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インスリン非依存型糖尿病(NIDDM)患者,152人179出産例について,妊娠中の糖尿病性網膜症の変化を検討した。妊娠初回検査時,132例には網膜症がみられず,そのうち21%(28/132例)には,妊娠中に単純型網膜症が生じたが,残り79%(104/132例)は,網膜症は生じなかった。また,47例には妊娠初回検査時より網膜症がみられ,このうち38%(18/47例)に網膜症の悪化が生じ,62%(29/47例)は網膜症の変化がみられなかった。特に,福田分類AⅡ以上の網膜症を有する例では,妊娠中の網膜症悪化率が高かった。
当初から,あるいは妊娠中に進展し前増殖期網膜症または増殖期網膜症を呈したものは9例あった。このうち5例は,光凝固により網膜症の進行は停止したが,2例は進行を阻止することができなかった。妊娠時にすでに網膜症があると,網膜症が進行しやすいが,糖尿病罹病期間が長いほど妊娠中の網膜症悪化率は高く,妊娠前の血糖コントロールが良好であると,妊娠中の網膜症悪化率は低かった。
We evaluated the course of diabetic retinopathy during 179 pregnancies in 152 females with non -insulin dependent diabetes mellitus. One preg-nancy was counted as one case, when a patient underwent more than pregnancies.
No detectable retinopathy was present in 132/179 cases (74%) when first seen after onset of preg-nancy. In these 132 cases, background retinopathy developed in 28 cases (21%). Retinopathy was con-sistently absent in the other 104 cases (79%). Retinopathy was already present in 47 cases(26%) when first seen after pregnancy. The state of retinopathy remained stationary in 29 cases (62%) and progressed in 18 (38%) during the course of pregnancy. We observed higher rate of exacerba-tion in cases with initial retinopathy with grading of All or more in Fukuda's classification.
Nine cases manifested preproliferative or proliferative retinopathy during pregnancy. Photocoagulation was followed by improvement in retinopathy in 5 and by further exacerbation in 2. We identified preexisting retinopathy, longer dura-tion of diabetes and poor glycemic control before onset of pregnancy as risk factors for exacerbation of retinopathy during pregnancy.
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