Retinal arteriolar dilation predicts retinopathy in adolescents with type 1 diabetes
Retinal arteriolar dilation predicts retinopathy in adolescents with type 1 diabetes
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DOI：
10.2337/dc08-0189
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发表时间：
2008-09-01
期刊：
影响因子：
16.2
通讯作者：
Wong, Tien Yin
中科院分区：
文献类型：
--
作者：
Cheung, Ning;Rogers, Sophie L.;Wong, Tien Yin
目的：视网膜血管管径的改变可能反映早期亚临床微血管功能障碍。在这项研究中，我们研究了年轻的1型糖尿病患者中视网膜血管口径与视网膜病变的关系。研究设计和方法--这是一项前瞻性队列研究，研究对象为645名年龄在12-20岁之间的最初无视网膜病变的1型糖尿病患者。参与者在基线和随访时拍摄了双眼的七视野立体视网膜照片。视网膜血管口径是根据基线照片使用基于计算机的程序按照标准化方案进行测量的。根据随访照片中修改的Airlie House分类对事件视网膜病变进行分级。结果：在平均2.5年的随访期内，274名参与者发展为视网膜病变(14.8/100人年)。在调整了年龄、性别、糖尿病病程、血糖、平均动脉压、BMI和胆固醇水平后，较大的视网膜小动脉口径(第四个四分位数与第一个四分位数)与视网膜病变风险增加三倍以上(危险比3.44[95%可信区间2.08-5.66])。视网膜小动脉口径每增加一个SD，视网膜病变风险增加46%(1.46[1.22-1.74])。这种联系在女性参与者中比在男性参与者中更强。经过类似的调整后，视网膜静脉口径与视网膜病变的发生率并不一致。结论：视网膜小动脉扩张可预测年轻I型糖尿病患者视网膜病变的发展。我们的数据表明，微动脉功能障碍可能在早期糖尿病视网膜病变的发病机制中发挥关键作用，基于计算机的视网膜血管内径测量可能提供关于糖尿病微血管并发症风险的额外预后信息。
OBJECTIVE - Alterations in retinal vascular caliber may reflect early subclinical microvascular dysfunction. In this study, we examined the association of retinal vascular caliber to incident retinopathy in young patients with type 1 diabetes.RESEARCH DESIGN AND METHODS - This was a prospective cohort study of 645 initially retinopathy-free type 1 diabetic patients, aged 12-20 years. Participants had seven-field stereoscopic retinal photographs taken of both eyes at baseline and follow-up. Retinal vascular caliber was measured from baseline photographs using a computer-based program following a standardized protocol. Incident retinopathy was graded according to the modified Airlie House classification from follow-up photographs.RESULTS - Over a median follow-up of 2.5 years, 274 participants developed retinopathy (14.8 per 100 person-years). After adjustments for age, sex, diabetes duration, glycemia, mean arterial blood pressure, BMI, and cholesterol levels, larger retinal arteriolar caliber (fourth versus first quartile) was associated with a more than threefold higher risk of retinopathy (hazard rate ratio 3.44 [95% CI 2.08-5.66]). Each SD increase in retinal arteriolar caliber was associated with a 46% increase in retinopathy risk (1.46 [1.22-1.74]). This association was stronger in female than in male participants. After similar adjustments, retinal venular caliber was not consistently associated with incident retinopathy.CONCLUSIONS - Retinal arteriolar dilatation predicts retinopathy development in young patients with type I diabetes. Our data suggest that arteriolar dysfunction may play a critical role in the pathogenesis of early diabetic retinopathy and that computer-based retinal vascular caliber measurements may provide additional prognostic information regarding risk of diabetes microvascular complications.