2型糖尿病视网膜血管改变研究

Study of retinal vessel diameter variation in patients with type 2 diabetic mellitus

摘要:

目的探讨2 型糖尿病T2（DM）视网膜动、静脉直径变化的影响因素。方法选取2015 年6 月-2015年12 月该院收治的105 例T2DM患者为研究对象，对所有患者的右眼进行彩色眼底照相，由系统半自动测量距离视乳头中心1.0～1.5 PD 范围内的动、静脉直径，采用多元线性回归方法来分析其与性别、年龄、高血压、空腹血糖（FBG）、糖化血红蛋白（HbA1c）、总三酰甘油（TG）、总胆固醇（TC）、DM 病程及视网膜病变（DR）分期等的相关性。结果全部患者的视网膜动脉、静脉的平均直径分别为（52.07±7.89）和（85.92±8.87）μm。有47 例（44.8%）合并DR。合并高血压、DM病程≥10年的视网膜动脉直径缩小，差异均有统计学意义（P <0.05）。年龄<65 岁、FBG≥10.5 mmol/L、HbA1c≥7.0%及DM 病程≥10 年的视网膜静脉直径增大，差异有统计学意义（P <0.05）。随着DM 分期的进展，视网膜动脉直径逐渐缩小，静脉直径逐渐增大，差异有统计学意义（P <0.05）。多元线性回归结果表明视网膜动脉直径与年龄（b=-0.236，P <0.05）、DM 病程（b=-2.230，P <0.05）和DR 分期（b=-2.017， P<0.05）存在线性关系。视网膜静脉直径与FBG（b=1.036， P<0.05）、DR 分期（b=2.256，P <0.05）等存在线性关系。结论合并DR的DM 患者容易出现视网膜动脉缩窄与静脉扩张现象，且随着DR 病情的加重，视网膜动脉直径越小，静脉直径越大。

Abstract:

Objective To investigate the related factors on the diameter variation of retinal arterioles and venula in patients with type 2 diabetic mellitus (T2DM). Methods In total, 105 patients with T2DM were selected in our hospital from June 2015 to December 2015. Fundus photographs were taken in right eyes, and the diameters of retinal arterioles and venula were measured within 1.0-1.5 PD. Multiple linear regression was performed to analyze the relationships between the diameters of retinal arterioles and venula and gender, age,hypertension, fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), total triglyceride (TG), total cholesterol (TC), duration of DM and diabetic retinopathy (DR) stage. Results The mean diameters of retinal arterioles and venula in all patients were (52.07 ±7.89) μm and (85.92 ±8.87) μm, and 47 cases (44.8%) had DR. The retinal arterioles diameters of patients with hypertension, duration of T2DM ≥10 years significantly decreased (P < 0.05). The retinal venula diameters of patients with age <65 years, FBG ≥10.5 mmol/L, HbA1c ≥7%, duration of DM ≥10 years significantly increased (P < 0.05). With the progression of T2DM stage, the retinal arterioles diameters gradually decreased while the venula diameters gradually increased (P <0.05).Multiple linear regression results showed that the retinal arterioles diameter had a linear relationship with age(b = -0.236,P < 0.05), duration of T2DM (b = -2.230, P< 0.05), DR stage (b = -2.017,P < 0.05), and the retinal venula diameter had a linear relationship with FBG (b = 1.036,P < 0.05), DR stage (b = 2.256,P <0.05). Conclusions T2DM patients with DR are apt to perform retinal arterioles narrowing and venula dilation.With the aggravation of DR, retinal venula diameters increase while retinal arterioles diameters decrease.