Chen Xinyi, Yang Wendy, Fong Ashley, Chahal Noor, Taha Abu T, Keenan Jeremy D, Stewart Jay M
Department of Ophthalmology, University of California, San Francisco, San Francisco, California.
Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.
Ophthalmol Sci. 2024 Jul 18;4(6):100580. doi: 10.1016/j.xops.2024.100580. eCollection 2024 Nov-Dec.
To investigate sex-based differences in inflammation-related biomarkers on spectral-domain OCT.
Cross-sectional study.
Patients with diabetic macular edema (DME) between February 1, 2019, and March 31, 2023, without intravitreal anti-VEGF injection within the previous 6 months.
We reviewed each patient's medical record for age, biological sex, race and ethnicity, most recent glycated hemoglobin A1c (HbA1c) level, visual acuity (VA), and central macular thickness (CMT). OCT biomarkers that have been found in literature to be associated with inflammation, including disorganization of retinal inner layers (DRIL), retinal hyperreflective retinal foci (HRFs), hyperreflective choroidal foci (HCFs), subfoveal neuroretinal detachment (SND), and perturbation in retinal nerve fiber layer thickness, ganglion cell layer thickness, and inner nuclear layer (INL) thickness were evaluated by graders masked to the clinical characteristics of the patients. We performed multivariable regression analyses with the OCT biomarkers as the outcome variables and sex, age, HbA1c, and CMT as independent variables.
OCT inflammation-related biomarkers, as listed above.
Female patients were, on average, 2 years older than male patients ( = 0.041). There were no significant differences in race and ethnicity, HbA1c, VA, or CMT between male and female patients. After controlling for age, HbA1c, and CMT, we found male sex to be associated with more HRF (incidence rate ratio [IRR] = 1.19; 95% confidence interval [CI] = 1.10-1.29), more HCF (odds ratio = 2.01; 95% CI = 1.12-3.64), and thicker INL (7 μm thicker in males; 95% CI = 2-12). Sex was not a significant predictor for either DRIL or SND in the multivariable regression models. Patients with higher HbA1c were more likely to have more HRF (IRR = 1.02 per 1 point increase; 95% CI = 1.00-1.04) after controlling for other factors.
Male sex was correlated with more inflammation-related biomarkers on OCT including more HRF, more HCF, and thicker INL, after accounting for age, glycemic control, and amount of DME. Further studies are needed to evaluate the potential implications of these sex-based differences for individualized treatment.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
研究光谱域光学相干断层扫描（OCT）上炎症相关生物标志物的性别差异。
横断面研究。
2019年2月1日至2023年3月31日期间患有糖尿病性黄斑水肿（DME）且在过去6个月内未接受玻璃体内抗VEGF注射的患者。
我们查阅了每位患者的病历，记录其年龄、生物学性别、种族和民族、最近的糖化血红蛋白A1c（HbA1c）水平、视力（VA）和中心黄斑厚度（CMT）。由对患者临床特征不知情的分级人员评估文献中发现与炎症相关的OCT生物标志物，包括视网膜内层紊乱（DRIL）、视网膜高反射灶（HRF）、脉络膜高反射灶（HCF）、黄斑下神经视网膜脱离（SND）以及视网膜神经纤维层厚度、神经节细胞层厚度和内核层（INL）厚度的扰动。我们以OCT生物标志物为结果变量，以性别、年龄、HbA1c和CMT为自变量进行多变量回归分析。
上述OCT炎症相关生物标志物。
女性患者平均比男性患者大2岁（P = 0.041）。男性和女性患者在种族和民族、HbA1c、VA或CMT方面无显著差异。在控制年龄、HbA1c和CMT后，我们发现男性与更多的HRF相关（发病率比[IRR]=1.19；95%置信区间[CI]=1.10 - 1.29）、更多的HCF相关（优势比=2.01；95% CI = 1.12 - 3.64）以及更厚的INL（男性厚7μm；95% CI = 2 - 12）。在多变量回归模型中，性别不是DRIL或SND的显著预测因素。在控制其他因素后，HbA1c较高的患者更有可能有更多的HRF（每增加1个单位IRR = 1.02；95% CI = 1.00 - 1.04）。
在考虑年龄、血糖控制和DME程度后，男性在OCT上与更多炎症相关生物标志物相关，包括更多的HRF、更多的HCF和更厚的INL。需要进一步研究评估这些性别差异对个体化治疗的潜在影响。
本文末尾的脚注和披露中可能包含专有或商业披露信息。
