糖尿病患者眼轴长度与糖尿病视网膜病变关系的探讨

Relationship between Axial Length and Diabetic Retinopathy

目的:评估糖尿病(DM)患者眼轴长度与糖尿病视网膜病变(DR)的关系。方法:回顾性2018年1月-2019年8月的DM患者临床资料,通过IOL master收集患者眼轴长度,根据其糖尿病视网膜分期,选取一眼得到无DR(no DR)组、非增殖性DR(NPDR)组和增殖性DR(PDR)组。对各组DM相关危险因素和眼轴长度进行统计分析,纳入眼轴长度及统计检验中P<0.1的因素进行多因素logistic回归分析。结果:本研究共收集患者399例,其中no DR组172例(43%)、NPDR组189例(47%)和PDR组38例(10%)。统计分析结果,糖尿病病程、高血压和心血管疾病在三组间的差异有统计学意义(P<0.05),NPDR组和PDR组的糖尿病病程、高血压及心血管疾病患病率明显高于no DR组。眼轴长度(AL)在no DR组、NPDR组和PDR组差异有统计学差异(P<0.001)。在logistic回归模型中,DM病程、高血压、心血管疾病和糖基化血红蛋白(HbA1c)均与NPDR和PDR的发病相关(P<0.001)。与no DR组相比,NPDR(OR:0.699,P<0.001,95%CI:0.664-0.735,AL每增长1 mm)组和PDR组(OR:0.404,P<0.001,95%CI:0.366-0.445,AL每增长1 mm)的眼轴长度都更短。结论:眼轴长度与DR的发生有明显的相关性,DM患者眼轴越长发生NPDR和PDR的可能性越低。

Objective:To explore the relationship between the axial length(AL)and the progress of diabetic retinopathy(DR)in patients with diabetes mellitus(DM).Methods:The clinical data of patients with DM were retrospectivelyanalyzed.According to the stage of DR,patients were divided intono DR group,non-proliferative DR(NPDR)group and proliferative DR(PDR)group.The AL was measured by IOL master,and one eye was randomly selected from each case if both eyes were in the same DR stage,or the worse eye if the two eyes were in different stage.AL,DM duration,hypertension,cardiovascular disease,dyslipidemia and HbA1c level were collected from subjects.Statistical methods were used to evaluate differences of all potential risk factors among no DR,DR and PDR group.Multivariate logistic regression models were built to further study the difference of AL as well as other factors with p value<0.1 among the three groups.Results:399 patients with DM were enrolled in the study.There were 172(43%)patients in the no DR group,189(47%)in the NPDR group and 38(10%)in the PDR group.DM duration,hypertension and cardiovascular disease were positively associated with DR situation(P<0.05).AL showed a downward trend among no DR group,NPDR group and PDR group(P<0.001).In the multivariate logistic regression models,DM duration,hypertension,cardiovascular disease,HbA1c and AL were associated with the development of NPDR and PDR(P<0.001).Patients with longer AL were less likely to have NPDR(OR:0.699;P<0.001;95%CI:0.664-0.735,per millimeter increase)or PDR(OR:0.404;P<0.001;95%CI:0.366-0.445,per millimeter increase).Conclusion:This study suggested that DM patients with longer AL were less likely to develop DR.