Retinal vascular changes and 20-year incidence of lower extremity amputations in a cohort with diabetes
Retinal vascular changes and 20-year incidence of lower extremity amputations in a cohort with diabetes
复制标题
DOI：
10.1001/archinte.163.20.2505
复制
发表时间：
2003-11-10
影响因子：
--
通讯作者：
Wong, TY
中科院分区：
文献类型：
--
作者：
Moss, SE;Klein, R;Wong, TY
目的：探讨糖尿病患者视网膜血管改变与下肢截肢（LEAs）发生率的关系。方法：对996名30岁前诊断为糖尿病并使用胰岛素的患者进行基线检查。在基线、4岁、10岁、14岁和20岁时获得LEA病史。用产品限法计算906例有随访资料的人20年首次LEA的累计发病率。视网膜小动脉和小静脉在基线时通过标准方案获得的数字化眼底照片上进行测量。全身性小动脉狭窄被定义为小动脉-小静脉比例最低的25%。对820人的至少一只眼睛进行了测量。局部小动脉狭窄和动静脉切口也通过标准方案从眼底照片确定。结果：LEAs 20年累积发病率为9.9%。广泛性小动脉狭窄患者发生LEA的未调整风险高于无广泛性小动脉狭窄患者（15.7% vs 5.7%；优势比[OR]， 3.08； 95%可信区间[CI]， 1.60-4.68）和局灶性小动脉狭窄患者（33.1% vs 6.8%； OR, 5.59; 95% CL 3.27-9.54）。动静脉划伤的结果不显著。对照年龄、性别、糖化血红蛋白水平、舒张压和足部溃疡史，相关性减弱，但在全局性狭窄（OR, 1.89; 95% CL 1.06-3.35）和局灶性狭窄（OR, 3.56-195% CL 1.87-6.78）方面仍具有统计学意义。结论：在糖尿病患者中，全身性和局灶性视网膜小动脉狭窄可能反映了微血管的损伤，这在身体的其他部位表现为需要LEAs。
Objective: To examine the association of retinal vascular changes with the incidence of lower extremity amputations (LEAs) in a cohort with diabetes mellitus.Methods: Baseline examinations were performed in a cohort of 996 persons with diabetes diagnosed before the age of 30 years and using insulin. History of LEA was obtained at baseline and at 4, 10, 14, and 20 years. The cumulative 20-year incidence of first LEA was calculated by the product-limit method in 906 persons with follow-up information. Retinal arterioles and venules were measured on digitized fundus photographs obtained at baseline by a standard protocol. Generalized arteriolar narrowing was defined as the lowest 25% of the arteriole-venule ratio. Measurements were obtained in at least one eye for 820 persons. Focal arteriolar narrowing and arteriovenous nicking were also determined from fundus photographs by a standard protocol.Results: The 20-year cumulative incidence of LEAs was 9.9%. The unadjusted risk of undergoing a LEA was higher in persons with generalized arteriolar narrowing than in those without it (15.7% vs 5.7%; odds ratio [OR], 3.08; 95% confidence interval [CI], 1.60-4.68), and in persons with focal narrowing (33.1% vs 6.8%; OR, 5.59; 95% CL 3.27-9.54). The results for arteriovenous nicking were not significant. With control for age, sex, levels of glycosylated hemoglobin, diastolic blood pressure, and history of ulcers of the feet, the relationships were attenuated but still statistically significant for both generalized narrowing (OR, 1.89; 95% CL 1.06-3.35) and focal narrowing (OR, 3.56-195% CL 1.87-6.78).Conclusion: In persons with diabetes, generalized as well as focal retinal arteriolar narrowing may reflect damage to the microvasculature, which manifests itself elsewhere in the body as a need for LEAs.