糖尿病性網膜症と臨床因子特にHbA1値との相関

Relationship between diabetic retinopathy and clinical factors including hemoglobin A1

　糖尿病と診断され1年間以上経過観察し得た446名（892眼）を対象に，糖尿病性網膜症と種々の臨床因子との関連を多変量解析法を用い統計学的に推定し，次の結果を得た．

（1）糖尿病罹病期間が長く，インスリン治療歴を有し，HbA₁の平均値および年齢の高いものに，糖尿病性網膜症の頻度が高く，網膜症も進行していた．

（2）糖尿病性網膜症の病期変化にはHbA₁の平均値が関連性が高く，HbA₁の平均値9.53％を境に，それ以上のものでは網膜症の悪化の傾向がみられた．

　これらのことより，糖尿病性網膜症の管理において，糖尿病罹病期間の長いもの，年齢の高いものやインスリン治療歴を有するものでは網膜症の発症に，またHbA₁値の高いものでは網膜症の発症および病期変化に十分な注意が必要で，観察期間の間隔にもこれらのことを考慮して治療にあたることが重要であると考えられる．

We evaluated a total of 892 eyes in 446 diabeticsubjects seen during the foregoing 20 months. All the cases were referred to us from the physician for possible eye complications of diabetes mellitus. The follow-up period ranged one year or more. In asses-sing the relationship between diabetic retinopathy and clinical factors, we applied multivariate statis-tical analysis including multiple stepwise logistic regression analysis and multiple discriminant anal-ysis. Following items were taken into considera-tion : state of diabetic retinopathy, age, sex, dura-tion of diabetes mellitus, hemoglobin A₁(H_bA₁),and, whenever performed, laser photocoagulation. The H_bA₁ value was checked every two months at the least.

The incidence and progression of diabetic retinopathy were positively correlated with age, duration of diabetes, history of insulin treatment, and average value of HbA,. Cases in whom the state of diabetic retinopathy progressd by more than one stage during the period of observation tended to show increased value of HbA,. Thosewith HbA, value of 9.53% or more showed highly significant tendency for exacerbation of diabetic retinopathy.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(9) : 1121-1125, 1987