NPDR伴糖尿病肾病患者黄斑区视网膜血管参数与尿白蛋白/尿肌酐比值的相关性分析

Correlations between Macular Microvascular Parameters and Urinary Albumin Creatinine Ratio in Patients with Non-Proliferative Diabetic Retinopathy with Diabetic Kidney Disease

目的:探讨非增殖性糖尿病视网膜病变(NPDR)伴糖尿病肾病(DKD)患者的黄斑区视网膜血管参数与尿白蛋白/尿肌酐比值(UACR)的相关性。方法:纳入NPDR患者120例为研究对象,根据是否合并DKD分为NPDR组(60例)、NPDR+DKD组(60例),同时纳入无眼底病变的2型糖尿病(T2DM)患者16例为T2DM组。所有受检者均行空腹血糖(FBG)、糖化血红蛋白(HbAlc)、血清总胆固醇(TC)和UACR等检测,行眼科相关检查并使用光相干断层扫描血管成像(OCTA)测量整体及浅层毛细血管丛(SCP)、深层毛细血管丛(DCP)血流密度以及黄斑中心凹无血管区(FAZ)面积、FAZ水平直径、SCP和DCP层微血管瘤数量;对黄斑区视网膜血管参数与UACR的相关性行Spearman分析。结果:NPDR组、NPDR+DKD组、T2DM组3组间FAZ面积、SCP和DCP微血管瘤数量比较,差异有统计学意义(P<0.05);与T2DM组、NPDR组相比,NPDR+DKD组的FAZ面积更大。Spearman相关性分析结果显示,UACR与黄斑中心凹区血流密度、FAZ水平直径呈负相关(r=-0.210、-0.167、P<0.05),与SCP、DCP微血管瘤数量呈正相关(r=0.164、0.138,P<0.05)。结论:NPDR伴DKD患者黄斑中心凹区血流密度、FAZ水平直径、SCP及DCP层微血管瘤数量与UACR相关,可用于判断DKD预后。

Objective:To investigate the correlation between macular microvascular parameters and urinary albumin creatinine ratio(UACR)in non-proliferative diabetic retinopathy(NPDR)patients with diabetic kidney disease(DKD)and to ascertain their association with optical coherence tomography angiography(OCTA)metrics.Methods:120 eyes of 120 NPDR or NPDR with DKD patients and 16 eyes of 16 patients from the control group were included.According to the NPDR,DKD,and T2DM diagnostic criteria,patients were subdivided into the NPDR group(60 eyes),the NPDR with DKD group(60 eyes),and the T2DM group(control group,16 eyes).All subjects underwent the fasting blood sugar,glycosylated hemoglobin(HbA1c),total cholesterol,and UACR level test.The vessel density of the superficial capillary plexus(SCP)and deep capillary plexus(DCP),as well as the area and diameter of the foveal avascular zone(FAZ)and the number of microaneurysms,were measured by optical coherence tomography angiography.The correlation between these parameters and UACR was analyzed by Spearman correlation analysis.Results:The area of FAZ,and the number of microaneurysms in SCP and DCP were significantly different among the three groups(P<0.05).Compared with the T2DM group and the NPDR group,the FAZ area in the NPDR+DKD was larger.The results of correlation analysis showed that foveal vessel density and the FAZ diameter of NPDR+DKD patients were negatively correlated with UACR(r=-0.210,r=-0.167,P<0.05).There was a positive correlation between the number of microaneurysms in SCP and DCP(r=0.164,r=0.138,P<0.05)with UACR.Conclusions:The foveal vessel density,FAZ diameter,and the number of microaneurysms of SCP and DCP in NPDR+DKD are correlated with UACR.