近视与糖尿病视网膜病变的相关性

Study of the Association between Myopia and Diabetic Retinopathy

目的:利用双眼糖尿病视网膜病变(DR)程度的不对称性探讨近视与DR的相关性。方法:横断面研究。根据糖尿病早期治疗研究(ETDRS)标准,将抚顺糖尿病视网膜病变队列研究的患者进行DR与糖尿病性黄斑水肿(DME)分级。DR分级包括无DR、轻度非增殖性DR(NPDR)、中度NPDR、重度NPDR与增殖性DR(PDR)。纳入双眼DR程度至少相差1级(314例,628眼)或仅单眼DME(74例,148眼)的患者共388例(776眼)。近视与高度近视分别定义为等效球镜度(SE)<-1 D与<-5 D。采用配对t检验比较较好眼与较差眼间SE的差异,采用McNemar配对检验比较较好眼与较差眼间近视及高度近视比例的差异。结果:388例患者年龄(60.6±8.5)岁,其中男147例(37.9%)。双眼DR程度大多数相差1级(297例,76.5%)。较好眼的SE较对侧眼偏负[(-0.22±2.24)D与(0.00±1.95)D,t=3.01,P=0.003],较好眼高度近视比例高于对侧眼(4.4%与2.1%,χ^2=6.23,P=0.01)。按较好眼DR程度分组后,NPDR患者较好眼的SE较对侧眼偏负[(-0.37±2.76)D与(0.14±1.89)D,t=2.57,P=0.01],高度近视比例高于对侧眼(7.8%与1.1%,χ^2=6.00,P=0.01)。无DR患者以及DME患者中,较好眼与较差眼间各屈光参数差异均无统计学意义。结论:本研究利用双眼DR程度的不对称性,证实了高度近视与DR的负相关关系。

Objective:To investigate the association between myopia and diabetic retinopathy(DR)using the bilateral asymmetry of the DR level.Methods:This was a cross-sectional study.The DR and diabetic macular edema(DME)levels of patients from Fushun Diabetic Retinopathy Cohort Study(FS-DIRECT)were classified according to the standards of the early treatment diabetic retinopathy study(ETDRS).The DR levels included no DR,mild nonproliferative DR(NPDR),moderate NPDR,severe NPDR,and proliferative DR(PDR).A total of 388 patients(776 eyes)with bilateral asymmetry of the DR level(at least 1 level,314 patients,628 eyes),or with unilateral DME(74 patients,148 eyes)were enrolled.Myopia and high myopia were defined as spherical equivalent(SE)<-1 D and<-5 D,respectively.Paired t-tests were used to compare the SE between the better eyes and worse eyes,and the McNemar paired tests were used to compare the proportion of myopia and high myopia between the better eyes and worse eyes.Results:The mean age of these 388 patients was 60.6±8.5 years,and 147 were males(37.9%).The majority of bilateral asymmetry of the DR level was one level(297,76.5%).The SE of the better eye was more myopic(-0.22±2.24 D vs.0.00±1.95 D,t=3.01,P=0.003),and the proportion of high myopia was higher(4.4%and 2.1%,χ^2=6.23,P=0.01)than that of the contralateral eye.When classified according to the DR level of the better eye,the SE of the better eye among NPDR patients was more myopic(-0.37±2.76 D vs.0.14±1.89 D,t=2.57,P=0.01),and the proportion of high myopia was higher(7.8%and 1.1%,χ^2=6.00,P=0.01)than that of the contralateral eye.There was no significant difference in refractive parameters between the better eyes and worse eyes in patients without DR or DME.Conclusions:The present study further confirms the negative association between high myopia and DR by using the bilateral asymmetry of the DR level.