Association of Microalbuminuria with Diabetic Retinopathy and Macular Edema

微量蛋白尿對於糖尿病視網膜病變及黃斑部水腫的相關性

10.6200/TCMJ.202003_17(1).0007

曾柏宸(Po-Chen Tseng)；廖國盟(Kuo-Meng Liao)；蔡麗婷(Li-Ting Tsai)；陳春森(Chung-Sen Chen)；柯明中(Ming-Chung Ko)；連欣怡(Hsin-Yi Lien)；蔡景耀(Ching-Yao Tsai)；翁林仲(Lin-Chung Woung)

Type 2 diabetes mellitus ； diabetic retinopathy ； diabetic macular edema ； microalbuminuria ； cohort study ； 第二型糖尿病 ； 糖尿病黃斑部水腫 ； 糖尿病視網膜病變 ； 微量白蛋白尿 ； 世代研究

北市醫學雜誌

17卷1期（2020 / 03 / 30）

71 - 86

英文

Background: Findings from previous studies have shown inconsistent results regarding the predictivity of microalbuminuria in the development or progression of diabetic retinopathy (DR) and diabetic macular edema (DME). Current diagnosis method for DR is based on the evidence of retina capillary changes. In addition to that, visual function is another important and sensitive functional indicator that reveals early and different stages of DR. Objective: To examine whether the severity of albuminuria could predict the development or progression of DR and DME in patients with type 2 diabetes in a long term diabetic cohort. Methods: This study was a retrospective cohort study. Participants were patients who joined the diabetic care program and met the inclusion criteria. Microalbuminuria status at baseline was used as the main exposure and DR and MME were diagnosed by ophthalmologists. Chi-square test and Independent T were used to analyze the differences of demographics and risk factors in DR and DME groups. A Cox proportional hazards model was used to investigate the contribution of microalbuminuria on DR and DME with adjustment of potential confounding factors, such as age, sex, duration of diabetes, biochemistry, comorbidity, and cigarette smoking. Results: Data of 2000 patients with type 2 diabetes mellitus (DM) were collected and the correlation between albuminuria and DR was found greater than that of albuminuria and DME. Discussion: Our findings reasonably coincided with expectation. DME is a more severe complication compared with DR in diabetes which is more difficult to early predict through related indicators. Future study may include additional biochemical indicators and their influences precisely controlled.

背景：過去研究結果指出，以微量白蛋白尿作為第2型糖尿病患者視網膜病變的預測因子，結論仍不一致。目前診斷糖尿病視網膜病變的方式，主要是依據視網膜血管變化之狀況。除此檢查方法外，對比視覺功能是另一個重要、敏感度高的功能性指標，反應早期和不同階段的糖尿病視網膜病變的視覺功能。目的：藉由長期追蹤的糖尿病世代研究，探討第二型糖尿病人微量白蛋白尿的嚴重度，是否可以預測糖尿病視網膜病變及黃斑部水腫？方法：研究為回溯性世代追蹤研究。對象是所有進入糖尿病照護且符合收案條件的糖尿病病人。微量白蛋白尿的測定以收案後第一次的測定為主。病例的定義為經眼科醫師診斷為糖尿病視網膜病變及黃斑部水腫者。使用Cox proportional hazard model回歸模式，控制潛在的干擾因子，如年齡、性別、罹患糖尿病時間長短、生化指標、其他共病、及抽菸等因素，來探討微量白蛋白尿的嚴重對於糖尿病視網膜病變及黃斑部水腫的影響。結果：收集了2000位第二型糖尿病患者之資料，結果顯示出蛋白尿量與視網膜病變的關係較為緊密，而與黃斑部水腫的關聯性較低。討論：研究的結果符合預期，因為黃斑部水腫相較於視網膜病變是較為嚴重的症狀，較難以相關指標進行早期預測。未來，研究可納入其他生化指標以更精確控制其他因素。