당뇨황반부종에서 장기간 당화혈색소 변동성과 유리체내 주사 효과와의 상관관계
Long-term HbA1c Variability and Treatment Outcomes of Intravitreal Injection in Diabetic Macular Edema
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목적: 당뇨황반부종 환자에서 장기간 당화혈색소 변동성과 항혈관내피성장인자항체 주사 치료의 임상효과와의 관련성을 알아보고자 한다. 대상과 방법: 당뇨황반부종으로 유리체강 내 항혈관내피성장인자항체 주사 치료를 받은 49안(38명)의 의무기록을 후향적으로 분석하였다. 주사 직전 및 주사 후 1, 6개월의 최대교정시력과 중심황반두께를 분석하였다. 주사 전후 각 1년 간 시행한 당화혈색소 수치를 이용하여 당화혈색소 변동성을 계산하고 임상 결과와 비교하였다. 결과: 주사 이전 평균 당화혈색소값이 낮은 군 중에서는 당화혈색소 변동성이 높은 군보다 낮은 군에서 주사 1개월 후 황반부종 감소 정도가 컸다(low HbA1c coefficient of variance [CV], 122.4 ± 123.2 μm vs. high HbA1c CV, 5.2 ± 37.0 μm, p=0.0027). 다변량분석에서 황반부종 감소 정도와 관련성이 있었던 인자는 초기 중심황반두께였으며(1개월 adjusted hazard ratio [aHR] 0.5, p<0.001; 6개월 aHR 0.3, p=0.023), 시력호전 정도와 관련성이 있었던 인자는 초기 시력(LogMAR)이었다(1개월 aHR 0.4, p<0.001; 6개월 aHR 0.4, p<0.001). 평균 당화혈색소 수치 및 당화혈색소 변동성은 주사 치료의 임상결과와 유의한 관련성을 보이지 않았다. 결론: 초기 황반부종 정도 및 초기 시력과 달리 평균 당화혈색소 및 당화혈색소 변동성은 황반부종 주사 치료와 유의한 관련성이 없었다.
Abstract
Purpose: To evaluate the association between long-term glycated hemoglobin A (HbA1c) variability and treatment outcomes of anti-vascular endothelial growth factor (VEGF) injection in diabetic macular edema patients. Methods: The medical records of 49 eyes (38 patients) that received anti-VEGF injection for diabetic macular edema were reviewed retrospectively. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) before injection and at one month and six months after injection were analyzed. HbA1c variability (HbA1c coefficient of variation [CV]) was calculated using the HbA1c results from the year prior to (before) and the year after injection and compared with clinical results. Results: In the group with a low mean HbA1c level before injection, the group with lower HbA1c CV showed greater reduction in macular edema one month after injection (low HbA1c CV, 122.4 ± 123.2 μm versus high HbA1c CV, 5.2 ± 37.0 μm, p = 0.027). In the group with high mean HbA1c, there was no significant difference between HbA1c variability and clinical features. In a multivariate analysis, the factor related to the reduction of macular edema was initial CMT (one month adjusted hazard ratio (aHR) 0.5, p < 0.001; six months aHR 0.3, p = 0.023). The factor associated with visual gain was initial visual acuity (LogMAR) (one month aHR 0.4, p < 0.001; six months aHR 0.4, p < 0.001). The association between mean HbA1c or HbA1c variability and clinical outcome was not significant. Conclusions: Unlike initial CMT or BCVA, mean HbA1c and HbA1c variability were not significantly associated with clinical outcomes of anti-VEGF injection in diabetic macular edema patients.
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