背景:糖尿病,困扰全球数百万人的健康危机,患病率迅速增加。糖尿病引发的微血管并发症已成为肾病和失明的主要原因。视网膜微血管网络可能对早期全身血管结构和功能变化敏感。因此,这项研究致力于辨别影响糖尿病患者和非糖尿病患者视网膜微血管网络的系统决定因素.
方法:开滦眼科研究是一项基于社区队列的横断面研究。参与者接受了光学相干断层扫描血管造影(OCTA)(ZeissCirrus5000;CarlZeissMeditec)和全面的全身性检查。灌注密度(PD)等指标,血管密度(VD),评估了黄斑浅表毛细血管丛(SCP)的中央凹无血管区(FAZ)参数。
结果:这项研究包括860名符合条件的参与者(平均年龄=62.75±6.52岁;21.9%为女性),其中449人是糖尿病患者。与没有糖尿病的人相比,糖尿病患者在整个黄斑和旁凹区域的PD和VD减少。整个黄斑区的PD降低与较高的空腹血糖(FPG,mmol/L)浓度(β=-0.19,95%CI=-0.42至-0.36,P<0.001),较长的轴向长度(AL,mm)(Beta=-0.13,95CI=-0.48至-0.25,P=0.002),心率升高(β=-0.10,95CI=-0.14至-0.19,P=0.014),在调整了年龄较小(Beta=-0.18,95CI=-0.24至-0.35,P<0.001)后,与整个黄斑区的VD一致。较高的FPG水平与黄斑和旁凹区域PD和VD的较低SCP密度显着相关(全部P<0.05),以及收缩压和低密度脂蛋白胆固醇浓度升高(均P<0.01)。
结论:在这项大样本横断面研究中,OCTA评估显示,糖尿病的高患病率和FPG水平升高与视网膜VD和PD降低相关。高血压和高脂血症是动脉粥样硬化性心血管疾病发展的重要危险因素,但对视网膜微血管异常无明显影响。
BACKGROUND: Diabetes, a health crisis afflicting millions worldwide, is increasing rapidly in prevalence. The microvascular complications triggered by diabetes have emerged as the principal cause of renal disease and blindness. The retinal microvascular network may be sensitive to early systemic vascular structural and functional changes. Therefore, this research endeavored to discern the systemic determinants influencing the retinal microvascular network in patients with and without diabetes.
METHODS: The Kailuan Eye Study is a cross-sectional study based on the community-based cohort Kailuan Study. Participants underwent optical coherence tomography angiography (OCTA) (Zeiss Cirrus 5000; Carl Zeiss Meditec) and comprehensive systemic examination. Metrics such as perfusion density (PD), vascular density (VD), foveal avascular zone (FAZ) parameters of the superficial capillary plexus (SCP) in the macula were assessed.
RESULTS: This study included 860 eligible participants (average age = 62.75 ± 6.52 years; 21.9% female), of which 449 were diabetics. People with diabetes had diminished PD and VD in the entire macular and parafoveal regions compared to people without diabetes. Reduced PD in the whole macular region was correlated with higher fasting plasma glucose (FPG, mmol/L) concentration (Beta = -0.19, 95% CI = -0.42 to -0.36, P < 0.001), longer axial length (AL, mm) (Beta = -0.13, 95%CI = -0.48 to -0.25, P = 0.002), and elevated heart rate (Beta = -0.10, 95%CI = -0.14 to -0.19, P = 0.014), after adjusting for younger age (Beta = -0.18, 95%CI = -0.24 to -0.35, P < 0.001), consistent with VD of the whole macular region. A higher FPG level was significantly correlated with lower SCP density of both PD and VD in the macular and parafoveal region (P < 0.05 for all), as well as increased systolic blood pressure and low-density lipoprotein cholesterol concentration (P < 0.01 for all).
CONCLUSIONS: In this large-sample cross-sectional study, OCTA evaluation revealed that high prevalence of diabetes and elevated FPG levels were correlated with reduced retinal VD and PD. Hypertension and hyperlipidemia are important risk factors for the development of atherosclerotic cardiovascular disease but have no significant effect on retinal microvascular abnormalities.