非增殖性糖尿病视网膜病变与血糖、糖化血红蛋白、血液流变学的相关性研究

Correlation of retinopathy with blood glucose,glycated hemoglobin and hemorrheology in patients with non-proliferative diabetes mellitus

目的探讨空腹血糖(FBG)、餐后2h血糖(2hPBG)、糖化血红蛋白(HbA1c)、血黏度水平在糖尿病视网膜病变(DiabeticRetinopathy,DR)发生和发展的临床意义。方法对44例2型糖尿病患者及20名正常人对照进行FBG、2hPBG、HbA1c、血液流变学检测,应用眼底荧光血管造影(Fluorescein Fundus Angiography,FFA)进行DR的诊断、分期。研究对象分为对照组、非糖尿病视网膜病变(Non Diabeticretinopathy Retinopathy,NDR)组和非增殖性糖尿病视网膜病变(Nonproliferative Diabeticretinopathy Retinopathy,NPDR)组,NPDR组进一步分为DR-Ⅰ、DR-Ⅱ、DR-Ⅲ组。结果NPDR组2hPBG、HbA1c高于NDR组(P<0.01)。FBG水平NPDR组与NDR组之间无统计学差异(P>0.05);血流变全血高切还原黏度及全血低切还原黏度、血浆黏度、血沉K值、红细胞变性指数、红细胞刚性指数,NPDR组、NDR组与对照组(正常人)之间具有统计学差异,但NPDR组之间及NPDR组、NDR组两者之间无统计学差异。结论DR的程度和进展与2hPBG、HbA1c水平、血流变学密切相关,FBG并不是一个控制糖尿病及其并发症的理想监测指标。

Objective To study the clinical significance of fasting blood glucose（FBG）, postprandial blood glucose（PBG）, glycated haemoglobin（HbAlc）, and hemorrheology in the occurrence and development of retinopathy in patients with diabetes mellitus. Methods FBG, 2hPBG, HbAlc and hemorrheology in 44 patients with type 2 diabetes mellitus and in 20 normal subjects were measured, respectively. Retinopathy was diagnosed and staged by fluorescein fundus angiography（FFA）. The patients were divided into control group, non diabetic retinopathy（NDR） group, and non proliferative diabetic retinopathy（NPDR） group. NPDR group was further divided into DR-Ⅰ, DR-Ⅱ and DR-Ⅲ groups. Results The 2hPBG and HbAlc levels were higher in NPDR group than in NDR group（P〈0.01）. No statistical difference was found in FBG between the two groups（P〉0.05）. The PBG and HbAlc levels were higher in NPDR group than in NDR and control groups（P〈0.01）. The blood high and low sheer-reduced viscosity, plasma viscosity, erythrocyte sedimentation rate（ESR） were higher in NPDR and NDR groups than in control group（P〈0.01）. However, the rigidity index（RI） and deformability index（DI） were lower in NPDR and NDR groups than in control group（P〈0.01）. Conclusion Diabetic retinopathy and its progression may be related to PBG, HbAlc and hemorrheology. FBG is not a desirable marker for the control of diabetes mellitus and its complications.