범망막광응고술을 시행한 증식당뇨망막병증에서 임상적으로 유의한 황반부종을 유발하는 전신 위험인자
The Association of Renal Function with Diabetic Retinopathy Complications
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목적: 증식당뇨망막병증 환자에서, 첫 범망막광응고술 시행 후 1년 안에 치료가 필요한 당뇨망막병증의 합병증이 발생할 확률과 전신위험인자의 상관관계를 분석하고자 한다. 대상과 방법: 2010년 1월부터 2016년 12월까지 처음 진단되어 본원에서 범망막광응고술을 시행한 증식당뇨망막병증 환자의 기록을 후향적으로 분석하였다. 전체 대상자 총 171안을 임상적으로 유의한 황반부종(85안)군과 임상적으로 유의한 황반부종이 없는 군(86안) 으로 분류하였다. 임상적으로 유의한 황반부종과 당화혈색소(HbA1c), 당뇨유병기간, 혈압, 체질량지수(body mass index, BMI), 이상지질혈증, 추정사구체여과율(excreted glomerular filtration rate, eGFR) 및 성별의 상관관계를 분석했다. 결과: 총 171명의 환자 중 단변수분석에서 당뇨유병기간, 총 콜레스테롤수치, 저밀도지단백(low density lipoprotein), HbA1c 및 eGFR 이 임상적으로 유의한 황반부종(clinically significant macula edema, CSME) 군에서 통계적으로 유의하게 높았다(p<0.05). 고밀도지단백(high density lipoprotein), 중성지방(triglycerides), BMI, 수축기 및 이완기 혈압은 유의한 상관관계가 없었다. 다변량분석을 통해 높은 총 콜레스테롤수치 및 HbA1c 수치가 임상적으로 유의한 황반부종을 유발하는 위험인자임이 밝혀졌다. 결론: 콜레스테롤수치 및 HbA1c 수치가 임상적으로 유의한 황반부종(CSME)의 발생에 유의한 영향을 미치는 인자이며 환자의 예후를 예측하고 설명하는 부분에 있어 유용하게 이용될 수 있다.
Abstract
Purpose: We investigated systemic risk factors for clinically significant macula edema (CSME) within 1 year after pan-retinal photocoagulation in patients with proliferative diabetic retinopathy. Methods: A retrospective chart review was performed on 171 patients who received pan-retinal photocoagulation at our hospital from January 2010 to December 2016. The patients were divided into Group Ⅰ with CSME (85 eyes) and Group Ⅱ without CSME (86 eyes). The associations between presence of CSME and glycated hemoglobin (HbA1c), duration of diabetes, systolic and diastolic blood pressure (BP), body mass index (BMI), lipid status, sex, and estimated glomerular filtration rate (eGFR) were evaluated. Results: In the present study of 171 patients, there was no significant difference in age and gender distribution between the two groups. Duration of diabetes, total serum cholesterol, serum low density lipoprotein, HbA1c, and eGFR were significantly higher in patients with CSME (p < 0.05). Serum high-density lipoprotein, triglycerides, BMI, and systolic and diastolic BP showed no correlation with CSME. Multiple logistic regression analysis showed that total serum cholesterol and HbA1c values had significantly high odds of developing CSME. Conclusions: HbA1c, total serum cholesterol, and eGFR are important risk factors associated with CSME in patients with proliferative diabetic retinopathy secondary to pan-retinal photocoagulation. Thus, early detection of these risk factors and their control have significant roles in preventing the development and progression of maculopathy and thereby preventing severe visual loss.
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