Retinal vascular geometry and 6 year incidence and progression of diabetic retinopathy
Retinal vascular geometry and 6 year incidence and progression of diabetic retinopathy
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DOI：
10.1007/s00125-017-4333-0
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发表时间：
2017-09-01
期刊：
影响因子：
8.2
通讯作者：
Wong, Tien Yin
中科院分区：
文献类型：
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作者：
Cheung, Carol Yim-lui;Sabanayagam, Charumathi;Wong, Tien Yin
目的/假设我们的目的是前瞻性地研究视网膜血管几何变量之间的关联测量视网膜照片和6年的发病率和糖尿病retinopathy.Methods的进展，我们进行了一项前瞻性的，以人口为基础的队列研究，亚洲马来人年龄在40-80岁的基线（n = 3280）谁返回了6年的后续行动。使用计算机辅助程序（新加坡I血管评估）从基线视网膜照片测量视网膜血管几何变量（迂曲度、分支、分形维数、口径）。采用改良的Airlie House分类系统对基线和随访照片进行糖尿病视网膜病变分级。糖尿病视网膜病变的发生率定义为基线时无糖尿病视网膜病变的患者随访时严重程度≥ 15。在基线时没有或轻度非增殖性糖尿病视网膜病变的参与者中，可缓解的糖尿病视网膜病变的发生率定义为随访时中度或重度非增殖性糖尿病视网膜病变、增殖性糖尿病视网膜病变或糖尿病黄斑水肿。糖尿病视网膜病变进展定义为随访时严重程度增加≥ 2级。对数二项式模型与期望最大化算法被用来估计RR调整年龄，性别，糖尿病病程，HbA（1c）水平，BP，BMI，估计GFR和总和HDL-胆固醇在baseline.Results共427例糖尿病患者参加了基线和6年的随访检查。其中，19.2%、7.57%和19.2%的患者分别发生了糖尿病视网膜病变、可缓解性糖尿病视网膜病变和糖尿病视网膜病变进展。经多变量校正后，小动脉单纯迂曲度（平均RR [95%CI]，1.34 [1.04，1.74]）、小静脉分支角（RR 1.26 [1.00，1.59]）和小静脉分支系数（RR 1.26 [1.03，1.56]）较大与糖尿病视网膜病变的发生率相关。小动脉简单迂曲度（RR 1.82 [1.32，2.52]）、小静脉分支系数（RR 1.46 [1.03，2.07]）、小动脉分形维数（RR 1.59 [1.08，2.36]）和小动脉口径（RR 1.83 [1.15，2.90]）与糖尿病视网膜病变的发生率相关。小动脉单纯迂曲度增大（RR 1.34 [1.12，1.61]）与糖尿病视网膜病变进展相关。增加视网膜血管变量改善了辨别力（C-统计量0.796 vs 0.733，p = 0.031）和总体重新分类（重新分类净改善18.8%，p = 0.025）的任何糖尿病视网膜病变风险超出既定的危险因素。眼底照片测量的视网膜血管几何形状可预测成人糖尿病视网膜病变的发病率和进展糖尿病患者，除了已知的风险因素。
Aims/hypothesis We aimed to examine prospectively the association between a range of retinal vascular geometric variables measured from retinal photographs and the 6 year incidence and progression of diabetic retinopathy.Methods We conducted a prospective, population-based cohort study of Asian Malay individuals aged 40-80 years at baseline (n = 3280) who returned for a 6 year follow-up. Retinal vascular geometric variables (tortuosity, branching, fractal dimension, calibre) were measured from baseline retinal photographs using a computer-assisted program (Singapore I Vessel Assessment). Diabetic retinopathy was graded from baseline and follow-up photographs using the modified Airlie House classification system. Incidence of diabetic retinopathy was defined as a severity of = 15 at follow-up among those without diabetic retinopathy at baseline. Incidence of referable diabetic retinopathy was defined as moderate or severe non-proliferative diabetic retinopathy, pro-liferative diabetic retinopathy or diabetic macular oedema at follow-up in participants who had had no or mild non-proliferative diabetic retinopathy at baseline. Progression of diabetic retinopathy was defined as an increase in severity of = 2 steps at follow-up. Log-binomial models with an expectation-maximisation algorithm were used to estimate RR adjusting for age, sex, diabetes duration, HbA(1c) level, BP, BMI, estimated GFR and total and HDL-cholesterol at baseline.Results A total of 427 individuals with diabetes participated in the baseline and 6 year follow-up examinations. Of these, 19.2%, 7.57% and 19.2% developed incidence of diabetic retinopathy, incidence of referable diabetic retinopathy and diabetic retinopathy progression, respectively. After multivariate adjustment, greater arteriolar simple tortuosity (mean RR [95% CI], 1.34 [1.04, 1.74]), larger venular branching angle (RR 1.26 [1.00, 1.59]) and larger venular branching coefficient (RR 1.26 [1.03, 1.56]) were associated with incidence of diabetic retinopathy. Greater arteriolar simple tortuosity (RR 1.82 [1.32, 2.52]), larger venular branching coefficient (RR 1.46 [1.03, 2.07]), higher arteriolar fractal dimension (RR 1.59 [1.08, 2.36]) and larger arteriolar calibre (RR1.83 [1.15, 2.90]) were associated with incidence of referable diabetic retinopathy. Greater arteriolar simple tortuosity (RR 1.34 [1.12, 1.61]) was associated with diabetic retinopathy progression. Addition of retinal vascular variables improved discrimination (C-statistic 0.796 vs 0.733, p = 0.031) and overall reclassification (net reclassification improvement 18.8%, p = 0.025) of any diabetic retinopathy risk beyond established risk factors.Conclusions/interpretation Retinal vascular geometry measured from fundus photographs predicted the incidence and progression of diabetic retinopathy in adults with diabetes, beyond established risk factors.