]目的 分析无视网膜病变2型糖尿病（T2DM）患者基础眼部参数与病情发展期间视网膜病变发生相关性。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年随访，统计随访期间视网膜病变发生人数，多因素逻辑回归分析视网膜病变发生相关因素，对多因素逻辑回归分析相关因素进行ROC曲线分析。结果 随访期间共49例（39.83%）患者发生糖尿病视网膜病变，将发生病变患者纳入病变组（n=49），其他患者纳入非病变组（n=74）。病变组、非病变组的性别、年龄、体质量指数、腰围、吸烟史、饮酒史、随访时间、基础疾病、T2DM病程、TG、TC、HDLC、LDLC、糖尿病周围神经病变、糖尿病肾病、球镜屈光度、柱镜屈光度、前房面积、眼压、角膜水平曲率、角膜垂直曲率对比，差异均无统计学意义（P＞0.05）；病变组的空腹血糖、HbAlC、前房深度均高于非病变组（P＜0.05），眼轴长度低于非病变组（P＜0.05）。多因素逻辑回归分析空腹血糖、HbAlC、中央角膜厚度、瞳孔直径是T2DM患者糖尿病视网膜病变发生风险因素（P＜0.05）。ROC曲线分析显示，中央角膜厚度、瞳孔直径及二者联合预测T2DM患者糖尿病视网膜病变发生的灵敏度分别为71.39%、73.51%、81.59%，特异度分别为70.18%、71.88%、89.22%，AUC分别为0.725（95%CI：0.596~0.814）、0.711（95%CI：0.602~0.814）、0.896（95%CI：0.835~0.976），中央角膜厚度截断值为556.87μm，瞳孔直径截断值为4.09mm。结论 T2DM患者眼部参数中央角膜厚度>556.87μm，瞳孔直径<4.09mm有更高发生糖尿病视网膜病变风险。

Objective To analyze the correlation between basic ocular parameters and the occurrence of retinopathy during progression in patients with type 2 diabetes mellitus (T2DM) without retinopathy. Methods A total of 123 patients with T2DM without retinopathy at baseline were admitted to our hospital from May 2020 to May 2021, and the clinical information and ocular parameters of the patients at baseline were prospectively included for at least 3 years of follow-up, the number of retinopathy occurrences during the follow-up period was counted, and the multifactorial logistic regression analysis was performed to analyze the factors related to the occurrence of retinopathy, and the ROC curves were analyzed for the factors related to the multifactorial logistic regression analysis. ROC curves were analyzed for the factors associated with the multifactorial logistic regression analysis. Results A total of 49 patients (39.83%) developed diabetic retinopathy during the follow-up period, and patients who developed lesions were included in the lesion group (n=49), while other patients were included in the non-lesion group (n=74). Comparison of gender, age, body mass index, waist circumference, smoking history, drinking history, follow-up time, underlying disease, duration of T2DM, TG, TC, HDLC, LDLC, diabetic peripheral neuropathy, diabetic nephropathy, diabetic nephropathy, spherical refractive error, columnar refractive error, anterior chamber area, intraocular pressure, horizontal curvature of the cornea, and vertical curvature of the cornea in the lesion group and the nondiseased group revealed no statistically significant difference (P＞0.05); the lesion group was included in the nondisorder group.; the fasting blood glucose, HbAlC, and anterior chamber depth in the lesion group were higher than those in the non-lesion group (P < 0.05), and the ocular axis length was lower than that in the non-lesion group (P < 0.05). Multifactorial logistic regression analysis of fasting glucose, HbAlC, central corneal thickness, and pupil diameter were risk factors for the development of diabetic retinopathy in patients with T2DM (P < 0.05).The ROC curve analysis showed that the sensitivities of central corneal thickness, pupil diameter, and the combination of the two in predicting the development of diabetic retinopathy in patients with T2DM were 71.39%, 73.51%, respectively, 81.59%, the specificity was 70.18%, 71.88%, and 89.22%, respectively, and the AUCs were 0.725 (95% CI: 0.596-0.814), 0.711 (95% CI: 0.602-0.814), and 0.896 (95% CI: 0.835-0.976), respectively, with a central corneal thickness cutoff value of 556.87 μm, and the pupil diameter cutoff value was 4.09 mm. Conclusion Patients with T2DM have a higher risk of developing diabetic retinopathy for ocular parameters central corneal thickness >556.87 μm and pupil diameter <4.09 mm.

福建省自然科学基金（编号2023J011867）