糖尿病视网膜病变与脑白质病变相关性分析

Correlation analysis of diabetic retinopathy and leukodystrophy

目的探讨糖尿病视网膜病变与脑白质病变的相关性。方法收集就诊的糖尿病视网膜病变患者150例,患者根据糖尿病视网膜病变分期分为轻度非增生组62例,中度非增生组48例,重度非增生组40例,并行轴位T1WI/T2WI/FLAIR检查,将脑白质病变分为脑室旁高信号(PVH)和深部白质高信号(DWMH),进行半定量分析。空腹抽取静脉血测定空腹血糖、糖化血红蛋白、三酰甘油、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白等指标。比较3组中脑白质病变程度分数以及生化指标相关性。结果重度非增生组患者年龄、高血压比例、高敏-CRP及同型半胱氨酸水平均高于中度非增生组和轻度非增生组,高密度脂蛋白胆固醇均低于中度非增生组和轻度非增生组,差异均有统计学意义(P<0.05)。重度非增生组呈脑室旁高信号的比例分别为72.50%显著高于深部白质高信号的37.50%,中度非增生组脑室旁高信号的比例分别为41.67%显著高于深部白质高信号的10.42%和轻度非增生组脑室旁高信号的比例为22.58%显著高于深部白质高信号的6.45%(P<0.05)。轻度非增生期的患者,视脑室旁高信号的发生率是无轻度非增生期患者的4.01倍(OR=4.01,95%CI:1.59~9.48,P=0.03),存在中度非增生期的患者,视脑室旁高信号的发生率是无中度非增生期患者的2.54倍(OR=2.54,95%CI:0.97~6.26,P=0.02),存在重度非增生期的患者,视脑室旁高信号的发生率是无中度非增生期患者的2.02倍(OR=2.02,95%CI:0.93~7.36,P=0.04)。年龄、高血压、心脏病、高密度脂蛋白胆固醇、高敏-CRP及同型半胱氨酸均与糖尿病视网膜病变有相关性,并且同糖尿病视网膜病变严重程度呈正相关,而高密度脂蛋白胆固醇则与之呈负相关。结论糖尿病视网膜病变中轻度非增生、中度非增生及重度非增生均是脑室旁高信号的危险因素;高密度脂蛋白胆固醇、高敏-CRP及同型半胱氨酸与糖尿病视网膜病变及脑室旁高信号相关。

Objective To investigate the correlation between diabetic retinopathy and leukodystrophy. Methods A total of 150 patients with diabetic retinopathy who were treated in our hospital were enrolled in the study. According to the stages of diabetic retinopathy,these patients were divided into mild non proliferative group（ n = 62）,moderate non proliferative group（ n = 48） and severe non proliferative group（ n = 40）. Moreover the axial T1 WI/T2 WI/FLAIR scan was performed to divide brain white matter lesions into paraventricular high signal（ PVH high signal） and deep white matter hyperintensities（ DWMH） to carry out semi quantitative analysis. Moreover the levels of fasting blood glucose,glycosylated hemoglobin,triglyceride,total cholesterol,high-density lipoprotein cholesterol,low density lipoprotein were detected to compare the degree of white matter lesions in the three groups and to analyze the correlation among biochemical indexes. Results The patient’s age,hypertension proportion,the levels of high-sensitive CRP and homocysteine in severe non proliferative group were significantly higher than those in moderate non proliferative group and mild non proliferative group,however,the levels of high density lipoprotein cholesterol were significantly lower than those in moderate non proliferative group and mild non proliferation group（ P 〈 0. 05）. The proportion of PVH high signal in severe non proliferative group was 72. 50%,which was significantly higher than that（ 37. 50%） of deep white matter hyperintensities,which in moderate non proliferative group was 41. 67%,which was significantly higher than that（ 10. 42%） of deep white matter hyperintensities. The proportion of periventricular hyperintensities in mild non proliferative group was 22. 58%,which was significantly higher than that（ 6. 45%） of deep white matter hyperintensities（ P 〈 0. 05）. The incidence rate of PVH high signal in mild non proliferative group was 4. 01 times as high as that of patients without mild non proliferative phase（ 95% ~ 9. 48 OR = 4. 01,CI： 1. 59,P 〈 0. 05）,which in patients with moderate non proliferative phase was 2. 54 times as high as that of patients without moderate non proliferative phase（ OR =2. 54,95%,CI： 0. 97 ~ 6. 26,P 〈 0. 05）,moreover,incidence rate of PVH high signal in severe non proliferative patients was 2. 02 times as high as that of patients without moderate non proliferative phase（ 95% ~ 7. 36 OR = 2. 02,CI： 0. 93,P 〈 0. 04）.Moreover the mean age,hypertension,heart disease,high density lipoprotein cholesterol,high-sensitive CRP and homocysteine are correlated with diabetic retinopathy,which were positively correlated with the severity of diabetic retinopathy,however,the levels of high density lipoprotein cholesterol were negatively correlated with the severity of diabetic retinopathy. Conclusion The mild non proliferation,moderate non hyperplasia and severe non hyperplasia in patients with diabetic retinopathy are risk factors of PVH high signal. Moreover the high density lipoprotein cholesterol（ HDL）,high-sensitive CRP and homocysteine are associated with diabetic retinopathy and PVH high signal.