房水中尿酸水平升高，而不是葡萄糖水平升高，是 2 型糖尿病患者糖尿病性黄斑水肿的危险因素。

ELEVATED LEVEL OF URIC ACID, BUT NOT GLUCOSE, IN AQUEOUS HUMOR AS A RISK FACTOR FOR DIABETIC MACULAR EDEMA IN PATIENTS WITH TYPE 2 DIABETES.

机构信息

Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.

Shantou University Medical College, Shantou, China.

出版信息

Retina. 2022 Jun 1;42(6):1121-1129. doi: 10.1097/IAE.0000000000003424.

DOI:10.1097/IAE.0000000000003424

PMID:35174802

Abstract

PURPOSE

To determine the association of uric acid (UA) and glucose in aqueous humor with diabetic macular edema (DME) in patients with Type 2 diabetes.

METHODS

Patients with DME or diabetes mellitus without retinopathy were enrolled from August 2016 to December 2020. Nondiabetic patients with age-related cataract or age-related macular degeneration were included as controls.

RESULTS

A total of 585 eyes from 585 patients were included for this study. Statistical analysis showed that aqueous UA was associated with central retinal thickness (r = 0.39, P < 0.0001), with higher levels of UA in severe DME and lower levels in mild DME, suggesting an ocular source of UA from the diabetic retina. Aqueous UA {odds ratio (OR), 6.88 (95% confidence interval [CI], 2.61-18.12)}, but not aqueous glucose (0.95 [95% CI, 0.73-1.23]) or serum UA (0.90 [95% CI, 0.66-1.23]), was a stronger predictor for DME than the duration of DM (1.26 [95% CI, 1.12-1.42]) or hemoglobin A1c (1.35 [95% CI, 0.99-1.83]). If aqueous UA (<2.46 mg/dL) and aqueous glucose (<6.43 mmol/L) were used as reference, high UA (≥2.46 mg/dL) alone was associated with 5.83-fold increase in risk of DME, but high glucose (≥6.43 mg/dL) alone was not associated with DME.

CONCLUSION

Increased aqueous UA, but not glucose, is an independent risk factor for DME. These data suggest that an intravitreal UA-lowering therapy could be beneficial for DME.

摘要

目的

确定 2 型糖尿病患者眼内液尿酸（UA）和葡萄糖与糖尿病性黄斑水肿（DME）的关系。

方法

纳入 2016 年 8 月至 2020 年 12 月期间患有 DME 或无视网膜病变的糖尿病患者。将年龄相关性白内障或年龄相关性黄斑变性的非糖尿病患者纳入对照组。

结果

本研究共纳入 585 例 585 只眼。统计分析显示，眼内液 UA 与中心视网膜厚度相关（r = 0.39，P < 0.0001），严重 DME 患者 UA 水平较高，轻度 DME 患者 UA 水平较低，提示 UA 来自糖尿病性视网膜。与 DM 持续时间（1.26 [95%CI，1.12-1.42]）或糖化血红蛋白（1.35 [95%CI，0.99-1.83]）相比，眼内液 UA（比值比 [OR]，6.88 [95%CI，2.61-18.12]）而不是眼内液葡萄糖（0.95 [95%CI，0.73-1.23]）或血清 UA（0.90 [95%CI，0.66-1.23]）是 DME 的更强预测因子。如果将眼内液 UA（<2.46 mg/dL）和眼内液葡萄糖（<6.43 mmol/L）作为参考，UA 升高（≥2.46 mg/dL）单独与 DME 风险增加 5.83 倍相关，而葡萄糖升高（≥6.43 mg/dL）单独与 DME 不相关。