Salardi S, Rubbi F, Puglioli R, Brancaleoni A, Bacchi-Reggiani L, Ragni L, Cacciari E
Department of Pediatrics, University of Bologna, Italy.
J Pediatr Endocrinol Metab. 2001 May;14(5):507-15. doi: 10.1515/jpem.2001.14.5.507.
Little is known about minimal retinal lesions occurring in the first months of disease in children with type 1 diabetes mellitus (DM).
To detect any early retinal change and to evaluate its progression in children diagnosed with type 1 DM.
From 1979 to 1997 we examined by fluorescein angiography at diagnosis or within 15 months from the onset of DM 130 young patients with type 1 DM (mean age at diagnosis 10.08 +/- 2.62 yr). In 112 patients follow-up by fluorescein angiography was performed every 1.26 years with a mean of 5.41 fluorescein angiographies/patient.
The stage of retinopathy was graded to detect minimal lesions. We also considered sex, pubertal stage, HLA, family history of DM, disease duration and HbA1c levels.
At first examination, 14 out of 127 (11%) readable angiographies showed minimal retinal changes. There was no statistically significant difference between the patients with or without lesions for all parameters considered. The 112 patients examined during follow-up were divided as follows: Group A: no retinopathy at first examination; Group A1: no retinopathy during follow-up; Group A2: retinal changes during follow-up; Group B: retinal changes at the first examination. Mean HbA1c value evaluated during the whole follow-up was lower in group A1 than in group A2. HbA1c levels at onset of the disease were significantly different in the three groups: in group A1 it was lower than in group A2 and in group B.
The presence of early lesions in the first year of disease in 11% of patients is probably due to the method of examination, which may detect even minimal retinal changes. This may be correlated to the acute metabolic failure present at the onset of disease. The prolonged follow-up seems to demonstrate that the early changes are not necessarily a negative prognostic factor in the evolution of diabetic retinopathy. We confirm that duration of DM and metabolic control are the main factors influencing the course of retinopathy in these young patients. Early fluorescein angiography is not particularly useful in the management of children with DM.
关于1型糖尿病（DM）患儿疾病最初几个月出现的微小视网膜病变，人们了解甚少。
检测1型DM患儿的任何早期视网膜变化并评估其进展情况。
1979年至1997年，我们在诊断时或DM发病后15个月内，通过荧光素血管造影检查了130例1型DM年轻患者（诊断时平均年龄10.08±2.62岁）。112例患者每隔1.26年进行一次荧光素血管造影随访，平均每位患者进行5.41次荧光素血管造影。
对视网膜病变阶段进行分级以检测微小病变。我们还考虑了性别、青春期阶段、HLA、DM家族史、病程和糖化血红蛋白（HbA1c）水平。
首次检查时，127份可读血管造影中有14份（11%）显示微小视网膜变化。在所考虑的所有参数方面，有病变和无病变的患者之间无统计学显著差异。随访期间检查的112例患者分为以下几组：A组：首次检查时无视网膜病变；A1组：随访期间无视网膜病变；A2组：随访期间出现视网膜变化；B组：首次检查时出现视网膜变化。整个随访期间评估的平均HbA1c值在A1组低于A2组。三组疾病发病时的HbA1c水平有显著差异：A1组低于A2组和B组。
11%的患者在疾病第一年出现早期病变可能归因于检查方法，该方法可能检测到即使是微小的视网膜变化。这可能与疾病发作时存在的急性代谢衰竭相关。长期随访似乎表明，早期变化不一定是糖尿病视网膜病变进展中的不良预后因素。我们证实，DM病程和代谢控制是影响这些年轻患者视网膜病变进程的主要因素。早期荧光素血管造影在1型DM患儿的管理中并非特别有用。
