2型糖尿病患者尿微量白蛋白含量与黄斑区视网膜微循环相关性分析  

Correlation analysis between microalbumin changes and macular retinal microcirculation in type 2 diabetic patients

作　　者：滕娟[1] 余海跃 陈志萍[1] 陈梅珠 王云鹏 TENG Juan;YU Haiyue;CHEN Zhiping;CHEN Meizhu;WANG Yunpeng(Department of Ophthalmology,the Second People’s Hospital of Bengbu,Bengbu 233000,Anhui Province,China;Department of Ophthalmology,the 900th Hospital of Joint Logistic Support Force,PLA,Dongfang Hospital Affiliated to Xiamen University,Clinical Medical College of Fujian Medical University,Fuzhou 350025,Fujian Province,China)

机构地区：[1]蚌埠市第二人民医院,安徽省蚌埠市233000 [2]联勤保障部队第900医院,厦门大学附属东方医院,福建医科大学福总临床医学院,福建省福州市350025

出　　处：《眼科新进展》2020年第10期952-956,共5页Recent Advances in Ophthalmology

基　　金：福建省科技厅重点项目(编号:2016Y0067);全军医药卫生科研重大项目(编号:15ZD041)。

摘　　要：目的应用光学相干断层扫描血管成像技术(optical coherence tomography angiography,OCTA)观察有或无微量白蛋白尿的糖尿病(DM)患者黄斑中心凹无血管区(foveal avascular zone,FAZ)面积和黄斑区血流密度(macular vascular density,MVD)的变化及其临床意义。方法横断面研究。确诊无视网膜病变的2型DM患者60例60眼纳入本研究,每例患者均根据尿中白蛋白的含量分为正常白蛋白尿组(30例)与微量白蛋白尿组(30例),同时取健康人30人30眼作为对照组。所有受试者均应用OCTA对黄斑区视网膜行3 mm×3 mm范围的模式扫描,获得浅层视网膜、深层视网膜、脉络膜毛细血管层3个层面的MVD图,同时测量黄斑FAZ面积和MVD指标。结果正常白蛋白尿组、微量白蛋白尿组及对照组的黄斑FAZ面积分别为(0.34±0.02)mm 2、(0.39±0.02)mm 2、(0.29±0.03)mm 2,三组间黄斑FAZ面积相比,差异均有统计学意义(均为P<0.05)。正常白蛋白尿组和微量白蛋白尿组的浅层视网膜MVD为(49.63±2.61)%、(47.60±2.63)%,深层视网膜MVD为(50.48±2.61)%、(49.50±2.49)%,脉络膜毛细血管层MVD为(53.85±2.03)%、(53.10±1.98)%,与对照组相应的MVD[(51.02±2.08)%、(53.48±2.32)%、(56.56±2.15)%]相比,差异均有统计学意义(均为P<0.05);正常白蛋白尿组和微量白蛋白尿组浅层视网膜MVD比较,差异有统计学意义(P<0.05);正常白蛋白尿组和微量白蛋白尿组深层视网膜、脉络膜毛细血管层MVD比较,差异均无统计学意义(均为P>0.05)。DM病程、糖化血红蛋白水平及尿白蛋白含量与DM患者浅层视网膜MVD变化均有相关性(r=0.934、0.896、0.717,均为P<0.05)。结论未出现糖尿病视网膜病变的DM患者可表现为视网膜微循环障碍。在DM早期,尿中微量白蛋白含量变化与视网膜微循环改变有关。视网膜微循环检查可作为评估2型DM患者早期微血管并发症发生的筛查手段。Objective To observe the changes in the area of the foveal avascular zone(FAZ)and macular vascular density(MVD)in diabetic patients with or without microalbuminuria using optical coherence tomography angiography(OCTA)and its clinical significance.Methods This was a cross-sectional study.A total of 60 patients(60 eyes)of type 2 diabetes mellitus(DM)without diabetic retinopathy(DR)were included in this study,and they were divided into two groups:normoalbuminuric group(30 patients)and microalbuminuric group(30 patients)according to the content of albumin in the urine.Meanwhile,30 eyes of 30 healthy people were collected as the control group.All subjects underwent the 3 mm×3 mm scanning of macular retina by OCTA to obtain MVD images of the superficial retina,deep retina,and choroid capillary layer.At the same time,the macular FAZ area and MVD indicators were measured.Results The area of FAZ was(0.34±0.02)mm2 in the normoalbuminuric group and(0.39±0.02)mm 2 in the microalbuminuric group,respectively,and the differences were statistically significant compared with the control group(0.29±0.03)mm 2(both P<0.05).The MVD in the superficial retinal layer,deep retinal and choroidal capillary layer was(49.63±2.61)%,(50.48±2.61)%,and(53.85±2.03)%in the normoalbuminuric group,and(47.60±2.63)%,(49.50±2.49)%,and(53.10±1.98)%in the microalbuminuric group,respectively,and the difference was statistically significant compared with the control group[(51.02±2.08)%,(53.48±2.32)%,and(56.56±2.15)%,respectively](all P<0.05).There was statistically significant difference in MVD between the normoalbuminuric group and microalbuminuric group in the superficial retinal layer(P<0.05),but not significant differences in the deep retinal and choroidal capillary layer(both P>0.05).Duration of diabetes,glycosylated hemoglobin and urinary albumin levels were significantly correlated with mean vessel densities of the superficial retinal layer in diabetic patients(r=0.934,0.896,0.717,all P<0.05).Conclusion Diabetic eyes without clinically

关 键 词：微量白蛋白 视网膜微循环 糖尿病 光学相干断层扫描血管成像 

分 类 号：R774.5[医药卫生—眼科]