超声评价血糖控制不良对糖尿病视网膜病变的影响

Evaluation of ultrasound about the effect of hemodynamics on lasting hyperglycemia

目的探讨糖尿病（DM）患者血糖控制不良在视网膜病变（DR）发生发展中的作用。方法应用彩色多普勒血流显像（CDFI）检测72例DM患者和26例正常对照组眼动脉（OA）、视网膜中央动脉（CRA）的各项参数。结果在DR发生过程中的不伴DR组，眼底荧光造影尚未发现明显病变时，CRA血流速度较对照组增高（P〈0．05），非增殖期DR组接近对照组（P〉0．05），增殖期DR组低于对照组（P〈0．05）并伴有OA舒张末期血流速度下降及阻力指数增高；DM不伴DR者或DR早期CRA血流速度与糖化血红蛋白（HbA1c）水平呈正相关，DR越重血糖水平对CRA血流速度的影响越小。结论CDFI是评价DR时OA、CRA的血流动力学变化的有效方法，持续而有效地血糖控制是DR治疗的首要措施。

Objective To investigate the role of lasting hyperglycemia in the pathogenesis of diabetic retinopathy （DR） in patients with diabetes mellitus （ DM）. Methods The ophthalmic artery＇s （OA） and central retinal artery＇s （CRA） hemodynamics were studied with color Doppler flow imaging （CDFI） in 72 DM eases and 26 normal volunteers. Results In the very early stage of the course of DR even no slight pathological change was able to be observed by the fundus fluorescein angiography, the blood flow of CRA was already increased, higher than that in the control group （ P 〈 0.05 ） , while in back ground DR stage, the blood flow velocity of CRA was almost as high as that in the control group（ P 〉 0.05 ） ,but in proliferate DR stages the blood flow was lower than that in the control group （P 〈0.05） , accompanied by the lower OA Vmin and a higher OA resistance index （ RI）. In the DM patients without DR or with early DR the blood flow of CRA was correlated to glucosylated hemoglobin Alc （HbAlc） positively. At this stage the severe the DR is, the less is the level of HbAlc influenced the blood flow velocity in CRA. Conclusion CDFI is proved to be an effective method in evaluation of CRA hemodynamics in DR, and stable glycemia controlled is essential in DR treatment.