目的：探讨糖尿病患者发生视网膜病变(DR)的危险因素及该危险因素对眼前段生物学结构特征的影响。

方法：采用横断面调查研究，选取2018-01/09至上海市同仁医院眼科就诊的2型糖尿病患者。采集其一般情况、糖尿病相关病史问卷、实验室检查(血糖、糖化血红蛋白、血脂)、眼部检查(视力、眼压、裂隙灯检查、角膜地形图、眼底照相、OCT)等信息。根据视网膜病变程度，将患者分为3组：0组为无DR组，1组：轻度及中度NPDR组，2组：重度NPDR及PDR组。分析三组间的差异，影响DR发生的危险因素，该危险因素对屈光度、角膜厚度、角膜曲率、前房深度等眼前段生物学结构特征的影响。

结果：糖尿病患者219例完成了本次调查。其中无DR者163例(74.4%)，有DR者56例(25.6%)。DR患者年龄(1组66.84±15.13岁，2组65.45±12.83岁)高于无DR患者(59.59±14.61岁)(P<0.05)。糖尿病病程DR患者(1组，13.69±10.22a，2组15.23±8.22a)高于无DR患者(9.21±7.92a)(P<0.05)。DR患者伴发糖尿病肾病的比例(1组28.0%，2组32.3%)高于无DR患者(14.1%)(P<0.05)。DR患者使用胰岛素治疗的比例(1组64.0%，2组83.9%)高于无DR患者(44.2%)(P<0.05)。Logistic回归分析显示糖尿病病程、糖尿病肾病、使用胰岛素是DR的危险因素(OR>1，P<0.05)。且该危险因素均会使DR患者矫正视力显著下降。DR患者角膜厚度(550.82±34.73μm)大于无DR患者(542.37±33.32μm)(P<0.05)。糖尿病病程>10a的患者前房深度(2.49±0.43mm)小于病程<10a的患者(2.68±0.40mm)(P<0.05)。

结论：糖尿病病程、糖尿病肾病、使用胰岛素是促进DR发生的危险因素。糖尿病病程长的患者前房深度更浅。

METHODS: This was a cross-sectional study. Patients with type 2 diabetes who had been treated in ophthalmology department of Shanghai Tongren Hospital were invited to participate in this study during January 2018 to September 2018. To evaluate clinical characteristics, each subject completed diabetes related history questionnaire, laboratory examination(blood glucose, glycosylated hemoglobin, blood lipid), eye examination(vision, intraocular pressure, slit lamp examination, corneal topography, fundus photography, OCT). According to the severity of retinopathy, patients were classified to three groups: group 0: none DR, group 1: mild and moderate NPDR, group 2: severe NPDR and PDR. Chi-square test, t-test and variance analysis were used to analyze the differences between groups, and risk factors of DR were studied through Logistic regression analysis. Then analyzed whether these risk factors would affect the biological structures of the anterior segment, such as refractive index, corneal thickness, corneal curvature and anterior chamber depth.

RESULTS: Totally 219 diabetic patients participated in the survey, and 56 patients(25.6%)were diagnosed with DR. The age of DR patients \〖(66.84±15.13a)(group 1)/(65.45±12.83a)(group 2)\〗 was higher than that of patients without DR(59.59±14.61a)(P<0.05). The course of diabetes in DR patients \〖(13.69±10.22a)(group 1)/(15.23±8.22a)(group 2)\〗 was higher than that in patients without DR(9.21±7.92)a(P<0.05).The proportion of diabetic nephropathy in DR patients \〖(28.0%)(group 1)/(32.3%)(group 2)\〗 was higher than that those without DR(14.1%)(P<0.05).The proportion of DR patients treated with insulin \〖(64.0%)(group 1)/(83.9%)(group 2)\〗 was higher than those without DR(44.2%)(P<0.05). Logistic regression analysis showed that the course of diabetes, diabetic nephropathy and insulin were the risk factors of DR(OR>1, P<0.05). All of the above risk factors will significantly reduce the corrected vision of DR patients.The corneal thickness of patients with DR(550.82±34.73)μm was greater than those without DR(542.37±33.32)μm(P<0.05). The anterior chamber depth of patients with diabetes over 10a(2.49±0.43)mm was less than those with diabetes less than 10y(2.68±0.40)mm(P<0.05).

CONCLUSION: The course of diabetes, diabetic nephropathy and insulin use were the risk factors for DR. Patients with long duration of diabetes had a shallower anterior chamber depth.