Department of Ophthalmology, Donostia University Hospital, Paseo Dr Beguiristain S/N, 20014, Donostia San-Sebastian, Gipuzkoa, Spain.
Department of Endocrinology, Donostia Universitary Hospital, Donostia-San Sebastian, Gipuzkoa, Spain.
Int Ophthalmol. 2023 Jun;43(6):2049-2056. doi: 10.1007/s10792-022-02604-y. Epub 2022 Dec 13.
Diabetic macular edema (DME) presents a suboptimal response to antiangiogenic treatment in approximately 30% of patients. We analyzed the relationship between renal function and response to antiangiogenic therapy in patients with DME.
A total of 367 patients were collected and distributed into three main groups: uncomplicated diabetic retinopathy (DR) group (n = 97), proliferative diabetic retinopathy (PDR) group (n = 94) and DME group (n = 175). Likewise, patients with DME were divided into two groups: responders to antiangiogenic drugs (n = 96) and non-responders to antiangiogenic drugs (n = 79). Age, type of diabetes, arterial hypertension (AHT), creatinine, HbA1c, albuminuria and glomerular filtration rate were analyzed. In the statistical analysis, chi-square test and t student were used to compare each group. The relationship between albuminuria and response to treatment in the DME group was studied with a binary logistic regression model, estimating odds ratio and their confidence intervals.
There are differences between the three main groups in terms of the presence or not of albuminuria. The presence of albuminuria is greater in the group of patients with more severe DR (PDR and DME), compared to the uncomplicated DR group (p < 0.009). In the logistic regression analysis model, a positive relationship was found and the odds ratio for the albuminuria variable and is 2.78 (CI: 1.42-5.36).
The presence of albuminuria is associated with a higher degree of DR and worse response to antiangiogenic therapy in patients with DME in our series. Multidisciplinary teams would be necessary to reduce albuminuria and thus optimize the treatment of patients with DME.
大约 30%的糖尿病黄斑水肿 (DME) 患者对抗血管生成治疗的反应不理想。我们分析了肾功能与 DME 患者抗血管生成治疗反应之间的关系。
共收集了 367 例患者，分为三组：单纯糖尿病视网膜病变 (DR) 组 (n=97)、增殖性糖尿病视网膜病变 (PDR) 组 (n=94)和 DME 组 (n=175)。同样，DME 患者也分为两组：抗血管生成药物治疗反应者 (n=96)和无反应者 (n=79)。分析年龄、糖尿病类型、动脉高血压 (AHT)、肌酐、HbA1c、蛋白尿和肾小球滤过率。在统计分析中，采用卡方检验和 t 检验比较各组间差异。用二元逻辑回归模型研究 DME 组蛋白尿与治疗反应的关系，估计优势比及其置信区间。
三组间是否存在蛋白尿存在差异。与单纯 DR 组相比，DR 更严重的患者（PDR 和 DME）蛋白尿的发生率更高 (p<0.009)。在逻辑回归分析模型中，发现了一种正相关关系，蛋白尿变量的优势比为 2.78(CI：1.42-5.36)。
在我们的研究中，存在蛋白尿与更高程度的 DR 及 DME 患者对抗血管生成治疗的反应较差相关。需要多学科团队来降低蛋白尿，从而优化 DME 患者的治疗。
