较薄的平均脉络膜厚度是糖尿病视网膜病变发病的一个危险因素。

Thinner Average Choroidal Thickness Is a Risk Factor for the Onset of Diabetic Retinopathy.

机构信息

Department of Ophthalmology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China.

Department of Ophthalmology, The Second Affiliated Hospital of Nantong University, Nantong, China.

出版信息

Ophthalmic Res. 2020;63(3):259-270. doi: 10.1159/000504756. Epub 2020 Feb 5.

DOI:10.1159/000504756

PMID:32023612

Abstract

PURPOSE

To analyze the relationships between choroidal thickness (CT) and diabetes mellitus (DM), diabetic retinopathy (DR), and DR severity in community residents diagnosed with type 2 DM, and to explore whether CT can improve the discriminatory ability of other risk factors to predict the incidence of DR.

METHODS

A total of 1,250 type 2 DM residents and 1,027 healthy controls in Xinjing community of Shanghai participated a cross-sectional survey of eye diseases in 2016. CT was measured using swept-source optical coherence tomography. DR was classified according to the 2002 international clinical classification of DR. A total of 537 subjects with type 2 DM without DR at the 2016 survey were followed up in 2018 to investigate the 2-year incidence of DR. Receiver operating characteristic curve analysis was used to test the accuracy of different indicators in predicting the onset of DR.

RESULTS

The central CT of the control, no DR, mild non-proliferative DR (NPDR), moderate NPDR, severe NPDR, and PDR groups were 223.40, 216.22, 213.57, 211.91, 178.47, and 168.15 μm, respectively (p for trend <0.001), and the average CT (ACT) were 197.83, 186.94, 182.03, 178.00, 156.91, and 136.72 μm respectively (p for trend <0.001). Body mass index (BMI), DM duration, fasting blood glucose, glycosylated hemoglobin (HbA1C), and ACT were risk factors for 2-year DR incidence. For the onset of DR, as predicted by ACT, after tenfold cross validation the average area under the curve was 0.55 (p = 0.048). Addition of ACT did not improve the discriminatory ability of DM duration, BMI, glucose and HbA1C on the incidence of DR (Z = 0.48; p = 0.63).

CONCLUSIONS

As the severity of DR increased, the CT of community type 2 DM patients showed a significant downward trend compared with the healthy controls. Thinner ACT was found to be a risk factor for DR incidence, but it did not improve the discriminatory ability of other risk factors to predict the incidence of DR.

摘要

目的

分析社区 2 型糖尿病患者脉络膜厚度（CT）与糖尿病（DM）、糖尿病视网膜病变（DR）及其严重程度之间的关系，并探讨 CT 是否能提高其他危险因素对 DR 发生的预测能力。

方法

2016 年对上海新泾社区的 1250 例 2 型 DM 居民和 1027 例健康对照者进行了眼部疾病的横断面调查。采用扫频源光学相干断层扫描测量 CT。根据 2002 年国际 DR 临床分类对 DR 进行分类。对 2016 年调查中无 DR 的 537 例 2 型 DM 患者进行了 2 年随访，以调查 DR 的 2 年发生率。采用受试者工作特征曲线分析测试不同指标预测 DR 发病的准确性。

结果

对照组、无 DR、轻度非增生性 DR（NPDR）、中度 NPDR、重度 NPDR 和 PDR 组的中央 CT 分别为 223.40、216.22、213.57、211.91、178.47 和 168.15μm（趋势 p<0.001），平均 CT（ACT）分别为 197.83、186.94、182.03、178.00、156.91 和 136.72μm（趋势 p<0.001）。体重指数（BMI）、DM 病程、空腹血糖、糖化血红蛋白（HbA1C）和 ACT 是 2 年 DR 发病的危险因素。对于 ACT 预测的 2 年 DR 发病，十倍交叉验证后平均曲线下面积为 0.55（p=0.048）。ACT 的加入并不能提高 DM 病程、BMI、血糖和 HbA1C 对 DR 发病的鉴别能力（Z=0.48；p=0.63）。