Banerjee S, Denniston A K O, Gibson J M, Dodson P M
Birmingham and Midland Eye Centre, Birmingham, UK.
Eye (Lond). 2004 Aug;18(8):821-5. doi: 10.1038/sj.eye.6701338.
To review the role of cardiovascular disease and therapy in the onset and recurrence of preretinal/vitreous haemorrhage in diabetic patients.
Retrospective case note analysis of diabetic patients with vitreous haemorrhage from the Diabetic Eye Clinic at Birmingham Heartlands Hospital.
In total, 54 patients (mean age 57.1, 37 males, 20 type I vs 34 type II diabetic patients) were included. The mean (SD) duration of diagnosed diabetes at first vitreous haemorrhage was significantly longer, 21.9 (7.6) years for type I and 14.8 (9.3) years for type II diabetic patients (P < 0.01, unpaired t-test, two-tailed).Aspirin administration was not associated with a significantly later onset of vitreous haemorrhage. Four episodes were associated with ACE-inhibitor cough. There was a trend towards HMGCoA reductase inhibitor (statin) use being associated with a delayed onset of vitreous haemorrhage: 21.4 years until vitreous haemorrhage (treatment group) vs 16.2 years (nontreatment group) (P = 0.09, two-tailed, unpaired t-test, not statistically significant). During follow-up 56 recurrences occurred, making a total of 110 episodes of vitreous haemorrhage in 79 eyes of 54 patients. The mean (range) follow-up post haemorrhage was 1067 (77-3842) days, with an average of 1.02 recurrences. Age, gender, diabetes type (I or II) or control, presence of hypertension or hypercholesterolaemia, and macrovascular complications were not associated with a significant effect on the 1-year recurrence rate. Aspirin (and other antiplatelet or anticoagulant agents) and ACE- inhibitors appeared to neither increase nor decrease the 1-year recurrence rate. However, statin use was significantly associated with a reduction in recurrence (Fisher exact P < 0.05; two-tailed) with an odds ratio (95% CI) of 0.25 (0.1-0.95).
In this retrospective analysis, the onset of preretinal/vitreous haemorrhage was not found to be accelerated by gender, hypertension, hypercholesterolaemia, evidence of macrovascular disease, or HbA1c. Neither aspirin nor ACE-inhibitor administration accelerated the onset or recurrence of first vitreous haemorrhage. Statins may have a protective role, both delaying and reducing the recurrence of haemorrhage.
探讨心血管疾病及其治疗在糖尿病患者视网膜前/玻璃体积血的发生和复发中的作用。
对伯明翰心脏地带医院糖尿病眼科门诊的玻璃体积血糖尿病患者进行回顾性病例分析。
共纳入54例患者（平均年龄57.1岁，男性37例，1型糖尿病患者20例，2型糖尿病患者34例）。首次发生玻璃体积血时，1型糖尿病患者确诊糖尿病的平均（标准差）病程显著更长，为21.9（7.6）年，2型糖尿病患者为14.8（9.3）年（P<0.01，非配对t检验，双侧）。服用阿司匹林与玻璃体积血的发病时间显著延迟无关。有4次发作与ACE抑制剂引起的咳嗽有关。使用HMGCoA还原酶抑制剂（他汀类药物）有使玻璃体积血发病延迟的趋势：至发生玻璃体积血的时间为21. years（治疗组），非治疗组为16.2年（P=0.09，双侧，非配对t检验，无统计学意义）。随访期间发生了56次复发，54例患者的79只眼中共出现了玻璃体积血110次。出血后的平均（范围）随访时间为1067（77-3842）天，平均复发1.02次。年龄、性别、糖尿病类型（1型或2型）或控制情况、是否存在高血压或高胆固醇血症以及大血管并发症对1年复发率均无显著影响。阿司匹林（以及其他抗血小板或抗凝药物）和ACE抑制剂似乎既不增加也不降低1年复发率。然而，使用他汀类药物与复发率降低显著相关（Fisher确切概率法P<0.05；双侧），优势比（95%CI）为0.25（0.1-0.95）。
在这项回顾性分析中，未发现性别、高血压、高胆固醇血症、大血管疾病证据或糖化血红蛋白水平会加速视网膜前/玻璃体积血的发生。服用阿司匹林和ACE抑制剂均未加速首次玻璃体积血的发生或复发。他汀类药物可能具有保护作用，既能延迟出血复发，又能降低复发率。
