糖尿病患者视网膜血管直径的影响因素

Factors Associated with Retinal Vascular Diameter in Diabetic Patients

目的:了解2型糖尿病患者视网膜血管直径及其影响因素。方法:横断面研究。将2012年7月至2013年5月辽宁省抚顺市将军街道15个社区所有已确诊为2型糖尿病的居民1913例纳入研究。采用计算机辅助软件定量测量视网膜中央动脉直径(CRAE)、视网膜中央静脉直径(CRVE),并计算视网膜动静脉比值(AVR)。不同特征的组间CRAE、CRVE和AVR差异比较采用Student-t检验或者方差分析。采用广义线性回归分别探讨CRAE、CRVE和AVR的影响因素。采用LOWESS下的广义估计方程探讨糖尿病视网膜病变(DR)严重程度与CRAE、CRVE和AVR之间可能存在的非线性关系。结果:身体质量指数(BMI)较大、高血压、高密度脂蛋白较低、糖化血红蛋白较低患者的CRAE较低,差异有统计学意义(均P<0.05);年龄较大、女性、糖尿病病程较长、不吸烟、糖化血红蛋白<7%患者的CRVE较低,差异有统计学意义(均P<0.05);年龄较大、女性、不吸烟、BMI较小、无高血压、高密度脂蛋白较高、甘油三酯较低、糖化血红蛋白<7%患者的AVR较高,差异有统计学意义(均P<0.05)。多因素回归显示男性、高血压、高糖化血红蛋白、较低的高密度脂蛋白和高BMI是较小的CRAE的影响因素(均P<0.05);年龄较大、吸烟、糖尿病病程增加、较高的高密度脂蛋白是较大的CRVE的影响因素(均P<0.05);年龄较小、吸烟、高血压是较小的AVR的影响因素(均P<0.05)。随着DR严重程度增加,CRAE、CRVE、AVR的改变并不呈线性关系,CRAE和CRVE存在先逐渐增加再逐渐减小的趋势;AVR存在先减小再增加的趋势。结论:DR患者的CRAE、CRVE显著降低,AVR显著升高,这种关系在中度非增生型DR和增生性DR患者中更明显。

Objective:To determine the retinal vessel diameters and their influencing factors in patients with type 2 diabetes.Methods:In this cross-sectional study,totally 1913 participants diagnosed with type 2 diabetes from 15 communities in Jiangjun Street,Fushun City,Liaoning Province,from July 2012 to May 2013 were included.Retinal central arterial(CRAE)and retinal central venous(CRVE)diameters were quantitatively measured using computer-assisted software,and the arteriovenous ratio(AVR)was also calculated.The differences of CRAE,CRVE,and AVR among groups with different characteristics were compared using Student's t-test or ANOVA.Generalized linear regression was used to explore the influencing factors of CRAE,CRVE,and AVR.The potential nonlinear relationships between the severity of diabetic retinopathy(DR)and CRAE,CRVE,and AVR were examined using LOWESS generalized estimating equations.Results:Significant differences were found in CRAE among groups with higher BMI,hypertension,lower high density lipoprotein(HDL),and lower glycated hemoglobin(HbA1c)(all P<0.05).Lower CRVE was associated with older age,female,longer duration of diabetes,non-smoking,and HbA1c<7%(all P<0.05).Higher AVR was correlated to older age,female,non-smoking,lower BMI,absence of hypertension,higher HDL,lower triglycerides,and HbA1c<7%(all P<0.05).Multivariate regression revealed that male,hypertension,higher HbA1c,lower HDL,and higher BMI were significant factors for lower CRAE(all P<0.05);older age,smoking,increased duration of diabetes,and higher HDL were associated with larger CRVE(all P<0.05);whereas lower age,smoking,and hypertension were factors for smaller AVR(all P<0.05).The alternations in CRAE,CRVE,and AVR did not show a linear relationship with the increasing severity of DR.CRAE and CRVE showed a trend of initial increase followed by a decrease.AVR exhibited a trend of initial decrease followed by an increase.Conclusions:In patients with DR,significant reductions in CRAE and CRVE,and an increase in AVR were observed.These alternations were more pronounced in patients with moderate non-proliferative DR and proliferative DR.