안저검사에서 이상이 발견되어 당뇨병을 새롭게 진단받은 환자의 임상분석
Clinical Analysis of Newly Diagnosed Diabetes Mellitus Patients by Abnormal Fundus Examination
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목적: 안과에 초진하여 시행한 안저검사에서 이상이 발견되어 새롭게 진단받은 당뇨병(newly diagnosed diabetes mellitus, NDM) 환자의 임상양상에 대하여 분석하고자 하였다. 대상과 방법: 2011년 2월부터 2016년 10월까지 과거력상 당뇨병이 없었으며 망막질환으로 안과에서 초진하여 발견한 NDM 환자 15명의 30안을 대상으로 의무기록을 후향적으로 조사하였다. 당뇨병의 기준으로는 임의 혈당이 200 mg/dL 이상이거나 공복혈당이 126 mg/dL 이상, 또는 당화혈색소(HbA1C)가 6.5% 이상인 환자를 NDM으로 진단하였다. 초진 시 나이, 성별, 과거력, 증상, 세극등현미경검사, 안저사진, 빛간섭단층촬영 등의 기본적인 검사에 더불어 형광안저혈관조영술과 전신검사로써 HbA1C를 포함한 혈액검사와 요검사를 시행하였으며 당뇨망막병증, 망막혈관질환, 기타 망막질환의 세 그룹으로 나누어 분석하였다. 결과: 당뇨망막병증 그룹에는 증식당뇨망막병증 3명, 심한 비증식당뇨망막병증 1명이 포함되었고 망막혈관질환 그룹에는 망막중심정맥폐쇄 1명, 망막분지정맥폐쇄 1명, 유리체출혈을 동반한 망막중심정맥폐쇄 1명, 황반부종 1명이 포함되었으며, 기타 망막질환 그룹에는 맥락막신생혈관 파열에 의한 유리체 출혈 1명, 삼출성 나이관련황반변성 3명, 중심장액맥락망막병 2명, 특발성 황반원공 1명이 포함되었다. 증식당뇨망막병증 3명의 환자는 모두 양안에서 증식당뇨망막병증이 있었고 latent autoimmune diabetes in adults (LADA)였다. 나머지 12명은 2형 당뇨병 환자였으며, 이들을 분석한 결과 3명(망막중심정맥폐쇄 1명, 망막분지정맥폐쇄 1명, 황반부종1명)이 반대 눈에 가벼운 비증식당뇨망막병증이 있었고, 9명의 환자들은 반대 눈에 당뇨망막병증이 없었다. 환자의 나이, HbA1C, 단백뇨는 당뇨망막병증 그룹이 기타 망막질환 그룹에 비하여 유의한 차이를 보였다(p=0.006, p=0.012, p=0.006, Mann-Whitney test). 결론: 다양한 망막질환으로 안과에 초진한 환자에서 기본적인 안과적 검사뿐만 아니라 형광안저혈관조영술 및 전신적 검사를 하여 NDM을 조기에 발견할 수 있었다. 또한 내과 의사와의 협의진료를 통하여 이미 발병한 당뇨망막병증 환자는 신속히 안과 및 내과적으로 치료하고, 망막혈관질환 환자에서는 안과 질환의 치료뿐 아니라 당뇨병 치료의 중요성을 교육시키고, 그 이외의 망막질환 환자에서는 지속적인 경과관찰을 통하여 향후 발생할 수도 있는 당뇨망막병증을 조기에 발견하는 데 도움을 줄 수 있다.
Abstract
Purpose: To investigate the clinical analysis of newly diagnosed diabetes mellitus (NDM) patients with abnormal fundus examination at the first visit. Methods: This retrospective study utilized the first visit medical records of 15 patients (30 eyes) who were diagnosed with NDM from February 2011 to October 2016. Results: Patients were divided into 3 groups: 1) diabetic retinopathy group including proliferative diabetic retinopathy (PDR) (3) and severe non-proliferative diabetic retinopathy (NPDR) (1); 2) retinal vascular disease group including central retinal vein occlusion (CRVO) (1), branch retinal vein occlusion (1), vitreous hemorrhage with CRVO (1) and macular edema (1); and 3) other retinal disease group including vitreous hemorrhage due to choroidal neovascular rupture (1), exudative age-related macular degeneration (3), central serous chorioretinopathy (2), and macular hole (1). All 3 PDR patients had latent autoimmune diabetes in adults (type 1.5 diabetes). The remaining 12 patients had type 2 diabetes. Three patients showed mild NPDR in the opposite eye and the other 9 patients did not have diabetic retinopathy in the opposite eye. Onset age, HbA1C and proteinuria were significantly different between the diabetic retinopathy group and the other retinal disease group (p = 0.006, p = 0.012 and p = 0.006, Mann-Whitney test). Conclusions: In patients with various retinal diseases, early detection of NDM could be achieved by performing fundoscopic imaging and systemic examination as well as basic ophthalmologic examination. In addition, patients with diabetic retinopathy should be treated promptly through ophthalmology and internal medicine consultation. For the retinal vascular disease and other retinal disease groups, not only treatment for ophthalmic diseases, but also education about diabetes treatment are important.
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