眼前段生物测量值与2型糖尿病患者视网膜病变程度的相关性研究

Correlation between anterior eye biometric values and different degrees of retinopathy in type 2 diabetic patients

摘要:

目的 探讨眼前段生物测量值与2型糖尿病（T2DM）患者视网膜病变程度的相关性。方法 选取2019年3月—2021年3月河北北方学院附属第一医院收治的T2DM患者156例，根据糖尿病性视网膜病变（DR）程度，将其分为无糖尿病性视网膜病变（NDR）组（51例）、非增殖型糖尿病性视网膜病变（NPDR）组（54例）、增殖型糖尿病性视网膜病变（PDR）组（51例）。比较各组患者眼前段生物测量值；采用Spearman法分析角膜厚度、前房深度、眼轴长度与DR程度的相关性；比较不同程度DR患者的一般资料；采用Logistic回归分析PDR的影响因素。结果 与NDR组比较，NPDR组和PDR组球镜屈光度增大，角膜厚度增厚，前房深度变浅，眼轴长度缩短（P <0.05）；与NPDR组比较，PDR组角膜厚度增厚、前房深度变浅、眼轴长度缩短（P <0.05）；但NPDR组、PDR组球镜屈光度比较，差异无统计学意义（P >0.05）。Spearman相关性分析结果显示，角膜厚度与DR程度呈正相关（r_s =0.882，P =0.000）；前房深度、眼轴长度与DR程度呈负相关（r_s =-0.921和-0.886，均P =0.000）。与NPDR组比较，PDR组T2DM病程延长，糖尿病周围神经病变（DPN）占比及尿微量白蛋白（mALB）水平升高（P <0.05）。Logistic回归分析结果显示，T2DM病程长［O^R=6.404（95% CI：3.358，9.451）］、DPN占比高［O^R=2.591（95% CI：1.153，4.029）］、mALB水平高［O^R=3.353（95% CI：2.365，4.342）］、角膜厚度厚［O^R=3.200（95% CI：2.086，4.313）］、前房深度浅［O^R=0.384（95% CI：0.124，0.645）］、眼轴长度短［O^R=0.408（95% CI：0.245，0.571）］是PDR的危险因素（P <0.05）。结论 角膜厚度、前房深度、眼轴长度与DR程度有相关性，且角膜厚度厚、前房深度浅、眼轴长度短是PDR的危险因素。

Abstract:

Objective To study the correlation between anterior eye biometrics and different degrees of retinopathy in patients with type 2 diabetes (T2DM).Methods A total of 156 T2DM patients in our hospital from March 2019 to March 2021 were selected and divided into non-DR (NDR) group (51 cases), non-proliferative DR (NPDR) group (54 cases), and proliferative DR (PDR) group (51 cases), according to the degree of diabetic retinopathy (DR). The biometric values of the anterior segment of the eye in patients with DR with different disease severity were compared. The correlation among corneal thickness, anterior chamber depth, axial length and the degree of DR lesions were analyzed by Spearman correlation analysis method. The general data of patients with different DR lesions were compared. The influencing factors of PDR were analyzed by Logistic regression analysis method.Results Compared with the NDR group, the spherical lens refractive power was increased in the NPDR group and the PDR group, in which the corneal thickness was increased and the anterior chamber depth were shallow, of which the axial length were shortened (P < 0.05). Compared with the NPDR group, the corneal thickness was increased in the PDR group, in which the depth of the chamber was shallower and the length of the eye axis was shortened (P < 0.05). There was no statistically significant difference in the spherical lens refractive power between the NPDR group and the PDR group (P > 0.05). Spearman correlation analysis showed that corneal thickness was positively correlated with the degree of DR lesions (r_s = 0.882, P = 0.000), and the anterior chamber depth and axial length were negatively correlated with the degree of DR lesions (r_s =- 0.921 and -0.886, all P = 0.000). Compared with the NPDR group, the duration of T2DM was prolonged in the PDR group, in which the proportion of diabetic peripheral neuropathy (DPN) and the level of urinary microalbumin (mALB) were increased (P < 0.05). The Logistic analysis showed that T2DM had a long course of disease [O^R = 6.404 (95% CI: 3.358, 9.451)], DPN [O^R = 2.591 (95% CI: 1.153, 4.029)], and high levels of mALB [O^R = 3.353 (95% CI: 2.365, 4.342)], thick corneal thickness [O^R = 3.200 (95% CI: 2.086, 4.313)], shallow anterior chamber depth [O^R = 0.384 (95% CI: 0.124, 0.645) ], and short axial length [O^R = 0.408 (95% CI: 0.245, 0.571) ] were all risk factors for PDR (P < 0.05).Conclusion Corneal thickness, anterior chamber depth, and axial length are related to the degree of DR. Thick corneal thickness is a risk factor for PDR. Deep anterior chamber depth and long axial length are all protective factors.