Chung Yoo-Ri, Park Sung Wook, Choi Shin-Young, Kim Seung Woo, Moon Ka Young, Kim Jeong Hun, Lee Kihwang
Department of Ophthalmology, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, South Korea.
Fight Against Angiogenesis-Related Blindness (FARB) Laboratory, Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea.
Cardiovasc Diabetol. 2017 Jan 7;16(1):4. doi: 10.1186/s12933-016-0486-2.
To investigate the effects of dyslipidemia and statin therapy on progression of diabetic retinopathy and diabetic macular edema in patients with type 2 diabetes.
The medical records of 110 patients with type 2 diabetes (70 statin users and 40 non-users) were retrospectively reviewed. The two outcome measures were progression of diabetic retinopathy by two or more steps on the early treatment diabetic retinopathy study scale and diabetic macular edema based on optical coherence tomography. Serum lipid profiles were analyzed from 6 months prior to diagnosis of diabetic macular edema.
Diabetic retinopathy progressed in 23% of statin users and 18% of non-users (p = 0.506), but diabetic macular edema was present in 23% of statin users and 48% of non-users (p = 0.008). Statins reduced low-density lipoprotein cholesterol levels in patients with and without diabetic macular edema (p = 0.043 and p = 0.031, respectively). Among statin users, patients with diabetic macular edema had higher levels of triglycerides (p = 0.004) and lower levels of high-density lipoprotein cholesterol (p = 0.033) than those without diabetic macular edema. Logistic regression analysis showed that statin use significantly lowered the risk of diabetic macular edema [odds ratio (OR): 0.33, 95% confidence interval (CI) 0.12-0.91, p = 0.032]. Hypertriglyceridemia at 6 months prior to development of macular edema was significantly associated with central retinal thickness (OR: 1.52; 95% CI 1.14-2.02, p = 0.005).
Lipid lowering therapy with statins protected against the development of diabetic macular edema and progression of diabetic retinopathy in patients with type 2 diabetes. Hypertriglyceridemia could be used as a surrogate marker for diabetic macular edema.
探讨血脂异常及他汀类药物治疗对2型糖尿病患者糖尿病视网膜病变进展及糖尿病性黄斑水肿的影响。
回顾性分析110例2型糖尿病患者（70例他汀类药物使用者和40例非使用者）的病历。两项观察指标分别为根据早期治疗糖尿病视网膜病变研究量表，糖尿病视网膜病变进展两步或更多步，以及基于光学相干断层扫描的糖尿病性黄斑水肿。在诊断糖尿病性黄斑水肿前6个月分析血清脂质谱。
23%的他汀类药物使用者和18%的非使用者糖尿病视网膜病变进展（p = 0.506），但23%的他汀类药物使用者和48%的非使用者存在糖尿病性黄斑水肿（p = 0.008）。他汀类药物降低了有和没有糖尿病性黄斑水肿患者的低密度脂蛋白胆固醇水平（分别为p = 0.043和p = 0.03）。在他汀类药物使用者中，有糖尿病性黄斑水肿的患者甘油三酯水平较高（p = 0.004），高密度脂蛋白胆固醇水平较低（p = 0.033），而没有糖尿病性黄斑水肿的患者则相反。逻辑回归分析显示，使用他汀类药物显著降低了糖尿病性黄斑水肿的风险[比值比（OR）：0.33，95%置信区间（CI）0.12 - 0.91，p = 0.032]。黄斑水肿发生前6个月的高甘油三酯血症与视网膜中央厚度显著相关（OR：1.52；95%CI 1.14 - 2.02，p = 0.005）。
他汀类药物降脂治疗可预防2型糖尿病患者糖尿病性黄斑水肿的发生及糖尿病视网膜病变的进展。高甘油三酯血症可作为糖尿病性黄斑水肿的替代标志物。
