糖尿病视网膜病变患者视网膜中央动脉血流变化及相关因素分析

Circulatory changes in central retinal artery and analysis of relevant factors in diabetic retinopathy

目的:探讨糖尿病视网膜病变(DR)患者视网膜中央动脉(CRA)的血流变化规律,分析DR病程进展的相关因素。方法:应用彩色多普勒超声检测31例糖尿病患者(62眼)和14例正常对照者(19眼)的CRA收缩期血流峰值速度(PSV)、舒张末期血流速度(EDV)、阻力指数(RI),同时行眼部检查,记录病史、并发症、糖化血红蛋白和血尿素氮数值。结果:CRA的PSV、EDV随视网膜病变程度的加重逐渐减降低,RI随视网膜病变程度的加重逐渐升高。在糖尿病无视网膜病变(NDR)组(10例,20眼)、背景型视网膜病变(BDR)组(11例,22眼)、增殖型视网膜病变(PDR)组(10例,20眼)中,CRA的PSV、EDV、RI与正常对照组比较均有显著差异(P<0.05)。随着糖尿病视网膜病变的加重,周围神经损伤的发生明显增加,BDR组中周围神经损伤发生率为17%(7/41例),PDR组中周围神经损伤发生率为73%(11/15例)。BDR、PDR组中糖化血红蛋白明显高于NDR组;PDR组中尿素氮水平明显高于NDR、BDR组,差异有显著性(P<0.05)。结论:在无视网膜病变的糖尿病患者视网膜血流动力学已发生变化,血流参数的变化可以动态监测视网膜病变的程度。糖尿病视网膜病变的进展与糖化血红蛋白、尿素氮水平以及是否有周围神经损伤密切相关。

Objective： To study circulatory changes in central retinal artery （CRA） in diabetic retinopathy（DR）, and to analyze the relevant factors on progression of diabetic retinopathy. Methods： The peak systolic velocity （PSV）, the end diastolic velocity （EDV） and the resistance index （RI） of CRA in patients with diabetes （31 cases,62 eyes） and normal volunteers （14 cases, 19 eyes） were determined with color Doppler ultrasonography. Ophthalmic examinations, medical history, systemic complications, the levels of glycosylhemoglobin （GHb） and blood urea nitrogen （BUN） were recorded. Results： Reduced blood flow velocity and increased resistance in CRA were found in patients with diabetes, and they appeared to become further accentuated with the progression of reti- nopathy. The circulatory alterations in CRA in non-diabetic retinopathy （NDR） group （10 cases , 20 eyes） , background diabetic retinopathy （BDR） group （11 cases, 22 eyess） and proliferative diabetic retinopathy （PDR） group （10 cases, 20 eyes） showed statistically significant differences compared to that of normal control （NC） group（P 〈0.05）. Peripheral neuropathy occurred in 17% （7/14 cases） of BDR group and in 73% （11/15 cases） of PDR group. The levels of GHb in BDR and PDR group were significantly higher than in NDR group. The levels of BUN in PDR group were significantly higher than that in NDR and BDR group（P〈0.05）. Conclusion： The circu- latory alterations in CRA appear before retinopathy and correlated with progression of retinopathy. GHb , BUN and peripheral neuropathy are significantly related to retinopathy .