糖尿病網膜症病期の5年推移とヘモグロビンA_<1c>値
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概要
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The change in diabetic retinopathy (DR) with time was evaluated over 5 years in 231 patients (218 NIDDMs, 13 IDDMs ; 460 eyes) who were distributed among the 5 DR stages at the beginning according to Fukuda's classification as follows: stage 0 (no DR), 297 eyes; A_<1-2> (simple DR), 99 eyes; B_1 (preproliferative DR), 32 eyes; B_<2-6> (proliferative DR), 22 eyes; and A_<3-5> (interrupted proliferative DR), 10 eyes. The glycosylated hemoglobin (HbA_<1c>) was also monitored at a certain interval for 5 years. From stage 0 (baseline), 16.5% advanced to stage A_<1-2> and 1.7% advanced to stage B_<2-6> at the end of the 5-year study period. Among the transitions from stage A_<1-2>, 16.2, 60.6, 11.1, 4.0 and 8.1% were designated to stages 0, A_<1-2>, B_1, B_<2-6> and A_<3-5>, respectively. Among the transitions from stage B_1, 43.7, 6.3, 6.3 and 43.7% were designated to stages A_<1-2>, B_1, B_<2-6> and A_<3-5>, respectively. These findings suggest that the DR between stages A_<1-2> and B_1 appears to be unstable and can be transferable with the same eye. From stage B_<2-6> 63.6% cured to the A_<3-5> stage, while 10% of stage A_<3-5> re-worsened to stage B_<2-6>. There was no significant difference in the baseline HbA_<1c> between the 5 DR stages. In the relationship between post-5-year DR change and glycemic control, the baseline HbA_<1c> and the mean HbA_<1c> for 5 years were significantly higher in stage 0 to A_<1-2> than those in stage 0 to 0 group (baseline HbA_<1c>: 9.2 ± 2.6 vs. 10.9 ± 3.5%; mean HbA_<1c>: 7.6 ± 1.5 vs. 8.7 ± 1.9%) and the baseline HbA_<1c> was much higher in stage 0 to B_<2-6> than that in stage 0 to 0 group (p<0.05), indicating that the DR prevalence is strongly related to the glycemic control. Ophthalmologic treatment mainly influenced the DR clinical course in the advanced stages. These results can be valuable in order to counsel diabetic patients, educate them in glycemic control, and refer them for timely preventive ophthalmologic treatment.
- 東京女子医科大学の論文
- 1996-07-25
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