Hwang Duck Jin, Lee Kyoung Min, Park Moon Seok, Choi Sung Hee, Park Ji In, Cho Joon Hee, Park Kyu Hyung, Woo Se Joon
Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Ophthalmology, HanGil Eye Hospital, Incheon, Korea.
PLoS One. 2017 Apr 7;12(4):e0175270. doi: 10.1371/journal.pone.0175270. eCollection 2017.
We aimed to investigate the prevalence of diabetic retinopathy (DR) in patients with diabetic foot ulcer (DFU) and elucidate the association between DR and DFU severities and their shared risk factors.
A retrospective review was conducted on DFU patients who underwent ophthalmic and vascular examinations within 6 months; 100 type 2 diabetic patients with DFU were included. The medical records of 2496 type 2 diabetic patients without DFU served as control data. DR prevalence and severity were assessed in DFU patients. DFU patients were compared with the control group regarding each clinical variable. Additionally, DFU patients were divided into two groups according to DR severity and compared.
Out of 100 DFU patients, 90 patients (90%) had DR and 55 (55%) had proliferative DR (PDR). There was no significant association between DR and DFU severities (R = 0.034, p = 0.734). A multivariable analysis comparing type 2 diabetic patients with and without DFUs showed that the presence of DR [OR, 226.12; 95% confidence interval (CI), 58.07-880.49; p < 0.001] and proliferative DR [OR, 306.27; 95% CI, 64.35-1457.80; p < 0.001), higher HbA1c (%, OR, 1.97, 95% CI, 1.46-2.67; p < 0.001), higher serum creatinine (mg/dL, OR, 1.62, 95% CI, 1.06-2.50; p = 0.027), older age (years, OR, 1.12; 95% CI, 1.06-1.17; p < 0.001), higher pulse pressure (mmHg, OR, 1.03; 95% CI, 1.00-1.06; p = 0.025), lower cholesterol (mg/dL, OR, 0.94; 95% CI, 0.92-0.97; p < 0.001), lower BMI (kg/m2, OR, 0.87, 95% CI, 0.75-1.00; p = 0.044) and lower hematocrit (%, OR, 0.80, 95% CI, 0.74-0.87; p < 0.001) were associated with DFUs. In a subgroup analysis of DFU patients, the PDR group had a longer duration of diabetes mellitus, higher serum BUN, and higher serum creatinine than the non-PDR group. In the multivariable analysis, only higher serum creatinine was associated with PDR in DFU patients (OR, 1.37; 95% CI, 1.05-1.78; p = 0.021).
Diabetic retinopathy is prevalent in patients with DFU and about half of DFU patients had PDR. No significant association was found in terms of the severity of these two diabetic complications. To prevent blindness, patients with DFU, and especially those with high serum creatinine, should undergo retinal examinations for timely PDR diagnosis and management.
我们旨在调查糖尿病足溃疡（DFU）患者中糖尿病视网膜病变（DR）的患病率，并阐明DR与DFU严重程度之间的关联及其共同的危险因素。
对6个月内接受眼科和血管检查的DFU患者进行回顾性研究；纳入100例2型糖尿病DFU患者。2496例无DFU的2型糖尿病患者的病历作为对照数据。评估DFU患者的DR患病率和严重程度。将DFU患者与对照组在每个临床变量方面进行比较。此外，根据DR严重程度将DFU患者分为两组并进行比较。
100例DFU患者中，90例（90%）患有DR，55例（55%）患有增殖性DR（PDR）。DR与DFU严重程度之间无显著关联（R = 0.034，p = 0.734）。一项比较有和无DFU的2型糖尿病患者的多变量分析显示，DR的存在[比值比（OR），226.12；95%置信区间（CI），58.07 - 880.49；p < 0.001]、增殖性DR[OR，306.27；95% CI，64.35 - 1457.80；p < 0.001]、更高的糖化血红蛋白（%，OR，1.97，95% CI，1.46 - 2.67；p < 0.001）、更高的血清肌酐（mg/dL，OR，1.62，95% CI，1.06 - 2.50；p = 0.027）、年龄较大（岁，OR，1.12；95% CI，1.06 - 1.17；p < 0.001）、更高的脉压（mmHg，OR，1.03；95% CI，1.00 - 1.06；p = 0.025）、更低的胆固醇（mg/dL，OR，0.94；95% CI，0.92 - 0.97；p < 0.001）、更低的体重指数（kg/m2，OR，0.87，95% CI，0.75 - 1.00；p = 0.044）和更低的血细胞比容（%，OR，0.80，95% CI，0.74 - 0.87；p < 0.001）与DFU相关。在DFU患者亚组分析中，PDR组的糖尿病病程更长、血清尿素氮更高、血清肌酐高于非PDR组。在多变量分析中，DFU患者中只有更高的血清肌酐与PDR相关（OR，1.37；95% CI，1.05 - 1.78；p = 0.021）。
DFU患者中DR很常见，约一半的DFU患者患有PDR。这两种糖尿病并发症的严重程度之间未发现显著关联。为预防失明，DFU患者，尤其是血清肌酐高的患者，应接受视网膜检查以便及时诊断和管理PDR。
