心血管状况与糖尿病视网膜血管内皮细胞的相关性（英文）

Association of systemic cardio- vasculature status with retinal vascular endothelium in diabetes

糖尿病视网膜病变及其并发大血管病变表明两者之间致病存在相关性。血管内皮细胞是糖尿病血管损伤的主要部位。糖尿病视网膜病变能并发全身动脉硬化和改变血管内皮的功能及结构。在黄斑,动静脉交叉处和在筛板区视神经中的视网膜血管内皮细胞不同与其余视网膜血管中内皮细胞。中央视网膜在视神经中动脉和静脉非常接近且共用同一外膜;因此,增加动脉壁的硬度和厚度可以影响该区域中的相邻中央视网膜静脉中的血流量。此外,小动脉床中的动脉硬化加剧与视网膜微血管扩张有关;这表明筛板中视网膜中央动脉压迫视网膜中央静脉的可能性,从而损害糖尿病患者视网膜中的小静脉流出。经观察发现糖尿病视网膜病变患者在后层流区的视网膜中央静脉中的血流量发生改变。在视网膜中央静脉中增加静水压可能在糖尿病视网膜病变的病情进展过程中起重要作用。这篇综述文章的主旨是强调这种常常被忽视的发病机制。

The relationship between diabetic retinopathy and macro- vascular complications in diabetes suggests a pathogenic association between these conditions. Vascular endothelium has been identified as a main site of blood vessel injury in diabetes. Diabetic retinopathy is associated with systemic arterial stiffness and altered vascular endothelium function and structure. Retinal vasculature endothelium at the macula, arterio-venous crossings, and in the optic nerve at the lamina cribrosa region is reported to differ from the endothelium in the rest of the retinal blood vessels. The central retinal artery and vein are in close proximity in the optic nerve where they share a common adventitia; thus, increased arterial wall stiffness and thickness may affect blood flow in the neighboring central retinal vein in this region. Moreover, increased arterial stiffness in small arterial beds is associated with retinal venular widening; it suggests the possibility of central retinal artery compressing the central retinal vein at the lamina cribrosa, thereby compromising venular outflow in the retina of diabetic patients. Altered blood flow in the central retinal vein in the postlaminar region has been detected in patients who experience progression of diabetic retinopathy. Increased hydrostatic pressure in the central retinal vein may play a major role in the pathogenesis of diabetic retinopathy. The aim of this review article is to emphasize this pathogenetic mechanism that has often been overlooked.