血浆胰岛素水平与视盘周围血管密度和视网膜神经纤维层厚度的关系  

Relationship between plasma insulin level and circumpapillary vascular density and thickness of retinal nerve fiber layer

作　　者：王萍 汪晓瑜 王小莉 喻磊 王文军 WANG Ping;WANG Xiaoyu;WANG Xiaoli;YU Lei;WANG Wenjun(Department of Ophthalmology,Xi'an People's Hospital(Xi'an Fourth Hospital),Xi'an,Shaanxi 710006,China)

机构地区：[1]西安市人民医院(西安市第四医院)眼科,陕西西安710006

出　　处：《安徽医药》2023年第10期1990-1994,共5页Anhui Medical and Pharmaceutical Journal

基　　金：陕西省重点研发计划项目(2021SF-336)。

摘　　要：目的探讨视盘周围血管密度(cpVD)和视网膜神经纤维层(RNFL)厚度与血浆胰岛素水平的关系。方法选取2020年7月至2021年7月西安市人民医院收治的2型糖尿病病人123例(123只眼)进行回顾性研究,根据是否发生糖尿病视网膜病变(DR)将病人分为:2型糖尿病非视网膜病变(NDR)组(50只眼)和非增生性糖尿病视网膜病变(NPDR)组(73只眼),此外选取58例(58只眼)正常眼(于该院进行健康体检)作为对照组。收集研究对象一般资料,包括年龄、性别、身体质量指数(BMI)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、收缩压(SBP)、舒张压(DBP),并进行比较;采用酶联免疫(ELISA)法检测血浆胰岛素水平;应用光学相干断层扫描血管成像(OCTA)观察cpVD和RNFL厚度;受试者操作特征(ROC)曲线评价cpVD与RNFL厚度对DR发生的预测价值。通过logistic回归分析DR发生的影响因素。结果与对照组比较,NDR组和NPDR组病人RNFL厚度显著变薄[(96.66±10.47)比(81.75±9.59)、(90.56±10.33)μm],cpVD显著降低,胰岛素水平显著降低(均P<0.05);与NPDR组相比,NDR组病人糖尿病病程及BMI、SBP、DBP水平均升高(P<0.05);NDR组和NPDR组病人血浆胰岛素水平与cpVD呈正相关(r=0.26,P<0.05),与RNFL厚度呈正相关(r=0.24,P<0.05),cpVD与RNFL厚度呈正相关(r=0.30,P<0.05);NDR组和NPDR组病人cpVD、RNFL厚度与糖尿病病程、BMI、SBP、DBP均呈负相关(P<0.05);logistic回归分析显示胰岛素水平、糖尿病病程是影响DR发生的因素(P<0.05);ROC结果显示,胰岛素、cpVD与RNFL厚度NPDR发生的曲线下面积(AUC)及95%CI分别为0.71(0.62,0.79)、0.62(0.53,0.71)、0.86(0.78,0.79),对应的灵敏度分别为83.56%、80.00%、88.00%,特异度分别为56.00%、41.10%、71.23%。三者联合NPDR发生的AUC 95%CI为0.89(0.83,0.94),灵敏度为87.67%,特异度为80.00%。结论2型糖尿病病人血浆胰岛素水平与cpVD和RNFL厚度均呈正相关。血浆Objective To investigate the relationship between circumpapillary vascular density(cpVD)and retinal nerve fiber layer(RNFL)thickness and plasma insulin level.Methods A total of 123 eyes(123 eyes)of type 2 diabetic patients admitted to Xi'an People's hospital from July 2020 to July 2021 were retrospectively studied.According to the occurrence of diabetic retinopathy(DR),patients were assigned into Type 2 diabetic non-retinopathy(NDR)group(n=50)and non-proliferative diabetic retinopathy(NPDR)group(n=73).In addition,58 normal eyes(n=58)were selected as the control group.The general information of the research subjects was collected and compared,including age,gender,body mass index(BMI),C peptide,total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),systolic blood pressure(SBP)and diastolic blood pressure(DBP);enzyme-linked immunoassay(ELISA)was used to detect plasma insulin level;optical coherence tomography(OCTA)was used to observe the cpVD and thickness of RNFL;receiver operating characteristic curve(ROC)was used to evaluate the predictive value of cpVD and RNFL thickness on the occurrence of DR.Logistic regression was used to analyze the influencing factors of DR.Results Compared with the control group,the thickness of RNFL in the NDR group and the NPDR group was significantly thinner[(96.66±10.47)vs.(81.75±9.59),(90.56±10.33)μm],the cpVD was significantly reduced,and the insulin level was significantly reduced(P<0.05).Compared with the NPDR group,the duration of diabetes and the levels of BMI,SBP and DBP in the NDR group were increased(P<0.05).Plasma insulin levels in NDR group and NPDR group were positively correlated with cpVD(r=0.26,P<0.05),positively correlated with RNFL thickness(r=0.24,P<0.05),and cpVD was positively correlated with RNFL thickness(r=0.30,P<0.05);cpVD and RNFL thickness were negatively correlated with diabetes duration,BMI,SBP and DBP in NDR group and NPDR group(P<0.05).Logistic regression analysis showed that insu

关 键 词：糖尿病视网膜病变 视盘周围血管密度 视网膜神经纤维层 胰岛素水平 因果律 

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