インスリン依存型糖尿病患者の網膜症の発症と悪化に関わる因子

Factors related with the incidence and severity of retinopathy in insulin-dependent diabetes mellitus

　インスリン依存型糖尿病と診断された患者で発症時から経過観察し得た43例につき，糖尿病発症時年齢を思春期で分け，各群につき罹病期間およびコントロール状態が網膜症発症に及ぼす影響につき検討した。思春期後発症群では，網膜症発生率は高く，コントロール不良なものに早期に重症となるものが多かった。何らかのpuberty factorに，コントロール不良という因子が加わると網膜症が発生，重症化しやすいものと考えられた。思春期前発症群では，HbA_1c値と網膜症の程度には関係はみられず，罹病期間が長くかつ高いHbA_1c値にもかかわらず未発症の症例も多く，何らかの抑制因子の存在が示唆された。

We reviewed 43 patients with insulin-dependent diabetes mellitus (IDDM) regarding retinopa-thy. Patients were assigned to group A when diabetes developed after puberty and to group B when it developed before puberty. Puberty was defined as 12 years of age for males and 11 years for females. The patients were aged 34.5±8.5 years in group A (N=22) and 23.4±4.5 years in group B (N=21) at the time of the present study. Retinopathy in group A differed from group B by higher incidence, earlier onset and tendency to be more severe. Patients with proliferative retinopathy in group A showed higher levels of HbA_lc than those without. Poor glycemic control appeared to play a role in the incidence and severity of retinopathy in group A. Patients in group B showed no correlation between the type of retinopathy and HbA_lc, levels. Retinopathy was frequently absent in patients with group B even when they showed higher levels of HbA_lc and longer duration of diabetic state.