延长区视网膜血管口径与 1 型糖尿病青少年糖尿病视网膜病变风险的关系。

Extended-Zone Retinal Vascular Caliber and Risk of Diabetic Retinopathy in Adolescents with Type 1 Diabetes.

机构信息

Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia; Department of Paediatrics, Campbelltown Hospital, Campbelltown, Australia.

Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, Australia.

出版信息

Ophthalmol Retina. 2020 Dec;4(12):1151-1157. doi: 10.1016/j.oret.2020.05.009. Epub 2020 May 21.

DOI:10.1016/j.oret.2020.05.009

PMID:32446907

Abstract

PURPOSE

Retinal vascular caliber has been linked to diabetic retinopathy (DR). Newer imaging technologies allow analysis of retinal vascular caliber beyond the standard areas surrounding the optic disc. We investigated the vascular caliber in extended zones in prediction of DR in adolescents with type 1 diabetes.

DESIGN

Prospective, longitudinal study.

PARTICIPANTS

Adolescents (n = 904) who attended the diabetes complications assessment service at the Children's Hospital at Westmead.

METHODS

Retinal caliber was assessed from baseline retinal photographs with a semiautomated computer software Singapore I Vessel Assessment: standard zone retinal vessel calibers were summarized as central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE), and extended-zone vessels (>2 disc diameters from the optic disc margin) were summarized as mean width of arterioles (MWa) and mean width of venules (MWv).

MAIN OUTCOME MEASURES

Retinal vessel calibers at baseline (upper 3 quartiles vs. lowest quartiles [Q2-4 vs. Q1]) and moderate DR (stage 3 or more) were analyzed using multivariate generalized estimating equations, with results expressed as odds ratios (OR) and 95% confidence intervals (CIs).

RESULTS

Among the 904 participants, baseline mean age ± standard deviation was 14.0 ± 1.5 years, hemoglobin A1C (HbA1C) level was 8.5 ± 1.3%, and median diabetes duration 4.6 years. After a median 3-year follow-up, 15% of adolescents demonstrated moderate DR. Wider extended-zone retinal arteriolar caliber (MWa; OR, 3.6 [95% CI, 2.06-6.1], comparing Q2-4 vs. Q1) and venular caliber (MWv; OR, 4.2 [95% CI, 2.2-7.5]) predicted moderate DR after adjusting for HbA1C and blood pressure. Standard zone CRAE and CRVE were not associated with moderate DR.

CONCLUSIONS

Extended-zone retinal vessel caliber predicts moderate DR in adolescents with type 1 diabetes.

摘要

目的

视网膜血管口径与糖尿病视网膜病变（DR）有关。较新的成像技术允许分析视盘周围标准区域以外的视网膜血管口径。我们研究了在青少年 1 型糖尿病中预测 DR 的扩展区域的血管口径。

设计

前瞻性、纵向研究。

参与者

参加 Westmead 儿童医院糖尿病并发症评估服务的青少年（n=904）。

方法

使用半自动计算机软件新加坡 I 血管评估从基线视网膜照片评估视网膜口径，总结标准区域视网膜血管口径为中心视网膜小动脉当量（CRAE）和中心视网膜小静脉当量（CRVE），扩展区域血管（距视盘边缘>2 个视盘直径）总结为小动脉平均宽度（MWa）和小静脉平均宽度（MWv）。

主要观察指标

使用多变量广义估计方程分析基线时（上 3 个四分位数与最低四分位数 [Q2-4 与 Q1]）和中度 DR（3 期或更高级别）的视网膜血管口径，结果表示为比值比（OR）和 95%置信区间（CI）。

结果

在 904 名参与者中，基线平均年龄±标准差为 14.0±1.5 岁，糖化血红蛋白（HbA1C）水平为 8.5±1.3%，中位糖尿病病程 4.6 年。中位 3 年随访后，15%的青少年出现中度 DR。更宽的扩展区域视网膜小动脉口径（MWa；OR，3.6[95%CI，2.06-6.1]，比较 Q2-4 与 Q1）和小静脉口径（MWv；OR，4.2[95%CI，2.2-7.5]）在调整 HbA1C 和血压后预测中度 DR。标准区 CRAE 和 CRVE 与中度 DR 无关。