预测 1 型糖尿病患者糖尿病视网膜病变四年进展和恶化的眼科和临床因素。
Ophthalmic and clinical factors that predict four-year development and worsening of diabetic retinopathy in type 1 diabetes.
机构信息
Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia.
Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia.
出版信息
J Diabetes Complications. 2018 Jan;32(1):67-74. doi: 10.1016/j.jdiacomp.2017.09.002. Epub 2017 Sep 14.
AIMS
To investigate the role of ophthalmic imaging markers - namely retinal thickness measures and corneal nerve morphology - in predicting four-year development and worsening of diabetic retinopathy (DR) in type 1 diabetes (T1DM).
METHODS
126 eyes of 126 participants with T1DM were examined at baseline and after four years. Diabetic retinopathy (DR) was graded using the Early Treatment Diabetic Retinopathy Study scale. HbA, nephropathy, neuropathy, cardiovascular factors, and retinal thickness using optical coherence tomography (OCT) and corneal nerve fiber length (CNFL) using corneal confocal microscopy at baseline were assessed by univariate and step-wise multiple logistic regression, and their diagnostic capabilities for single and combined measures.
RESULTS
Four-year development of DR was 19% (13 of 68 without DR at baseline). Worsening of DR was seen in 43% (25 of 58 with DR at baseline). When adjusted for potential confounders, a lower CNFL (AUC=0.637, p=0.040, 64% sensitivity and 64% specificity at 14.9mm/mm cut-off), higher triglycerides (AUC=0.669, p=0.012, 64% sensitivity, 62% specificity at 0.85mmol/L) and an elevated vibration threshold (AUC=0.708, p=0.002, 96% sensitivity, 40% specificity at 3.55Hz) were significant predictors for four-year worsening of DR.
CONCLUSIONS
Reduced CNFL, elevated vibration perception threshold and higher triglycerides can predict future worsening of DR.
目的
研究眼部影像学标志物 - 即视网膜厚度测量和角膜神经形态 - 在预测 1 型糖尿病（T1DM）中 4 年糖尿病视网膜病变（DR）的发展和恶化中的作用。
方法
对 126 名 T1DM 患者的 126 只眼进行了基线检查和 4 年后的检查。使用早期治疗糖尿病视网膜病变研究量表对糖尿病视网膜病变（DR）进行分级。使用单变量和逐步多元逻辑回归分析基线时的糖化血红蛋白、肾病、神经病、心血管因素和光学相干断层扫描（OCT）测量的视网膜厚度以及角膜共聚焦显微镜测量的角膜神经纤维长度（CNFL），并评估它们对单一和联合措施的诊断能力。
结果
DR 的 4 年发展率为 19%（基线时无 DR 的 13 例）。基线时患有 DR 的 43%（25 例）出现 DR 恶化。在调整了潜在的混杂因素后，较低的 CNFL（AUC=0.637，p=0.040，在 14.9mm/mm 截止值时具有 64%的敏感性和 64%的特异性）、较高的甘油三酯（AUC=0.669，p=0.012，在 0.85mmol/L 时具有 64%的敏感性和 62%的特异性）和较高的振动阈值（AUC=0.708，p=0.002，在 3.55Hz 时具有 96%的敏感性和 40%的特异性）是 DR 恶化的显著预测因子。
结论
CNFL 降低、振动感知阈值升高和甘油三酯升高可预测 DR 的未来恶化。
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