Department of Ophthalmology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC.
Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2018 Mar;81(3):230-235. doi: 10.1016/j.jcma.2017.09.013. Epub 2017 Dec 2.
This pilot study was carried to determine the prevalence of retinopathy, especially proliferative retinopathy, in patients with acromegaly.
We analyzed 43 acromegalic patients and 129 age- and gender-matched patients with type 2 diabetes. The retinopathy status was determined from the medical records based on the ophthalmologist consultations of patients with acromegaly. Color photographs of the macula- and disc-centered views were obtained at an angle of 45° with a fundus camera after pharmacologic-induced mydriasis in patients with type 2 diabetes.
Compared with age- and gender-matched patients with type 2 diabetes, the acromegalic patients had lower fasting plasma glucose levels and lower systolic and diastolic blood pressures, but were taller and had higher IGF-1 levels. Any degree of retinopathy was present in 9.3% (4 of 43) of patients with acromegaly and 34.9% (45 of 129) of patients with type 2 diabetes (odds ratio [OR] = 0.191; 95% confidence interval [CI] = 0.064-0.570). Proliferative retinopathy was present in 9.3% (4 of 43) of patients with acromegaly and 9.3% (12 of 129) of patients with type 2 diabetes (OR = 1.000; 95% CI = 0.305-3.281). Non-proliferative retinopathy was absent in patients with acromegaly, but present in 25.9% (33 of 129) of patients with type 2 diabetes.
The high proliferative, but absence of non-proliferative retinopathy in our patients with acromegaly may reflect the pathogenic effect of IGF-1 on neovascularization. IGF-1 may play an important role in proliferative retinopathy, but may play no role in non-proliferative retinopathy.
本研究旨在探讨肢端肥大症患者中视网膜病变，特别是增生性视网膜病变的流行情况。
我们分析了 43 例肢端肥大症患者和 129 例年龄和性别匹配的 2 型糖尿病患者。根据肢端肥大症患者的眼科会诊，从病历中确定视网膜病变情况。2 型糖尿病患者在药物性散瞳后，使用眼底相机以 45°角获得黄斑和视盘中心区的彩色照片。
与年龄和性别匹配的 2 型糖尿病患者相比，肢端肥大症患者的空腹血糖水平较低，收缩压和舒张压较低，但身高较高，IGF-1 水平较高。43 例肢端肥大症患者中有 9.3%（4 例）存在任何程度的视网膜病变，129 例 2 型糖尿病患者中有 34.9%（45 例）存在视网膜病变（比值比 [OR] = 0.191；95%置信区间 [CI] = 0.064-0.570）。43 例肢端肥大症患者中有 9.3%（4 例）存在增生性视网膜病变，129 例 2 型糖尿病患者中有 9.3%（12 例）存在增生性视网膜病变（OR = 1.000；95% CI = 0.305-3.281）。肢端肥大症患者中无非增生性视网膜病变，但 2 型糖尿病患者中有 25.9%（33 例）存在非增生性视网膜病变。
我们的肢端肥大症患者中存在高增生性、无非增生性视网膜病变可能反映了 IGF-1 对新生血管形成的致病作用。IGF-1 可能在增生性视网膜病变中发挥重要作用，但在非增生性视网膜病变中可能没有作用。
