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目的:评估增生性糖尿病视网膜病变(PDR)的复杂度及手术预后的影响因素。方法:本研究为CONCEPT临床试验的历史性队列研究，纳入2017年6月至2018年1月于南京医科大学第一附属医院诊断为PDR且接受23G经睫状体扁平部三通道玻璃体切割术治疗的患者97例97眼，所有患者术前接受0.5 mg康柏西普玻璃体腔注射。根据PDR复杂度评分分为>3分组和≤3分组，比较2个组间全身因素的差异；采用多因素Logistic回归分析评估性别、年龄、高血压病史、肾功能不全、糖尿病病程、糖化血红蛋白水平对PDR病变程度及手术预后的影响；根据年龄分为<45岁组、45～<60岁组和≥60岁组，比较不同年龄组间平均手术时间，术中出血、医源性裂孔、硅油填充发生率，及术后1和6个月彩色眼底照相显示出血、光学相干断层扫描成像仪检查黄斑水肿发生率的差异。结果:PDR复杂度评分>3分组患者年龄为46.5(36.0，51.8)岁，小于PDR复杂度≤3分组的54.0(45.5，61.5)岁，差异有统计学意义( Z＝1.835， P＝0.002)。Logistic回归分析显示，在预测PDR复杂度评分>3分的模型中，仅年龄因素有统计学意义( P＝0.005)，年龄每下降1岁，PDR复杂度>3分的发生风险增加7.4%( OR：0.929，95% CI：0.883～0.977)；全身因素中，<45岁组、45～<60岁组和≥60岁组年龄、糖尿病病程、合并高血压患者比例和肾功能不全患者比例总体比较差异均有统计学意义(均 P<0.05)。眼部因素中，3个组有视网膜激光治疗史、合并纤维血管膜和复杂度评分>3分患者比例总体比较差异均有统计学意义(均 P<0.05)，其中<45岁组合并纤维血管膜和复杂度评分>3分患者比例明显高于45～<60岁组和≥60岁组，差异均有统计学意义(均 P<0.017)。<45岁组、45～<60岁组和≥60岁组术中出血和硅油填充患者比例总体比较差异均有统计学意义(均 P<0.05)，其中<45岁组术中出血和硅油填充患者比例明显高于45～<60岁组和≥60岁组，差异均有统计学意义(均 P<0.017)。<45岁组术后1个月出现黄斑水肿比例明显高于45～<60岁组和≥60岁组，差异均有统计学意义(均 P<0.05)。 结论:在全身因素中，年龄是PDR复杂度升高以及导致患者预后不佳的主要影响因素；与高龄组相比，低龄组患者术中并发症及术后早期黄斑水肿的比例较高。

Objective:To evaluate the risk factors for the complexity and surgical prognosis in patients with proliferative diabetic retinopathy (PDR).Methods:A historical cohort study of the CONCEPT trial, including 97 patients (97 eyes) who were diagnosed with PDR and requiring three-channel 23-gauge transconjunctival pars plana vitrectomy (PPV) from June 2017 to January 2018 at the First Affiliated Hospital of Nanjing Medical University.All patients received preoperative intravitreal injection of 0.5 mg conbercpet.Based on the PDR complexity score, patients were divided into >3 group or ≤3 group, and the systematic risk factors were compared between the two groups.The influence of sex, age, hypertension, renal insufficiency, duration of diabetes mellitus, and hemoglobin A1c level on the PDR complexity score was evaluated by multivariate logistic regression analysis.Based on age, patients were divided into <45 years group, 45-<60 years group, and ≥60 years group, and the differences in mean operative time, incidence of intraoperative hemorrhage, surgically induced lacrimation and silicone oil filling, and incidence of hemorrhage on color fundus photos and macular edema by optical coherence tomography at postoperative months 1 and 6 were analyzed among different age groups.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of The First Affiliated Hospital of Nanjing Medical University (No.2017-SR-283).Written informed consent was obtained from each subject.Results:The age of patients with PDR complexity score >3 was 46.5(36.0, 51.8) years, which was less than 54.0(45.5, 61.5) years for PDR complexity score ≤3, and the difference was statistically significant ( Z=1.835, P=0.002).Among the factors predicting PDR complexity score >3, logistic regression analysis indicated that only age was statistically significant ( P=0.005).For each 1-year increase in age, the risk of PDR complexity score >3 would increase by 7.4%( OR: 0.929, 95% CI: 0.883-0.977).Among the systemic factors, there were significant differences in age, history of diabetes, proportion of patients with hypertension and renal insufficiency among the three age groups (all at P<0.05).Among the ocular factors, there were significant differences in the proportion of patients with history of retinal laser treatment, fibrovascular membrane and complexity score >3 among the three groups (all at P<0.05).The proportion of patients with fibrovascular membrane and complexity score >3 in the <45 years group was significantly higher than that in the 45-<60 and ≥60 years groups (all at P<0.05).There were significant differences in the proportion of patients with intraoperative bleeding and silicone oil filling in the three age groups (all at P<0.017).The proportion of intraoperative bleeding and silicone oil filling in <45 years group was significantly higher than that in 45-<60 and ≥60 years groups (all at P<0.05).The macular edema on postoperative month 1 in the <45 years old group was significantly higher than that in the 45-<60 and ≥60 years groups (both at P<0.05). Conclusions:Among systemic factors, age has a significant impact on the increased PDR complexity and contributes to the poor prognosis of patients.There is a higher percentage of intraoperative complications and early postoperative macular edema in patients in the younger age group compared to the older age group.