Thinner Average Choroidal Thickness Is a Risk Factor for the Onset of Diabetic Retinopathy
Thinner Average Choroidal Thickness Is a Risk Factor for the Onset of Diabetic Retinopathy
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平均脉络膜厚度较薄是糖尿病视网膜病变发病的危险因素
DOI：
10.1159/000504756
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发表时间：
2020-02
影响因子：
2.1
通讯作者：
Haidong Zou
中科院分区：
文献类型：
--
作者：
Xiaobo Huang;Pei Zhang;Xinrong Zou;Yi Xu;Jianfeng Zhu;Jiangnan He;Bo Zhang;Lina Lu;Haidong Zou
用途：分析社区2型糖尿病患者脉络膜厚度（CT）与糖尿病（DM）、糖尿病视网膜病变（DR）及DR严重程度的关系，探讨CT是否能提高其他危险因素对DR发生率的预测能力。2016年，上海市新景社区共有1,250名2型糖尿病居民和1,027名健康对照者参加了眼科疾病的横断面调查。使用扫频光源光学相干断层扫描测量CT。根据2002年国际DR临床分类标准对DR进行分类，对2016年调查时未发生DR的537例2型DM受试者进行2018年随访，调查DR的2年发生率，采用受试者工作特征曲线分析法检验不同指标预测DR发生的准确性。对照组、无DR组、轻度非增殖性DR（NPDR）组、中度NPDR组、重度NPDR组和PDR组的中心CT分别为223.40、216.22、213.57、211.91、178.47和168.15 μm平均CT（ACT）分别为197.83、186.94、182.03、178.00、156.91和136.72 μm（趋势p <0.001）。体重指数（BMI）、DM病程、空腹血糖、糖化血红蛋白（HbA 1C）和ACT是2年DR发生率的危险因素。对于DR的发作，如ACT所预测的，在10倍交叉验证后，曲线下平均面积为0.55（p = 0.048）。ACT的增加并没有改善糖尿病病程、BMI、血糖和HbA 1C对DR发生率的区分能力（Z = 0.48; p = 0.63）。结论：随着DR严重程度的增加，社区2型DM患者的CT较健康对照组呈明显下降趋势。ACT较薄是DR发生的危险因素，但不能提高其他危险因素对DR发生的预测能力。
Purpose: To analyze the relationships between choroidal thickness (CT) and diabetes mellitus (DM), diabetic retinopathy (DR), and DR severity in community residents diagnosed with type 2 DM, and to explore whether CT can improve the discriminatory ability of other risk factors to predict the incidence of DR. Methods: A total of 1,250 type 2 DM residents and 1,027 healthy controls in Xinjing community of Shanghai participated a cross-sectional survey of eye diseases in 2016. CT was measured using swept-source optical coherence tomography. DR was classified according to the 2002 international clinical classification of DR. A total of 537 subjects with type 2 DM without DR at the 2016 survey were followed up in 2018 to investigate the 2-year incidence of DR. Receiver operating characteristic curve analysis was used to test the accuracy of different indicators in predicting the onset of DR. Results: The central CT of the control, no DR, mild non-proliferative DR (NPDR), moderate NPDR, severe NPDR, and PDR groups were 223.40, 216.22, 213.57, 211.91, 178.47, and 168.15 μm, respectively (p for trend <0.001), and the average CT (ACT) were 197.83, 186.94, 182.03, 178.00, 156.91, and 136.72 μm respectively (p for trend <0.001). Body mass index (BMI), DM duration, fasting blood glucose, glycosylated hemoglobin (HbA1C), and ACT were risk factors for 2-year DR incidence. For the onset of DR, as predicted by ACT, after tenfold cross validation the average area under the curve was 0.55 (p = 0.048). Addition of ACT did not improve the discriminatory ability of DM duration, BMI, glucose and HbA1C on the incidence of DR (Z = 0.48; p = 0.63). Conclusions: As the severity of DR increased, the CT of community type 2 DM patients showed a significant downward trend compared with the healthy controls. Thinner ACT was found to be a risk factor for DR incidence, but it did not improve the discriminatory ability of other risk factors to predict the incidence of DR.
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