2型糖尿病视网膜病变患者玻璃体切除术后全身性健康事件和死亡率的风险

IF 4.6 Q1 OPHTHALMOLOGY

Ophthalmology science Pub Date : 2025-07-07 DOI:10.1016/j.xops.2025.100880

Dane A. Jester BS , Muhammad Z. Chauhan MD, MS , Zain S. Hussain MD , Sam Karimaghaei MD , Jawad Muayad BS , Asad Loya MD , Ahmed F. Shakarchi MD, MPH , Ahmed B. Sallam MD, PhD

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引用次数: 0

摘要

目的量化2型糖尿病（T2DM）因糖尿病视网膜病变（DR）而行玻璃体切割（PPV）的患者与不需要PPV的患者的死亡率、心肌梗死（MI）、中风和截肢的风险。设计一项利用TriNetX美国协作网络的回顾性队列研究。研究对象：年龄≥18岁的T2DM合并PPV合并DR患者9081例，T2DM合并DR但不合并PPV患者363 116例，T2DM合并DR患者92 645例，健康个体3 264 709例。方法采用特定的《国际疾病分类》第十版和现行程序技术规范进行队列鉴定。我们使用倾向评分匹配来调整协变量，包括年龄、性别、种族、民族、全身病理和与糖尿病无关的眼部状况。主要结局指标主要结局指标是与对照组相比，PPV后1、3、5年的死亡率、心肌梗死、卒中和截肢的危险比（hr）。结果T2DM患者行PPV治疗DR有较高的全身性事件和死亡率。与不需要PPV的DR患者相比，PPV队列在1年时发生卒中的风险更高(HR: 1.51；95%可信区间[CI]: 1.03, 2.21)和截肢(HR: 1.85；95% ci: 1.08, 3.16)。在3年时，心肌梗死的风险(HR: 1.44；95% CI: 1.17, 1.78)，卒中(HR: 1.61；95% CI: 1.25, 2.07)和截肢(HR: 2.17；95% CI: 1.54, 3.05)显著升高。5岁时，死亡风险(HR: 1.28；95% ci: 1.13, 1.43), mi (hr: 1.50；95% CI: 1.26, 1.78)，卒中(HR: 1.54；95% CI: 1.25, 1.91)和截肢(HR: 2.10；95% CI: 1.58, 2.81)均显著增高。与没有DR的糖尿病患者或健康患者相比，PPV队列在1年、3年和5年的时间间隔中面临着更高的健康结局风险。结论：与非PPV合并DR的患者、无DR的糖尿病患者和健康个体相比，T2DM合并DR需要PPV的患者与死亡率、心肌梗死、卒中和截肢的风险增加有显著相关性。这些发现强调了对接受PPV治疗的晚期dr糖尿病患者进行全身性健康监测和管理的必要性。财务披露作者对本文中讨论的任何材料没有专有或商业利益。

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Risk of Systemic Health Events and Mortality After Vitrectomy for Diabetic Retinopathy in Patients with Type 2 Diabetes

Purpose

To quantify the risk of mortality, myocardial infarction (MI), stroke, and amputation in patients with type 2 diabetes mellitus (T2DM) who underwent pars plana vitrectomy (PPV) for diabetic retinopathy (DR) compared with those not requiring PPV.

Design

A retrospective cohort study utilizing the TriNetX US Collaborative Network.

Subjects

The study included 9081 patients with T2DM who underwent PPV for DR, 363 116 patients with T2DM with DR but no PPV, 92 645 patients with T2DM without DR, and 3 264 709 healthy individuals, all aged ≥18 years.

Methods

We identified cohorts using specific International Classification of Diseases, 10th Revision and Current Procedural Technology codes. We used propensity score matching to adjust for covariates including age, gender, race, ethnicity, systemic pathology, and ocular conditions unrelated to diabetes.

Main Outcome Measures

The primary outcome measures were the hazard ratios (HRs) for mortality, MI, stroke, and amputation at 1, 3, and 5 years after PPV compared with the control groups.

Results

Patients with T2DM undergoing PPV for DR had higher risk of systemic events and mortality. Compared with patients with DR not requiring PPV, the PPV cohort had a higher risk at 1 year for stroke (HR: 1.51; 95% confidence interval [CI]: 1.03, 2.21) and amputation (HR: 1.85; 95% CI: 1.08, 3.16). At 3 years, the risks for MI (HR: 1.44; 95% CI: 1.17, 1.78), stroke (HR: 1.61; 95% CI: 1.25, 2.07), and amputation (HR: 2.17; 95% CI: 1.54, 3.05) were significantly elevated. At 5 years, the risks for mortality (HR: 1.28; 95% CI: 1.13, 1.43), MI (HR: 1.50; 95% CI: 1.26, 1.78), stroke (HR: 1.54; 95% CI: 1.25, 1.91), and amputation (HR: 2.10; 95% CI: 1.58, 2.81) were all significantly higher. When compared with diabetic patients without DR or healthy patients, the PPV cohort faced higher risk of each health outcome analyzed at intervals of 1, 3, and 5 years.

Conclusions

We found a significant association between patients with T2DM with DR requiring PPV and an increased risk of mortality, MI, stroke, and amputation compared with non-PPV patients with DR, diabetics without DR, and healthy individuals. These findings underscore the need for monitoring and management of systemic health in diabetic patients undergoing PPV for advanced DR.