非增生期糖尿病视网膜病变患者眼轴长度与眼部彩色多普勒血流动力学的关系

Relationship between ocular axial length and hemodynamics in non-proliferative diabetic retinopathy

目的观察眼轴长度对非增生期糖尿病视网膜病变（DR）眼部彩色多普勒血流动力学的影响。方法前瞻性比较病例系例。2012年1月至2013年12月间我院眼科及内分泌科住院的患者,排除中心视网膜有明显的水肿、出血、渗出及有明显的其它眼底病变者,有完整的眼轴长度资料及眼部彩色多普勒血流动力学资料的患者248例（248只眼）。依据眼科AB型超声测量眼球轴长将本研究组患者的眼轴长度分为正常组（22-23 mm）、长眼轴组（24-25 mm）及超长眼轴组（26 mm及以上）,观察患者的眼轴长度及眼部彩色多普勒血流动力学指标,分析两者的相关性。结果正常眼轴组与长眼轴组比较,长眼轴组眼动脉（OA）的收缩峰值血液速度（PSV）（cm/s）无明显变化（t=1.362,P=0.20）,视网膜中央动脉（CRA）的PSV（cm/s）较低（t=-2.335,P=0.02）,睫状后动脉（PCA）的PSV（cm/s）较高（t=2.756,P=0.01）,搏动指数（PI）（t=-2.371,-2.585,-2.67;P=0.02、0.01、0.01）及阻力指数（RI）（t=2.348,2.462,2.293 P=0.02、0.01、0.03）相对较低,差异均有统计学意义（P〈0.05）。正常眼轴组与超长眼轴组比较,超长眼轴组OA、CRA及PCA的PSV（t=3.290、-5.520、-4.900;P=0.00、0.00、0.00）高;RI（t=4.970,6.160、5.990;P=0.00、0.00、0.00）,PI（t=-4.310、-5.230、-4.390;P=0.00、0.00、0.00）低,差异有统计学意义（P〈0.005）。长常眼轴组与超长眼轴组比较,超长眼轴组组OA的PSV（cm/s）较快,但两者比较无统计学意义（t=1.967,P=0.07）、CRA的PSV（cm/s）较低（t=-2.543,P=0.01）,PCA的PSV（cm/s）较高（t=-2.198,P=0.04）,PI（t=-2.331,-2.135,-4.191;P=0.03、0.03、0.00）及RI（t=2.570,2.360,2.490;P=0.01、0.02、0.01）相对较低,差异均有统计学意义（P〈0.05）。结论 DR眼中心视网膜厚度与眼部彩色多普勒血流动力学指标有着明显的相关性。

Objective To observe the effects of axial length on hemodynamics in eyes with non-proliferative diabeticretinopathy. Methods This was a prospectivecase series study. Patients that were admitted to Department of Endocrinology between January 2012 and December 2013 were screened for diabetic retinopathy. Those with confirmed diabetic retinopathy and complete color Doppler retinal hemodynamic data（ n = 248） were recruited in the study. Patients with active central retinal lesions,including severe edema,exudation,bleeding,or other severe lesions,were excluded. Enrolled subjects were divided into 3 groups according to axial length that was measured with A /B ultrasound： normal group（22 - 23mm）,long axis group（24 - 25 mm）,and ultra-long axis group（26 mm or longer）. Axial length was then correlated to patients＇ retinal hemodynamics data. Results Peak systolic velocity（ PSV）,pulsatility index（ PI） and resistance index（RI） were measured at ophthalmic artery（OA）,central retinal artery（CRA）,and short posterior ciliary artery（PCA）for all patients. Although resistance（RI） was found to be lower in all arteries in ultra-long axis eyes（ P 〈0. 005）,pulsatility（PI） and velocity（PSV） were still significantly lower than that of control group in all arteries except PCA. Similarly,pulsatility（PI） was significantly lower in ultra-long axis eyes than in long axis eyes in all arteries despite lower resistance（RI）. However,velocity（PSV） was higher in ultra-long axis eyes than in long axis eyes in CRA and PCA. Conclusion We found a clear correlation between axial length and hemodynamics in eyes with non-proliferative diabetic retinopathy.