2型糖尿病缺血性脑卒中患者视网膜血管直径变化及其临床意义  

Changes of retinal vessel diameter in patients with type 2 diabetes mellitus complicated with ischemic stroke and its clinical significance

作　　者：王梅 王媛媛 杨洪涛[2] 裴存文[2] WANG Mei;WANG Yuanyuan;YANG Hongtao;PEI Cunwen(Kunming Aier Eye Hospital,Kunming 650000,China;不详)

机构地区：[1]昆明爱尔眼科医院,昆明650000 [2]承德市中心医院眼科

出　　处：《山东医药》2023年第21期40-44,共5页Shandong Medical Journal

摘　　要：目的观察有缺血性脑卒中病史的2型糖尿病(T2DM)患者视网膜血管直径变化,并分析其临床意义。方法T2DM患者480例,根据有无缺血性脑卒中病史分为缺血性脑卒中组73例、非缺血性脑卒中组407例,使用眼底照相机和半自动测量软件ARIA测量视网膜动脉和静脉直径,计算视网膜中央静脉等效值(CRVE)、视网膜中央动脉等效值(CRAE)、动静脉比值(AVR)。收集患者的年龄、体质量指数(BMI)、吸烟史、饮酒史、高血压病史、糖尿病视网膜病变(DR)病史、糖尿病肾病(DN)病史等一般资料。将研究对象分别按照CRVE、CRAE、AVR四分位数分为4组,作为等级变量纳入logistic回归分析模型进行趋势性检验,以缺血性脑卒中患病率为因变量,分析T2DM患者视网膜血管直径与缺血性脑卒中患病率的关系。按年龄、性别、糖尿病病程、有无DR病史、有无DN病史、有无高血压病史进行分层,通过在logistic回归模型中包含交叉积交互项来检验CRAE、AVR与每个分层变量之间的交互作用,分析T2DM患者不同分层人群中视网膜血管直径与缺血性脑卒中患病率变化趋势的稳健性。结果缺血性脑卒中组患者CRVE、AVR均低于非缺血性脑卒中组(P均<0.05)。与非缺血性脑卒中组相比,缺血性脑卒中组患者年龄更大,糖尿病病程更长,有高血压、DN、DR病史者更多,SBP、SCr、Cys-C水平更高,TC、LDL-C水平更低(P均<0.05)。T2DM患者缺血性脑卒中的患病率随CRAE、AVR减小而增加(P for trend均<0.05),与CRVE无关(P for trend>0.05)。T2DM患者的CRAE和AVR与年龄、性别、糖尿病病程、有无DR病史、有无DN病史、有无高血压病史均无交互作用(P for interaction均>0.05)。结论与无缺血性脑卒中病史的T2DM患者相比,有缺血性脑卒中病史的T2DM患者CRAE、AVR变小。T2DM患者缺血性脑卒中的患病率随CRAE、AVR减小而增加,与CRVE无关。Objective To observe the changes of retinal vessel diameter in type 2 diabetes mellitus(T2DM)patients with ischemic stroke and to analyze its clinical significance.Methods According to the history of ischemic stroke,480 T2DM patients were divided into the ischemic stroke group(73 cases)and non-ischemic stroke group(407 cases).Retinal artery and vein diameters were measured using fundus camera and semi-automatic measurement software ARIA.Central retinal vein equivalent(CRVE)value,central retinal artery equivalent(CRAE)value and arteriovenous ratio(AVR)were calculated.General data such as age,body mass index(BMI),smoking history,drinking history,hypertension history,diabetic retinopathy(DR)history,and diabetic nephropathy(DN)history were collected.The subjects were divided into four groups according to the quartile of CRVE,CRAE and AVR.CRVE,CRAE and AVR were included in the logistic regression analysis model as grade variables for trend test.The relationship between retinal vessel diameter and the prevalence rate of ischemic stroke was analyzed with the prevalence rate of ischemic stroke as dependent variable.T2DM patients were stratified according to age,gender,duration of diabetes,history of DR,history of DN and history of hypertension.The interactions between CRAE,AVR and each stratified variable were examined by including cross-product interaction terms in the logistic regression model.We analyzed the robustness of changes in retinal vessel diameter and ischemic stroke prevalence in different stratified populations of T2DM patients.Results The CRVE and AVR in the ischemic stroke group were lower than those in the non-ischemic stroke group(both P<0.05).Compared with the non-ischemic stroke group,patients in the ischemic stroke group were older,had longer duration of diabetes,had more history of hypertension,DN and DR,had higher levels of SBP,SCr and Cys-C,and had lower levels of TC and LDL-C(all P<0.05).The prevalence of ischemic stroke in T2DM patients increased with the decrease of CRAE and AVR(both P for tren

关 键 词：2型糖尿病 缺血性脑卒中 视网膜血管直径 视网膜中央静脉等效值 视网膜中央动脉等效值 

分 类 号：R774[医药卫生—眼科]