Retinal vascular fractals predict long-term microvascular complications in type 1 diabetes mellitus: the Danish Cohort of Pediatric Diabetes 1987 (DCPD1987)
Retinal vascular fractals predict long-term microvascular complications in type 1 diabetes mellitus: the Danish Cohort of Pediatric Diabetes 1987 (DCPD1987)
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DOI：
10.1007/s00125-014-3317-6
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发表时间：
2014-10-01
期刊：
影响因子：
8.2
通讯作者：
Grauslund, Jakob
中科院分区：
文献类型：
--
作者：
Broe, Rebecca;Rasmussen, Malin L.;Grauslund, Jakob
目的/假设视网膜血管的分形分析为视网膜血管的复杂性和密度提供了一个全局度量，总结为一个变量：分形维数。我们研究了分形维数作为1型糖尿病微血管病变的长期预测因子。方法对180例1型糖尿病患者进行为期16年的随访研究。在基线视网膜照片（1995年）中，使用新加坡研究所血管评估-分形图像分析软件追踪了距椎间盘边缘0.5-2.0椎间盘直径区域内的所有血管。通过认证的分级器去除伪影，并使用盒计数法计算分形维数。在2011年的随访中，对糖尿病性神经病变、肾病和增生性视网膜病变进行了评估，并在多重回归中与基线分形维数相关，经性别和基线年龄、糖尿病病程、HbA（1c）、BP、BMI、振动感知阈值、蛋白尿、视网膜病变和血管直径校正。结果平均基线年龄和糖尿病病程分别为21.0岁和13.4岁，50.0%为男性。平均分形维数为1.3817。16年神经病变、肾病和增生性视网膜病变的发生率分别为10.8%、8.0%和27.9%。多元回归分析显示，较低的分形维数可显著预测神经病变（比值为1.17 / 0.01分形维数减少[95% CI 1.01, 1.36]）、肾病（比值为1.40 / 0.01分形维数减少[95% CI 1.10, 1.79]）和增生性视网膜病变（比值为1.22 / 0.01分形维数减少[95% CI 1.09, 1.37]）的发生。结论/解释视网膜血管分形维数是糖尿病微血管病变的共同生物标志物，提示可能存在共同的致病途径。因此，视网膜分形分析是1型糖尿病风险分层的潜在工具。
Aims/hypothesis Fractal analysis of the retinal vasculature provides a global measure of the complexity and density of retinal vessels summarised as a single variable: the fractal dimension. We investigated fractal dimensions as long-term predictors of microvasculopathy in type 1 diabetes.Methods We included 180 patients with type 1 diabetes in a 16 year follow-up study. In baseline retinal photographs (from 1995), all vessels in a zone 0.5-2.0 disc diameters from the disc margin were traced using Singapore Institute Vessel Assessment-Fractal image analysis software. Artefacts were removed by a certified grader, and fractal dimensions were calculated using the box-counting method. At follow-up (in 2011), diabetic neuropathy, nephropathy and proliferative retinopathy were assessed and related to baseline fractal dimensions in multiple regressions adjusted for sex and baseline age, diabetes duration, HbA(1c), BP, BMI, vibration perception threshold, albuminuria, retinopathy and vessel diameters.Rusults Mean baseline age and diabetes duration were 21.0 and 13.4 years, respectively, and of patients 50.0% were males. The mean fractal dimension was 1.3817. The 16 year incidences of neuropathy, nephropathy and proliferative retinopathy were 10.8%, 8.0% and 27.9%, respectively. Multiple regression analyses showed a lower fractal dimension to significantly predict incident neuropathy (OR 1.17 per 0.01 fractal dimension decrease [95% CI 1.01, 1.36]), nephropathy (OR 1.40 per 0.01 fractal dimension decrease [95% CI 1.10, 1.79]) and proliferative retinopathy (OR 1.22 per 0.01 fractal dimension decrease [95% CI 1.09, 1.37]).Conclusion/interpretation The retinal vascular fractal dimension is a shared biomarker of diabetic microvasculopathy, thus indicating a possible common pathogenic pathway. Retinal fractal analysis therefore is a potential tool for risk stratification in type 1 diabetes.