脂类代谢异常与糖尿病视网膜微血管病变及神经元退行性改变的相关性研究  

Effects of dyslipidemia on retinal micro-vasculopathy and retinal neuron degeneration in patients with diabetic

作　　者：王凯悦 张新媛 聂瑶 邱冰洁 赵琳 康文婷[2] Wang Kaiyue;Zhang Xinyuan;Nie Yao;Qiu Bingjie;Zhao Lin;Kang Wenting(Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Institute of Ophthalmology,Beijing Key Laboratory of Ophthalmology and Visual Sciences,Beijing 100730,China;Medical Research Center,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院,北京同仁眼科中心,北京市眼科研究所,北京市眼视光与视觉科学重点实验室,100730 [2]首都医科大学附属北京同仁医院中心实验室,100730

出　　处：《中华眼科医学杂志（电子版）》2020年第4期212-218,共7页Chinese Journal of Ophthalmologic Medicine(Electronic Edition)

基　　金：国家自然科学基金面上项目(81570850,81170859);国家科技部国家重点研发计划重大慢性非传染性疾病防控研究项目(2016YFC1305604)。

摘　　要：目的探究脂类代谢异常在糖尿病(DM)视网膜微血管病变及神经元退行性病变中的作用。方法前瞻性病例对照研究。随机入组2016年4月至2017年6月于北京同仁医院门诊就诊的2型DM患者111例(176只眼)。其中,男性62例(104只眼),女性49例(72只眼),年龄27~76岁,平均年龄(55.05±10.65)岁。根据美国DM协会关于DM及糖尿病视网膜病变(DR)指南将患者进一步分为DM组、非增生性DR(NPDR)组及增生性DR(PDR)组。全部患者均行视力、眼压、裂隙灯检查、散瞳眼底检查、彩色眼底照相及扫频光学相干断层扫描成像(OCT)-光学相干断层扫描血管成像(OCTA)检查。空腹生化检查检测患者血清空腹血糖、糖化血红蛋白、胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)及甘油三酯(TG)等。定量分析OCT-OCTA图像黄斑无血管区(FAZ)面积、视网膜神经纤维层(RNFL)、神经节细胞层(GCL+)及神经节细胞复合体层(GCC)平均厚度。患者年龄、DM病程、糖化血红蛋白、TG、TC及LDL-C水平采用均数±标准差描述,组间比较采用单因素方差分析。年龄、性别、DM病程、糖化血红蛋白、TG、TC、LDL-C水平及其他因素对DM及DR患者的影响采用多元Logistic回归分析。患者FAZ面积、RNFL、GCL+、及GCC平均厚度用均数±标准差描述,组间比较采用独立样本t检验。结果DM组、NPDR组及PDR组的DM病程分别为(7.92±6.06)年、(12.72±5.87)年及(12.25±7.12)年,PDR组和NPDR组大于DM组,差异有统计学意义(F=5.46,P<0.05);三组患者血清TC含量分别为(4.42±1.02)mmol/L、(4.66±1.18)mmol/L及(5.15±1.33)mmol/L,PDR组高于DM组,差异有统计学意义(F=3.08,P<0.05);血清LDL-C含量分别为(2.48±0.97)mmol/L、(2.85±1.01)mmol/L及(3.24±0.99)mmol/L,PDR组高于DM组,差异有统计学意义(F=4.38,P<0.05);血清TG含量分别为(1.91±1.33)mmol/L、(1.50±1.11)mmol/L及(1.62±1.05)mmol/L,三组间差异无统计学意义(F=1.07,P>0.05)。多元Logistic回归分析结果显示,DMObjective To investigate the correlation between dyslipidemia with retinal microangio-pathy and neuronal degeneration in diabetic patients.Methods Prospective cohort study.111 patients 62 males and 49 females,average age(55.05±10.65)years with diabetic mellitus(DM)and diabetic retinopathy(DR)were enrolled during April 2016 to June 2017 in Beijing Tongren Hospital.According to the Diabetes Association guidelines on DM and DR,patients were divided into DM,non-proliferative DR and proliferative DR(PDR)groups.All patients underwent routine ophthalmologic examinations and swept source optical coherent tomography(OCT)-optical coherent tomography angiography(OCTA).Serum fasting blood glucose,glycated hemoglobin,total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),and triglyceride(TG)were determined by biochemical examination.The area of foveal avascular zone(FAZ)and the average thickness of the retinal nerve fiber layer(RNFL),ganglion cell layer(GCL+)and ganglion cell complex(GCC)were obtained by quantitative analysis of OCT and OCTA.The age,DM duration,serum levels of glycated hemoglobin,TG,TC and LDL-C of patients were described by mean±standard deviation.One-way ANOVA was used for comparison among three groups.The risk factors such as age,sex,DM duration,glycated hemoglobin,TG,TC,LDL-C levels and other factors on DM and DR patients were analyzed by Logistic regression.The area of FAZ and the average thickness of RNFL,GCL+,GCC were described by mean±standard deviation.Independent sample t testing was used for comparison between groups.Results DM duration of DM group,NPDR group and PDR group was(7.92±6.06)years,(12.72±5.87)years and(12.25±7.12)years,respectively,and the DM duration of PDR and NPDR groups were longer than the DM group.The difference was statistically significant(F=5.46,P<0.05).The content of TC in three groups was(4.42±1.02)mmol/L,(4.66±1.18)mmol/L,and(5.15±1.33)mmol/L.The content of LDL-C in three groups was(2.48±0.97)mmol/L,(2.85±1.01)mmol/L and(3.24±0.99)mmol/L.Compared to the

关 键 词：血脂代谢异常 糖尿病视网膜微血管病变 神经元退行性改变 扫频源相干光断层扫描技术 

分 类 号：R587.2[医药卫生—内分泌] R774.1[医药卫生—内科学]