Liu Kaiqun, Fu Yihang, Ye Mengmeng, Liu Riqian, Li Ting, Mao Yuxiang, Huang Wenyong
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China.
Department of Rheumatology and Immunology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
Eye (Lond). 2025 Jan;39(1):162-169. doi: 10.1038/s41433-024-03401-w. Epub 2024 Nov 12.
This prospective cohort study investigated the longitudinal relationship between hypertension (HTN), defined by the 2017 ACC/AHA guidelines, and changes in choroidal thickness (CT) in patients with type 2 diabetes.
Patients aged 30-80 years from the Guangzhou Diabetic Eye Study were categorized into non-HTN, stage 1-HTN, and stage 2-HTN groups based on BP criteria. Macular and parapapillary CT were measured using swept-source optical coherence tomography (SS-OCT). Mixed linear regression models analysed CT decline rates over a median 2.1-year follow-up, adjusting for confounders.
803 diabetes patients were included. Both stage 1-HTN and stage 2-HTN groups showed significantly thinner macular and parapapillary CT compared to non-HTN (all P < 0.05). Stage 2-HTN correlated with reduced macular CT thinning (coef = -11.29 μm/year; 95% CI, -22.36 to -0.22; P = 0.046) after adjustment, but not in the parapapillary area (coef = -4.07 μm/year; 95% CI, -12.89 to 4.74; P = 0.365). Subgroup analyses indicated faster macular CT decline in stage 2-HTN among those <65 years old (coef = -20.31 μm/year; 95% CI, -35.67 to -4.95; P = 0.10), males (coef = -14.1 μm/year; 95% CI, -32.54 to -4.33; P = 0.004), BMI ≥ 25 kg/m (coef = -10.24 μm/year; 95% CI, -26.86 to -6.38; P = 0.007), HbA1c > 6.5% (coef = -8.91 μm/year; 95% CI, -13.49 to -4.68; P = 0.001), and diabetes duration <10 years (coef = -12.78 μm/year; 95% CI, -27.48 to -1.91; P = 0.008).
Stage 2-HTN is associated with accelerated macular CT loss in diabetic patients, suggesting macular CT measurements could potentially serve as early indicators of systemic hypertension. Further research is needed to establish precise CT cutoff values for clinical use in detecting and monitoring hypertension-related ocular changes.
这项前瞻性队列研究调查了根据2017年美国心脏病学会/美国心脏协会（ACC/AHA）指南定义的高血压（HTN）与2型糖尿病患者脉络膜厚度（CT）变化之间的纵向关系。
来自广州糖尿病眼病研究的30 - 80岁患者根据血压标准分为非高血压组、1期高血压组和2期高血压组。使用扫频源光学相干断层扫描（SS - OCT）测量黄斑和视乳头旁CT。混合线性回归模型分析了在中位2.1年随访期间CT的下降率，并对混杂因素进行了调整。
纳入了803例糖尿病患者。与非高血压组相比，1期高血压组和2期高血压组的黄斑和视乳头旁CT均显著变薄（所有P < 0.05）。调整后，2期高血压与黄斑CT变薄减少相关（系数 = -11.29μm/年；95%置信区间，-22.36至-0.22；P = 0.046），但在视乳头旁区域不相关（系数 = -4.07μm/年；95%置信区间，-12.89至4.74；P = 0.365）。亚组分析表明，在65岁以下（系数 = -20.31μm/年；95%置信区间，-35.67至-4.95；P = 0.10）、男性（系数 = -14.1μm/年；95%置信区间，-32.54至-4.33；P = 0.004）、体重指数（BMI）≥25kg/m（系数 = -10.24μm/年；95%置信区间，-26.86至-6.38；P = 0.007）、糖化血红蛋白（HbA1c）>6.5%（系数 = -8.91μm/年；95%置信区间，-13.49至-4.68；P = 0.001）以及糖尿病病程<10年（系数 = -12.78μm/年；95%置信区间，-27.48至-1.91；P = 0.008）的2期高血压患者中，黄斑CT下降更快。
2期高血压与糖尿病患者黄斑CT加速丢失相关，提示黄斑CT测量可能作为系统性高血压的早期指标。需要进一步研究以确定用于检测和监测高血压相关眼部变化的临床应用中精确的CT临界值。
