全视网膜光凝治疗后糖尿病视网膜病变进展的危险因素分析

李景兰; 王培红; 陈文倩; 高艺; 马天驹; 叶子; 李朝辉

doi:10.3969/j.issn.2095-5227.2022.10.005

全视网膜光凝治疗后糖尿病视网膜病变进展的危险因素分析

Risk factors for progression of diabetic retinopathy after panretinal photocoagulation

摘要

摘要:
背景糖尿病视网膜病变(diabetic retinopathy，DR)经全视网膜光凝(panretinal photocoagulation，PRP)治疗后仍有较高的进展风险。
目的研究与PRP后DR进展相关的全身和眼部因素。
方法本研究为单中心回顾性研究，选取2017年1月1日- 2021年6月1日在解放军总医院第一医学中心眼科会诊并因DR接受PRP治疗的患者。将患者分为DR进展组和DR平稳组，对DR进展的危险因素进行单因素和多因素logistic回归分析。
结果共纳入289例患者，平均年龄(51.1 ± 11.4)岁，其中172人(59.5%)为男性。常见的全身合并症为高血压(74.4%)、慢性肾疾病(chronic kidney disease，CKD)(38.1%)、高脂血症(30.8%)、冠心病(12.1%)等。DR进展组163例，DR进展发生率为56.4%。单因素分析显示，两组年龄、基线视力、肾功能、脂质代谢、贫血等方面的指标差异有统计学意义(P＜0.05)。将这些变量纳入logistic回归，结果显示CKD(OR=3.257，95% CI：1.671 ~ 6.351)、基线视力(OR=6.149，95% CI：1.770 ~ 21.358)、年龄＜50岁 (OR=1.034，95% CI：1.003 ~1.067)为DR进展的危险因素，CKD分期高、基线视力差、年龄＜50岁则DR进展的风险高。其中CKD分期预测DR进展，ROC曲线下面积为0.784(95% CI：0.559～0.990)，截断界值点为CKD分期为1期，敏感度为71.2%，特异性为82.5%。
结论肾功能较差、基线视力较差和年龄＜50岁是PRP后DR进展的独立危险因素，亦有一定的DR进展预测评估效能。

Abstract:
Background Diabetic retinopathy (DR) still has a high risk of progression after panretinal photocoagulation (PRP) therapy.
Objective To investigate the systemic and ocular factors associated with DR progression after PRP.
Methods This study was a single-center retrospective study. Patients who received PRP treatment for DR from January 1, 2017 to June 1, 2021 in the Department of Ophthalmology of the First Medical Center of Chinese PLA General Hospital were selected, and then they were divided into DR-progressive group and DR-stable group. The potential risk factors were analyzed by univariate and multivariate logistic regression to predict progression.
Results A total of 289 patients were finally included, with an average age of (51.1 ± 11.4) years, and 59.5% of them were male. Systemic complications were mainly hypertension (74.4%), followed by chronic kidney disease (CKD) (38.1%), hyperlipidemia (30.8%) and coronary heart disease (12.1%). There were 163 cases in the DR-progressive group, and the incidence of DR progression was 56.4%. According to univariate logistic regression, 16 potential risk factors for DR progression were screened, which were mainly reflected in age, baseline visual acuity, renal function, lipid metabolism, and anemia (P<0.05). Incorporating these variables into logistic regression revealed that CKD (OR=3.257, 95% CI: 1.671-6.351), baseline best corrected vision (LogMAR) (OR=6.149, 95% CI: 1.770-21.358) and age (OR =1.034, 95% CI: 1.003-1.067) were risk factors for DR progression, indicating that the higher stage of CKD, the worse baseline vision, and age less than 50 years were associated with higher risk of DR progression. Among them, the prediction performance of CKD stage was better, the area under the ROC curve was 0.784 (95% CI: 0.559-0.990), the cut-off point was CKD stage = 1 stage with the sensitivity of 71.2% and the specificity of 82.5%.
Conclusion Worse renal function, lower baseline vision and age less than 50 years are independent risk factors with good prediction efficiency for DR progression after PRP.

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