The Children’s Hospital at Westmead, Westmead, New South Wales, Australia.
Diabetes Care. 2011 Jul;34(7):1622-7. doi: 10.2337/dc10-2419. Epub 2011 May 18.
To examine the association between retinal vascular geometry and subsequent development of incident retinopathy in young patients with type 1 diabetes.
A prospective cohort study of 736 people with type 1 diabetes aged 12 to 20 years, retinopathy-free at baseline, attending an Australian tertiary care hospital. Retinopathy was determined from seven-field retinal photographs according to the modified Airlie House Classification. Retinal vascular geometry, including length/diameter ratio (LDR) and simple tortuosity (ST), was quantified in baseline retinal photographs. Generalized estimating equations were used to determine risk of retinopathy associated with baseline LDR and ST, adjusting for other factors.
After a median 3.8 (interquartile range 2.4-6.1) years of follow-up, incident retinopathy developed in 287 of 736 (39%). In multivariate analysis, lower arteriolar LDR (odds ratio 1.8 [95% CI 1.2-2.6]; 1st vs. 4th quartile) and greater arteriolar ST (1.5 [1.0-2.2]; 4th vs. 1st quartile) predicted incident retinopathy after adjusting for diabetes duration, sex, A1C, blood pressure, total cholesterol, and BMI. In subgroup analysis by sex, LDR predicted incident retinopathy in male and female participants (2.1 [1.1-4.0] and 1.7 [1.1-2.7]; 1st vs. 4th quartiles, respectively) and greater arteriolar ST predicted incident retinopathy in male participants (2.4 [1.1-4.4]; 4th vs. 1st quartile) only.
Lower arteriolar LDR and greater ST were independently associated with incident retinopathy in young people with type 1 diabetes. These vascular geometry measures may serve as risk markers for diabetic retinopathy and provide insights into the early structural changes in diabetic microvascular complications.
研究视网膜血管几何形状与年轻 1 型糖尿病患者随后发生视网膜病变的关系。
对 736 名年龄在 12 至 20 岁、基线时无视网膜病变的 1 型糖尿病患者进行前瞻性队列研究，这些患者均来自澳大利亚的一家三级护理医院。根据改良的 Airlie House 分类法，从七区视网膜照片中确定视网膜病变。在基线视网膜照片中定量评估视网膜血管几何形状，包括长度/直径比（LDR）和简单迂曲度（ST）。使用广义估计方程来确定与基线 LDR 和 ST 相关的视网膜病变风险，同时调整其他因素。
中位随访 3.8 年后（四分位距 2.4-6.1 年），736 例患者中有 287 例（39%）发生了新的视网膜病变。在多变量分析中，较低的小动脉 LDR（比值比 1.8[95%CI 1.2-2.6]；第 1 四分位与第 4 四分位）和较大的小动脉 ST（1.5[1.0-2.2]；第 4 四分位与第 1 四分位）调整糖尿病病程、性别、A1C、血压、总胆固醇和 BMI 后，预测了新的视网膜病变。按性别进行亚组分析时，LDR 预测了男性和女性参与者的新的视网膜病变（2.1[1.1-4.0]和 1.7[1.1-2.7]；第 1 四分位与第 4 四分位），而较大的小动脉 ST 仅预测了男性参与者的新的视网膜病变（2.4[1.1-4.4]；第 4 四分位与第 1 四分位）。
较低的小动脉 LDR 和较大的 ST 与年轻 1 型糖尿病患者的新的视网膜病变独立相关。这些血管几何形状测量值可能作为糖尿病视网膜病变的风险标志物，并提供对糖尿病微血管并发症早期结构变化的深入了解。
