影响糖尿病患者角膜生物力学的因素。

Factors Influencing Corneal Biomechanics in Diabetes Mellitus.

机构信息

Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.

出版信息

Cornea. 2020 May;39(5):552-557. doi: 10.1097/ICO.0000000000002275.

DOI:10.1097/ICO.0000000000002275

PMID:32044826

Abstract

PURPOSE

Diabetes mellitus (DM) induces changes in corneal biomechanical properties. The influence of disease-specific factors was evaluated, and a novel DM index was created.

METHODS

Eighty-one patients with DM and 75 healthy subjects were matched according to age, intraocular pressure, and central corneal thickness. Information on the disease was collected, and measurements with the Ocular Response Analyzer and the Corvis ST were taken. Results were compared between the groups, and the influence of disease-specific factors was evaluated. From dynamic corneal response parameters, a DM index was calculated.

RESULTS

In DM, corneal hysteresis was higher than in healthy subjects (10.5 ± 1.9 vs. 9.7 ± 1.9 mm Hg, P = 0.008). In addition, dynamic corneal response parameters showed significant differences. Among others, highest concavity (HC) (17.212 ± 0.444 vs. 16.632 ± 0.794 ms, P < 0.001) and A2 time (21.85 ± 0.459 vs. 21.674 ± 0.447 ms, P = 0.017) as well as A1 (0.108 ± 0.008 vs. 0.104 ± 0.011 mm, P = 0.019) and A2 deflection amplitudes (0.127 ± 0.014 vs. 0.119 ± 0.014 mm, P < 0.001) were increased in DM. In DM type 1, HC deformation amplitude (1.14 ± 0.19 vs. 1.095 ± 0.114 mm, P = 0.035) was higher than in type 2. The time of deflection amplitude max correlated with the severity of retinopathy (R = 0.254, P= 0.023). In case of diabetic maculopathy, A1 velocity (0.155 ± 0.018 vs. 0.144 ± 0.019 ms, P = 0.043) and A2 time (22.052 ± 0.395 vs. 21.79 ± 0.46 ms, P = 0.04) were increased. Deformation amplitude max (R = 0.297, P = 0.024), HC time (R = 0.26, P = 0.049), HC deformation amplitude (R = 0.297, P = 0.024), and A2 deformation amplitude (R = 0.276, P = 0.036) were associated to disease duration. The DM index revealed a sensitivity of 0.773 and a specificity of 0.808 (area under the curve of receiver operating characteristic = 0.833).

CONCLUSIONS

In DM, changes in corneal biomechanics were correlated with disease-specific factors. The DM index achieved reliable sensitivity and specificity values.

摘要

目的

糖尿病（DM）可引起角膜生物力学特性的变化。本研究评估了疾病特异性因素的影响，并创建了一种新的 DM 指数。

方法

将 81 例 DM 患者和 75 例健康对照者按照年龄、眼内压和中央角膜厚度进行匹配。收集疾病相关信息，并使用眼反应分析仪和角膜生物力学分析仪进行测量。比较两组间的结果，并评估疾病特异性因素的影响。从动态角膜反应参数中计算出 DM 指数。

结果

DM 组的角膜滞后值高于健康对照组（10.5 ± 1.9 比 9.7 ± 1.9mmHg，P = 0.008）。此外，动态角膜反应参数也存在显著差异。其中，最高凹陷度（HC）（17.212 ± 0.444 比 16.632 ± 0.794ms，P<0.001）和 A2 时间（21.85 ± 0.459 比 21.674 ± 0.447ms，P = 0.017）以及 A1（0.108 ± 0.008 比 0.104 ± 0.011mm，P = 0.019）和 A2 变形幅度（0.127 ± 0.014 比 0.119 ± 0.014mm，P<0.001）均升高。1 型 DM 患者的 HC 变形幅度（1.14 ± 0.19 比 1.095 ± 0.114mm，P = 0.035）高于 2 型。变形幅度最大值的时间与视网膜病变的严重程度相关（R = 0.254，P= 0.023）。在糖尿病性黄斑病变患者中，A1 速度（0.155 ± 0.018 比 0.144 ± 0.019ms，P = 0.043）和 A2 时间（22.052 ± 0.395 比 21.79 ± 0.46ms，P = 0.04）均升高。最大变形幅度（R = 0.297，P = 0.024）、HC 时间（R = 0.26，P = 0.049）、HC 变形幅度（R = 0.297，P = 0.024）和 A2 变形幅度（R = 0.276，P = 0.036）与疾病持续时间相关。DM 指数的敏感性为 0.773，特异性为 0.808（受试者工作特征曲线下面积 = 0.833）。