小児糖尿病における網膜細小血管異常について

Microangiopathic abnormalities of the retina in childhood diabetes

　小児糖尿病患者（インスリン依存性糖尿病〔IDDM〕74名，インスリン非依存性糖尿病〔NIDDM〕99名，耐糖能異常〔IGT〕27名）計200名を対象に，半年から1年の間隔で眼底検査を施行し，学童期以上の症例には螢光眼底造影検査を行い，網膜細小血管症の発症頻度と，糖尿病の病型，年齢，罹病期間，コントロールの良否との関係を検討した．

　検眼鏡的異常所見としては，網膜小出血と毛細血管瘤を認め，その出現頻度は200名中26名13.0％であった．病型別に検討すると，IDDM 74例中19例25.7％，NIDDM 99例中6例6.1％，IGT 27例中1例3.7％であった．IDDMとNIDDMおよびIGTとの間に有意差を認めた．

　螢光眼底造影は157名に行い，毛細血管の限局性拡張および濃染，毛細血管瘤，黄斑部周囲毛細血管網の限局性閉塞などの異常所見を69名44.0％に認めた．病型別の出現頻度はIDDM 59例中36例61.0％，NIDDMでは77例中31例40.1％，IGTでは21例中2名39.5％であり，各病型間に有意差を認めた．

　血糖コントロールの良否との関係は，検眼鏡的および螢光眼底造影異常所見いずれも，コントロール良好群で低率であったが有意差は認められなかった．

　年齢および罹病期間と検眼鏡的および螢光眼底造影所見の異常所見出現率との間に相関を認め，かつ両因子には相剰効果が認められた．

I evaluated 200 diabetic children by funduscopy and fluorescein angiography. The age of onset of diabetes was 15 years or earlier. The series included 74 cases of IDDM, 99 cases of NIDDM and 27 cases of IGT. Funduscopy was repeated at intervals between 6 and 12 months in all the cases. Fluores-cein angiography was performed at similar inter-vals in 157 cases older than 6 years.

Funduscopic abnormalities, including retinal hemorrhage and microaneurysms, were detected in 26 cases (13%). The incidence was 26% in IDDM, 6% in NIDDM and 4% in IGT. Retinal hemorrhages were, in general, of short duration.

Fluorescein angiographic abnormalities, includ-ing dilatation or staining of capillaries, microaneu-rysms and dropout of perifoveal capillaries, were detected in 69 cases (44%). The incidence was 60% in IDDM, 40% in NIDDM and 10% in IGT.

There was no correlation between the state of control of diabetes and the funduscopic or angio-graphic abnormalities. The incidence of fundus-copic or angiographic abnormalities was higher in subjects aged 15 years or more and in the group with duration of diabetes of 5 years or more. The incidence was highest in those with more adganced age and longer duration of diabetes.

Rinsho Ganka (Jpn J Clin Ophthalmol) 42(2) : 113-117, 1988