目的：探讨无视网膜病变2型糖尿病(T2DM)患者基线时期眼部参数与随访期间发生视网膜病变的相关性与诊断性能。

方法：2020年5月至2021年5月我院收治基线时期无视网膜病变T2DM患者共123例，前瞻性收录患者基线时期临床资料信息及眼部参数指标，进行至少为期3 a随访，统计随访期间发生糖尿病视网膜病变的例数，多因素逻辑回归分析糖尿病视网膜病变发生的相关因素，对多因素逻辑回归分析的相关因素进行ROC曲线分析。

结果：随访期间共49例(39.8%)患者发生糖尿病视网膜病变(病变组)，其他未发生病变的患者纳入非病变组(74例)。病变组的空腹血糖、糖化血红蛋白(HbA1c)、前房深度、中央角膜厚度高于非病变组(均P<0.01)，眼轴长度、瞳孔直径低于非病变组(均P<0.01)。低空腹血糖、HbAlC、中央角膜厚度是T2DM患者发生糖尿病视网膜病变的保护因素\〖OR(95%CI)：0.356(0.130-0.978)、0.213(0.057-0.797)、0.971(0.950-0.992)，均P<0.05\〗，低瞳孔直径是T2DM患者发生糖尿病视网膜病变的危险因素\〖OR(95%CI)：389.483(20.298-7473.596)，P<0.05\〗。ROC分析曲线显示，空腹血糖、HbAlC、中央角膜厚度、瞳孔直径联合的AUC最高，为0.962(95%CI：0.934-0.991)，眼部参数中央角膜厚度、瞳孔直径AUC值0.725(95%CI：0.596-0.814)、0.711(95%CI：0.602-0.814)与空腹血糖的0.709(95%CI：0.615-0.803)和HbAlC的0.708(95%CI：0.613-0.804)差异不大，而中央角膜厚度与瞳孔直径联合可将AUC提升至0.896(95%CI：0.835-0.976)。

结论：T2DM患者基线时期眼部参数中央角膜厚度与瞳孔直径可用于预测糖尿病视网膜病变的发生风险。

METHODS: From May 2020 to May 2021, our hospital admitted a total of 123 patients with type 2 diabetes mellitus(T2DM)who had no retinopathy at baseline. Clinical data and ocular parameters at baseline were prospectively collected, followed by at least a 3-year follow-up period. The number of cases of diabetic retinopathy occurred during the follow-up period was statistically analyzed, and a multivariable Logistic regression analysis was conducted to identify factors associated with the development of diabetic retinopathy. ROC curve analysis was performed on the factors identified in the multivariable Logistic regression analysis.

RESULTS: During the follow-up period, 49 patients(39.8%)developed diabetic retinopathy. Patients who developed retinopathy were included in the retinopathy group, while the remaining patients were included in the non-retinopathy group(n=74). The fasting blood glucose, glycated hemoglobin(HbA1c), anterior chamber depth, and central corneal thickness were higher in the retinopathy group than in the non-retinopathy group(all P<0.01), while the axial length and pupil diameter were lower in the retinopathy group than in the non-retinopathy group(all P<0.01). Low fasting blood glucose, HbA1c, and central corneal thickness are protective factors against diabetic retinopathy in T2DM patients \〖OR(95% CI): 0.356(0.130-0.978), 0.213(0.057-0.797), 0.971(0.950-0.992), all P<0.05\〗, while low pupil diameter is a risk factor for diabetic retinopathy in T2DM patients \〖OR(95% CI): 389.483(20.298-7473.596), P<0.05\〗. ROC curve analysis showed that the AUC was highest when combining fasting blood glucose, HbA1c, central corneal thickness, and pupil diameter, at 0.962(95% CI: 0.934-0.991). The AUC values for the central corneal thickness and pupil diameter were 0.725(95% CI: 0.596-0.814)and 0.711(95% CI: 0.602-0.814), respectively, which were not significantly different from the AUC values of fasting blood glucose 0.709(95% CI: 0.615-0.803)and HbA1c 0.708(95% CI: 0.613-0.804), while the combined diagnosis of central corneal thickness and pupil diameter can increase the AUC to 0.896(95% CI: 0.835-0.976).

CONCLUSION: Baseline ocular parameters, including central corneal thickness and pupil diameter, in patients with T2DM can be used to predict the risk of developing diabetic retinopathy.