基于目诊仪研究“丘”对糖尿病微血管病变辅助诊断价值

Auxiliary Diagnostic Value of"Hill"on Diabetic Microangiopathy Based on Ophthalmoscope

目的基于目诊仪探究“丘”在2型糖尿病微血管病变中的辅助诊断价值。方法采用横断面观察和诊断试验,纳入2021年7月—2022年5月于山东省立医院内分泌科住院治疗的2型糖尿病患者,其中无微血管病变组96例,有微血管病变组222例。收集患者的一般资料、眼象形态(包括血脉、丘、斑、雾漫、月晕),总结中医证候结果,以临床检查为金标准,比较两组患者的眼象特征及中医证候的差异,并评价差异指标的辅助诊断效能。结果与无微血管病变组比较,有微血管病变组“丘”的分值更高(P<0.001)。形态特征“丘”对应的受试者工作特征曲线(ROC)下面积(AUC)为0.621(P=0.001);当“丘2”时对糖尿病微血管病变有辅助诊断价值,“丘”与病程、血清胱抑素C(Cys C)联合均能增加单一指标的诊断效能,“丘”、年龄、病程、Cys C四个指标联合的诊断效能最大,AUC为0.739(P<0.001)。同时有微血管病变组中医证候中“痰湿证”的占比较无微血管病变组更高(P<0.001)。结论眼象特征“丘”在筛查T2DM患者是否合并微血管病变方面有辅助诊断价值,且与年龄、病程、Cys C联合诊断效能更高。

Objective To explore the auxiliary diagnostic value of"hill"in microangiopathy of type 2 diabetes mellitus(T2DM)based on ophthalmoscope.Methods A cross-sectional observational study and diagnostic test were conducted on T2DM admitted to the Department of Endocrinology at Shandong Provincial Hospital between July 2021 and May 2022.There were 96 cases without microangiopathopathy and 222 cases with microangiopathopathy.The general data and ocular morphology of patients(including blood vessel,hill,speckle,mistiness,lunar halo)were collected,and the results of Chinses medicine(CM)syndrome were summarized.The clinical examination was the gold standard,the differences of ocular characteristics and CM syndrome between the two groups were compared,and the auxiliary diagnostic efficacy of the difference index was evaluated.Results Compared with the group without microangiopathopathy,the"hill"score in the microangiopathy group was higher(P<0.001).The area under the receiver operating characteristic curve(AUC)for the"hill"was 0.621(P=0.001).A"hill"score of 2 or higher was indicative of microangiopathy,and combining the"hill"score with disease duration and cystatin C(CysC)levels enhanced diagnostic accuracy.The combination of"hill"score,age,disease duration,and CysC levels provided the highest diagnostic efficacy,with an AUC of 0.739(P<0.001).Compared with the group without microangiopathopathy,the proportion of phlegm-dampness syndrome was significantly higher in the microangiopathy group(P<0.001).Conclusions The"hill"feature in eye images holds auxiliary diagnostic value for screening type 2 diabetes patients for microangiopathy.Combining the"hill"feature with age,disease duration,and CysC levels further improves diagnostic efficiency.