非对称性糖尿病视网膜病变的发生原因分析

Analysis of risk factors in bilateral asymmetric diabetic retinopathy

目的探讨糖尿病性视网膜病变发生双眼非对称性改变的原因。方法收集非对称性糖尿病性视网膜病变患者30例。根据双眼病变的不对称程度将患者分为轻度不对称和重度不对称两组。对每组病人分析可能引起非对称性病变的多种因素，包括：颈动脉粥样斑块检出率，双侧眼动脉血流速峰值，眼压，视网膜分支静脉阻塞的发生和是否行白内障手术。结果在轻度不对称的病例组中，双侧颈动脉粥样斑块检出率相同，具有统计学意义的危险因素为眼动脉的血流速度减慢和眼压升高。在重度不对称病例组中，病变较重侧颈动脉粥样斑块检出率为64％，较轻侧为18％，颈动脉粥样斑块的形成是一个明显的危险因素，而且双侧眼动脉血流速度和眼压的不平衡程度亦更明显。两组患者中，视网膜分支静脉阻塞和是否行白内障手术均与病变的不对称程度无关。结论双侧眼灌注的不平衡是发生非对称性糖尿病性视网膜病变的根本原因。而单侧颈动脉的血流障碍是加重双眼病变不对称程度的重要因素。

Objective To explore risk factors in bilateral asymmetric diabetic retinopathy.Methods 30 patients with bilateral asymmetric diabetic retinopathy were divided into mild and severe asymmetric groups.Possible factors involved in this disease, including carotid atherosclerosis plaque, velocity of ophthalmic artery, intraocular pressure （IOP）, branch retinal vein occlusion （BRVO）and cataract surgery, were investigat- ed.Results in mild group,detection rates of carotid atherosclerosis plaques were same on the both eyes.Sta- tistically significant risk factors were slower ophthalmic artery velocity and higher IOP.In severe asymmetric group, carotid atherosclerosis plaque formation was an important risk factor, because detection rate of carotid atherosclerosis plaque was 64% on the severe eye side,much higher than 18% of the mild eye side.And imbal- ance degrees of bilateral ophthalmic artery flow and IOP were more significant.BRVO and cataract surgery had no significant relationship with the asymmetric degree in both mild and severe asymmetric groups.Conclu- sions Asymmetric perfusion of both eyes is the fundamental cause of bilateral asymmetric diabetic retinopa- thy.Carotid flow obstacle on one side is an important risk factor aggravating the asymmetric status.