糖尿病控制对青光眼患者结构和功能丧失率的影响。
Effect of Diabetes Control on Rates of Structural and Functional Loss in Patients with Glaucoma.
机构信息
Vision, Imaging, and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina.
Vision, Imaging, and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina; Department of Statistical Science and Forge, Duke University, Durham, North Carolina.
出版信息
Ophthalmol Glaucoma. 2021 Mar-Apr;4(2):216-223. doi: 10.1016/j.ogla.2020.09.013. Epub 2020 Sep 19.
PURPOSE
To investigate the association between levels of diabetes mellitus (DM) control and rates of visual field and retinal nerve fiber layer (RNFL) loss over time in glaucoma.
DESIGN
Retrospective cohort study.
PARTICIPANTS
A total of 351 eyes of 222 patients with type 2 DM with concomitant primary open-angle glaucoma (POAG) or suspected glaucoma extracted from the Duke Glaucoma Registry.
METHODS
All patients had at least 2 reliable standard automated perimetry (SAP) tests, 2 spectral domain OCT (SD-OCT) tests, and 2 glycated hemoglobin (HbA1c) measures over time with a minimum follow-up of 6 months. Values of HbA1c were summarized for each patient as mean, peak, and fluctuation across time. Multivariable linear mixed models were used to estimate the effect of HbA1c on rates of change in SAP mean deviation (MD) and OCT RNFL thickness loss over time while adjusting for various confounding factors.
MAIN OUTCOME MEASURES
Rates of change in MD and RNFL thickness over time.
RESULTS
Subjects had a mean baseline age of 62.5 ± 10.2 years and follow-up time of 6.9 ± 5.1 years. Subjects had an average of 4.8 SAP tests (range, 2-28), 3.6 SD-OCT tests (range, 2-10), and 8.3 HbA1c tests (range, 2-21). Average HbA1c mean was 7.1% ± 1.1% (range, 5.4-11.7), peak HbA1c over time was 8.1% ± 2% (range, 5.5-15.6), and HbA1c fluctuation was 0.6% ± 0.6% (range, 0-4.4). Mean rate of SAP MD change was -0.09 ± 0.20 decibel/year (median -0.06 decibel/year; interquartile range -0.15 to 0.01 decibel/year), and mean rate of RNFL change was -0.83 ± 0.51 μm/year (median -0.76 μm/year; interquartile range -1.06 to 0.56 μm/year). After adjustment for confounding factors, mean, peak, and fluctuation in HbA1c levels were not significantly associated with rates of MD change over time (P = 0.994, P = 0.689, P = 0.920, respectively), nor were rates of change in RNFL loss over time (P = 0.805, P = 0.575, P = 0.770).
CONCLUSIONS
We did not find a significant association between diabetes control, as measured by levels of HbA1c, and rates of visual field or RNFL loss over time in individuals with glaucoma or suspected glaucoma.
目的
探讨糖尿病（DM）控制水平与青光眼患者随时间推移的视野和视网膜神经纤维层（RNFL）丢失率之间的关系。
设计
回顾性队列研究。
参与者
从杜克青光眼登记处中提取了 222 名患有 2 型糖尿病合并原发性开角型青光眼（POAG）或疑似青光眼的患者的 351 只眼。
方法
所有患者均至少有 2 次可靠的标准自动视野计（SAP）检查、2 次光谱域 OCT（SD-OCT）检查和 2 次糖化血红蛋白（HbA1c）测量，随访时间至少为 6 个月。将每位患者的 HbA1c 值汇总为平均值、峰值和随时间的波动。使用多变量线性混合模型，在调整各种混杂因素的情况下，估计 HbA1c 对 SAP 平均偏差（MD）和 OCT RNFL 厚度随时间变化的速率的影响。
主要观察指标
随时间变化的 MD 和 RNFL 厚度的变化率。
结果
受试者的平均基线年龄为 62.5 ± 10.2 岁，随访时间为 6.9 ± 5.1 年。受试者平均进行了 4.8 次 SAP 测试（范围为 2-28）、3.6 次 SD-OCT 测试（范围为 2-10）和 8.3 次 HbA1c 测试（范围为 2-21）。平均 HbA1c 平均值为 7.1% ± 1.1%（范围为 5.4-11.7），HbA1c 随时间的峰值为 8.1% ± 2%（范围为 5.5-15.6），HbA1c 波动为 0.6% ± 0.6%（范围为 0-4.4）。SAP MD 变化的平均速率为-0.09 ± 0.20 分贝/年（中位数为-0.06 分贝/年；四分位距为-0.15 至 0.01 分贝/年），RNFL 变化的平均速率为-0.83 ± 0.51 μm/年（中位数为-0.76 μm/年；四分位距为-1.06 至 0.56 μm/年）。在调整混杂因素后，HbA1c 水平的平均值、峰值和波动与 MD 随时间变化的速率均无显著相关性（P=0.994、P=0.689、P=0.920），RNFL 损失随时间变化的速率也无显著相关性（P=0.805、P=0.575、P=0.770）。
结论
我们未发现 HbA1c 水平所衡量的糖尿病控制与青光眼或疑似青光眼患者随时间推移的视野或 RNFL 丢失率之间存在显著关联。
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