetic retinopathy and clinically significant macular edema(CSME)required ophthalmic therapy were assigned to the need-treatment group, while the remaining patients with DR were assigned to the need-observation group. Correlation and regression analyses were performed to determine the required-treatment rate and risk factors for DR. Logistic regression models were used to estimate odds ratios(OR)and 95% confidence intervals(CI)after adjustment for age, gender and the duration of diabetes.

RESULTS: DR was present in 334(11.68%)of the 2859 community residents aged >60 years old and 1097(25.66%)of the 4275 hospital patients with T2DM, and 48(14.81%)of the residents and 172(15.68%)of the hospital patients required ophthalmic therapy. In univariate and multivariate logistic analyses, factors including the age of the patients(51-60 years old: OR, 1.68; 95%CI, 1.21-1.72; 61-70 years old: OR, 1.55; 95%CI, 1.38-1.76), the duration of diabetes(11-15 years: OR, 2.61; 95%CI, 1.51-4.72; >15 years: OR, 4.15; 95%CI, 2.32-5.77), glycaemic control(medium: OR, 2.51; 95%CI, 1.98-3.92; poor: OR, 4.69; 95%CI, 3.39-6.95), and knowledge of DR(did not understand: OR, 1.45; 95%CI, 1.21-1.95)were significantly associated with the required-treatment rate in DR, while gender, low and advanced age(31-50 years old and >70 years old), duration of disease(<10y), hypertension, and insulin treatment did not.

CONCLUSION: The prevalence rate and the required-treatment rate in DR in Qingdao are relatively high. Being aged 51-70 years old and having a duration of diabetes >10y, poor glycaemic control and a lack of knowledge of DR were found to be potential risk factors that increased the rate of required ophthalmic therapy in patients with DR. In patients with T2DM who were aged 51-70 years old, we found that focusing on using science and education to strengthen the patients' knowledge of DR, establishing specifications for a community DR screening system, and effectively implementing early intervention in the community of DR-affected individuals were particularly important for preventing and controlling the high DR prevalence and the high rate of DR-associated blindness