视网膜血管几何特征与糖尿病视网膜病变的发生和进展的关系。
The Relationship of Retinal Vessel Geometric Characteristics to the Incidence and Progression of Diabetic Retinopathy.
机构信息
Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin.
Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin.
出版信息
Ophthalmology. 2018 Nov;125(11):1784-1792. doi: 10.1016/j.ophtha.2018.04.023. Epub 2018 May 18.
PURPOSE
To examine the relationships of retinal vessel geometric characteristics (RVGCs) to the incidence and progression of diabetic retinopathy (DR).
DESIGN
Observational, prospective cohort study.
PARTICIPANTS
Nine hundred ninety-six persons with type 1 diabetes mellitus (T1DM) and 1370 persons with type 2 diabetes mellitus (T2DM) seen at a baseline examination who were eligible for follow-up examinations at subsequent 5-year intervals. A total of 3846 person-interval data from these follow-up examinations are the basis for the analyses.
METHODS
Diabetic retinopathy and macular edema were assessed by grading of 30° stereoscopic color fundus photographs. Retinal vessel geometric characteristics were assessed using the Singapore I Vessel Assessment program from a digitized copy of 1 of the field 1 fundus photographs obtained at baseline and follow-up.
MAIN OUTCOME MEASURES
The 5-year incidence of any DR, progression of DR, and incidence of proliferative diabetic retinopathy (PDR) and clinically significant macular edema (CSME) in right eyes.
RESULTS
Incident DR occurred in 45%, progression in 32%, PDR in 10%, and CSME in 5%. While adjusting for glycated hemoglobin, duration of diabetes, and other factors, retinal arteriolar simple tortuosity was associated significantly with the incidence of any DR (odds ratio [OR], 1.17; 95% confidence interval [CI], 1.01-1.35). Retinal venular branching angle was associated significantly with progression of DR (OR, 1.18; 95% CI, 1.03-1.36), retinal venular curvature tortuosity was associated significantly with the incidence of PDR (OR, 1.15; 95% CI, 1.01-1.30), and retinal venular branching angle (OR, 1.41; 95% CI, 1.10-1.82) was associated significantly with the incidence of CSME. There were no significant associations of other RVGCs with any of the DR outcomes in the full multivariate model. Inclusion of all possible RVGCs did not improve the predictive value of the models that already included retinal vessel diameter and baseline DR severity level.
CONCLUSIONS
Retinal vessel geometric characteristics of the retinal venules were associated with progression of DR; however, most of the RVGCs measured from digitized fundus photographs added little to the assessment of risk of incidence and progression of DR when other risk factors were considered in T1DM and T2DM.
目的
探讨视网膜血管几何特征（RVGC）与糖尿病视网膜病变（DR）发病和进展的关系。
设计
观察性、前瞻性队列研究。
参与者
在基线检查时，共有 996 名 1 型糖尿病（T1DM）患者和 1370 名 2 型糖尿病（T2DM）患者符合后续每 5 年一次的随访检查条件。这些随访检查中共有 3846 人次的数据作为分析的基础。
方法
使用 30°立体彩色眼底照片分级评估 DR 和黄斑水肿。使用新加坡 I 血管评估程序从基线和随访时获得的 1 张眼底照片的数字化副本评估视网膜血管几何特征。
主要观察指标
右眼 5 年任何 DR 的发病率、DR 的进展、增生性糖尿病视网膜病变（PDR）和临床显著黄斑水肿（CSME）的发病率。
结果
DR 发生率为 45%，进展率为 32%，PDR 发生率为 10%，CSME 发生率为 5%。在调整糖化血红蛋白、糖尿病病程和其他因素后，视网膜小动脉单纯迂曲与任何 DR 的发病显著相关（比值比 [OR]，1.17；95%置信区间 [CI]，1.01-1.35）。视网膜小静脉分支角与 DR 的进展显著相关（OR，1.18；95%CI，1.03-1.36），视网膜小静脉曲率迂曲与 PDR 的发病显著相关（OR，1.15；95%CI，1.01-1.30），视网膜小静脉分支角（OR，1.41；95%CI，1.10-1.82）与 CSME 的发病显著相关。在全多变量模型中，其他 RVGC 与任何 DR 结果均无显著相关性。包含所有可能的 RVGC 并不能提高已经包含视网膜血管直径和基线 DR 严重程度的模型的预测价值。
结论
视网膜小静脉的视网膜血管几何特征与 DR 的进展相关；然而，在考虑 T1DM 和 T2DM 的其他危险因素后，从数字化眼底照片中测量的大多数 RVGC 对评估 DR 的发病和进展风险几乎没有增加。
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