2型糖尿病视网膜病变与下肢血管病变的关系

Relationship between Diabetic Retinopathy and Peripheral Arterial Disease in Type 2 Diabetes Patients

【目的】探讨2型糖尿病患者糖尿病视网膜病变与下肢血管病变是否存在共同的危险因素及预测关系。【方法】对99例糖尿病下肢血管病变的患者行双侧胫前动脉、胫后动脉、足背动脉共6条血管的超声检查,每条血管根据狭窄程度评分,狭窄程度在30%~49%评0分,50%~99%评1分,管腔闭塞者(即狭窄100%)评2分,各段血管评分相加为总得分;0-2分为1级,3~4分为2级,5~12分为3级。同时对这些患者行眼底检查,判断视网膜病变情况。分析2型糖尿病视网膜病变与下肢血管病变的关系。【结果】99例2型糖尿病合并下肢血管病变患者中,男性占58.6%,平均年龄(67.3±7.9)岁,1级病变患者45例(45.4%),2级病变患者30例(30.3%),3级病变患者24例(24.2%)。3组间年龄、性别、吸烟史、SBP、DBP、BMI、FBG、TC、LDL-C、HDL-C、TG、Hb A1C等指标差异无统计学意义。糖尿病下肢血管病变与视网膜病变具有相同的危险因素,其中病程、血糖控制水平对视网膜病变的影响更大。随着2型糖尿病患者下肢血管病变严重程度增加,视网膜病变患者比例逐渐增高(P for trend=0.004)。2级、3级的糖尿病下肢血管病变可以预测糖尿病视网膜病变的出现。【结论】2型糖尿病视网膜病变与下肢血管病变严重程度有关;2级和3级的糖尿病下肢血管病变可以预测糖尿病视网膜病变的发生;积极控制血糖,有助于延缓糖尿病微血管病变的发生发展;对于糖尿病大血管病变,则应早期筛查、早期预防。

【Objective】To explore the relationship between peripheral arterial disease（PAD）and diabetic retinopathy（DR）in type 2 diabetes patients.【Methods】A total of 99 patients diagnosed with PAD were classified into grade 1-3 by their total scores of peripheral arterial stenosis assessed by color doppler ultrasound examinations,where the degree of stenosis 30% ~ 49% scored 0,50% ~ 99% scored 1,lumen occlusion（i.e. degree of stenosis 100%）scored 2,and therefore the total score 0-2 was categorized into Grade 1,3 ~ 4 into Grade 2,5 ~ 12 into Grade 3. The bilateral anterior tibial artery,posterior tibial artery and dorsalis pedis artery of these patients were analyzed. The presence of diabetic retinopathy（DR）was graded from retinal photographs using a standard protocol.【Results】Among 99 cases of type 2 diabetic patients with peripheral arterial disease,58.6% of them were male with average age of 67.3 ± 7.9 years old. Patients of Grade 1,Grade2,Grade 3 lesion accounted for 45.4%,30.3%,24.2%,respectively. Age,gender,smoking history,SBP,DBP,BMI,FBG,TC,TG,LDL-C,HDL-C,Hb A1 C among 3 groups were not statistically significant. The associations of DM duration and Hb A1 C value were significantly larger in DR than in PAD. The proportion of DR patients increased with the severity degree of PAD（p for trend=0.004）. Degree of stenosis Grade 2 and Grade 3 could be predictive for DR.【Conclusions】DR is associated with the severity degree of PAD in type 2 diabetes patients as evaluated by duplex ultrasonography.Degree of stenosis Grade 2 and 3 could be used for screening or finding DR. Strategies for optimum treatment and early prevention are needed.