糖尿病性黄斑水肿和增殖性糖尿病视网膜病变与心血管疾病的关联：一项系统评价和荟萃分析。
Association of Diabetic Macular Edema and Proliferative Diabetic Retinopathy With Cardiovascular Disease: A Systematic Review and Meta-analysis.
作者信息
Xie Jing, Ikram M Kamran, Cotch Mary Frances, Klein Barbara, Varma Rohit, Shaw Jonathan E, Klein Ronald, Mitchell Paul, Lamoureux Ecosse L, Wong Tien Yin
机构信息
Centre for Eye Research Australia, University of Melbourne, East Melbourne, Victoria, Australia.
Singapore Eye Research Institute, Singapore National Eye Centre, National University of Singapore, Singapore3Duke-NUS Medical School, National University of Singapore, Singapore.
出版信息
JAMA Ophthalmol. 2017 Jun 1;135(6):586-593. doi: 10.1001/jamaophthalmol.2017.0988.
IMPORTANCE
Previous studies on the relationship between diabetic retinopathy (DR) and cardiovascular disease (CVD) focused on the early stages of DR. Understanding whether patients with type 2 diabetes and severe stages of DR (diabetic macular edema [DME] and proliferative diabetic retinopathy [PDR]) have a higher risk of CVD will allow physicians to more effectively counsel patients.
OBJECTIVE
To examine the association of severe stages of DR (DME and PDR) with incident CVD in patients with type 2 diabetes.
DATA SOURCES
English-language publications were reviewed for articles evaluating the relationship of DR and CVD in MEDLINE, EMBASE, Current Contents, and the Cochrane Library from inception (January 1, 1950) to December 31, 2014, using the search terms diabetic retinopathy OR macular edema AND stroke OR cerebrovascular disease OR coronary artery disease OR heart failure OR myocardial infarction OR angina pectoris OR acute coronary syndrome OR coronary artery disease OR cardiomyopathy.
STUDY SELECTION
Among 656 studies screened for eligibility, 7604 individuals were included from 8 prospective population-based studies with data on photographic-based DR grading, follow-up visits, and well-defined incident CVD end point.
DATA EXTRACTION AND SYNTHESIS
Two independent reviewers conducted a systematic search of the 4 databases, and a single pooled database was developed. Incidence rate ratios (IRRs) were estimated for patients with DME, PDR, and vision-threatening DR, compared with persons without these conditions, by using individual participant data followed by a standard inverse-variance meta-analysis (2-step analysis). The review and analyses were performed from January 1, 2009, to January 1, 2017.
MAIN OUTCOME AND MEASURES
Incident CVD, including coronary heart disease, stroke, or death from cardiovascular causes.
RESULTS
Among 7604 patients with type 2 diabetes, the prevalence of DME was 4.6% and PDR, 7.4%. After a mean follow-up of 5.9 years (range, 3.2-10.1 years), 1203 incident CVD events, including 916 coronary heart disease cases, were reported. Persons with DME or PDR were more likely to have incident CVD (IRR, 1.39; 95% CI, 1.16-1.67) and fatal CVD (IRR, 2.33; 95% CI, 1.49-3.67) compared with those without DME or PDR.
CONCLUSIONS AND RELEVANCE
Patients with type 2 diabetes and DME or PDR have an increased risk of incident CVD, which suggests that these persons should be followed up more closely to prevent CVD.
重要性
既往关于糖尿病视网膜病变（DR）与心血管疾病（CVD）关系的研究主要聚焦于DR的早期阶段。了解2型糖尿病且处于DR严重阶段（糖尿病性黄斑水肿[DME]和增殖性糖尿病视网膜病变[PDR]）的患者是否具有更高的CVD风险，将有助于医生更有效地为患者提供咨询。
目的
探讨2型糖尿病患者中DR严重阶段（DME和PDR）与新发CVD之间的关联。
数据来源
检索MEDLINE、EMBASE、《现刊目次》和Cochrane图书馆中自1950年1月1日创刊至2014年12月31日期间评估DR与CVD关系的英文出版物，检索词为糖尿病视网膜病变或黄斑水肿与中风或脑血管疾病或冠状动脉疾病或心力衰竭或心肌梗死或心绞痛或急性冠状动脉综合征或冠状动脉疾病或心肌病。
研究选择
在656项筛选合格的研究中，从8项基于人群的前瞻性研究中纳入了7604名个体，这些研究提供了基于眼底照片的DR分级、随访以及明确的新发CVD终点数据。
数据提取与合成
两名独立的评审员对4个数据库进行了系统检索，并建立了一个单一的汇总数据库。通过使用个体参与者数据，随后进行标准的逆方差荟萃分析（两步分析），估计了患有DME、PDR和威胁视力的DR患者与未患这些疾病的患者相比的发病率比（IRR）。评审和分析于2009年1月1日至2017年1月1日进行。
主要结局和指标
新发CVD，包括冠心病、中风或心血管原因导致的死亡。
结果
在7604例2型糖尿病患者中，DME的患病率为4.6%，PDR为7.4%。平均随访5.9年（范围3.2 - 10.1年）后，报告了1203例新发CVD事件，其中包括916例冠心病病例。与没有DME或PDR的患者相比，患有DME或PDR的患者更有可能发生新发CVD（IRR，1.39；95%CI，1.16 - 1.67）和致命性CVD（IRR，2.33；95%CI，1.49 - 3.67）。
结论与意义
2型糖尿病合并DME或PDR的患者发生新发CVD的风险增加，这表明应对这些患者进行更密切的随访以预防CVD。
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