| 代莉,李娟,邹明菊.增殖性糖尿病视网膜病变微创玻璃体切割术预后影响因素[J].安徽医药,2022,26(7):1433-1436. |
| 增殖性糖尿病视网膜病变微创玻璃体切割术预后影响因素 |
| Influence factors of minimally invasive vitrectomy for proliferative diabetic retinopathy |
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| DOI：10.3969/j.issn.1009-6469.2022.07.037 |
| 中文关键词: 糖尿病视网膜病变 玻璃体切割术 预后不良 促红细胞生成素 |
| 英文关键词: Diabetic retinopathy Vitrectomy Poor prognosis Erythropoietin |
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| 中文摘要: |
| 目的探讨增殖性糖尿病视网膜病变(PDR)微创玻璃体切割术(PPV)的预后影响因素及促红细胞生成素(EPO)的术前预测价值。方法 2017年 12月至 2019年 12月在重庆市江津区第二人民医院接受 PPV治疗的 PDR病人 98例 98眼的临床资料并作为 PDR组，根据术后 3月视力变化情况将其分为预后良好(n=82)、预后不良(n=16)。同期在该院进行体检的健康志愿者 100例作为正常对照组。对比 PDR组、正常对照组 EPO水平的差异，预后良好、预后不良 PDR病人 EPO水平的差异及其对预后不良的预测价值。采用单因素、多因素 logistics回归分析 PDR病人 PPV后预后不良的危险因素。结果 PDR组病人的术前 EPO水平为(13.59±2.92) U/L，正常对照组的 EPO水平为(12.16±3.21)U/L。PDR组病人的术前 EPO水平高于正常对照组，差异有统计学意义( P=0.001)。 PDR组中，预后良好者术前 EPO的水平(13.27±2.19)U/L低于预后不良者［(15.22±2.74)U/L］(P=0.002)。logistics回归分析发现:黄斑水肿严重程度 ≥500 μm、入院时收缩压 ≥140 mmHg、入院时舒张压 ≥90 mmHg及HbA1c、HDL-C、LDL-C、EPO水平较高是 PDR病人 PPV后预后不良的独立影响因素(P<0.05)。受试者工作特征(ROC)曲线显示，术前 EPO预测 PDR病人 PPV后预后不良的最佳截断值为 14.12 U/L，AUC(95%CI)为0.82(0.72~0.92)，对应的灵敏度、特异度为 68.75%、71.95%。结论术前 EPO水平较高是 PDR病人 PPV后预后不良的独立危险因素，且术前 EPO水平对 PPV后预后不良具有一定预测价值。 |
| 英文摘要: |
| Objective To investigate the prognostic factors of minimally invasive vitrectomy (PPV) in proliferative diabetic retinopa-thy (PDR) and the preoperative predictive value of erythropoietin (EPO).Methods Clinical data of 98 cases PDR patients (98 eyes) whowere treated with PPV in The Second People's Hospital, Jiangjin District, Chongqing from December 2017 to December 2019 were takenas PDR group, they were assigned into good prognosis (n=82) and bad prognosis (n=16) according to the changes of visual acuity 3 monthsafter surgery. 100 cases of healthy volunteers who underwent physical examination in The Second People's Hospital, Jiangjin District,Chongqing during the same period were used as normal control group. Difference of EPO level between PDR group and normal controlgroup was compared, difference of EPO level between PDR patients with good prognosis and poor prognosis and its predictive value forpoor prognosis was analyzed. Univariate and multivariate logistic regression were used to analyze the risk factors for poor prognosis ofPDR patients after PPV.Results The preoperative EPO level of the patients in the PDR group was (13.59±2.92) U/L, and the EPO levelof the normal control group was (12.16±3.21) U/L. The preoperative EPO level in the PDR group was higher than that in the normal con-trol group, and the difference was statistically significant (P=0.001). In the PDR group, the preoperative EPO level of patients with goodprognosis was (13.27±2.19), and the preoperative EPO level of patients with poor prognosis was (15.22±2.74). The preoperative EPO levelof patients with poor prognosis was higher than that of patients with good prognosis (P=0.002). Logistic regression analysis found that theseverity of macular edema ≥500 μm, systolic blood pressure ≥140 mmHg on admission, diastolic blood pressure ≥90 mmHg on admis-sion, and higher levels of HbA1c, HDL-C, LDL-C, and EPO were associated with poor prognosis in PDR patients after PPV independent influencing factors (P<0.05). The receiver operating characteristic (ROC) curve showed that the optimal cut-off value of preoperative EPO for predicting poor prognosis after PPV in PDR patients was 14.12 U/L, and the AUC (95%CI) was 0.82 (0.72-0.92). The corresponding sensitivity and the specificity was 68.75% and 71.95%, respectively.Conclusions High preoperative EPO level is an independent riskfactor for poor prognosis after PPV in PDR patients, and it has certain predictive value for poor prognosis after PPV. |
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