【摘要】 目的探讨血压与2型糖尿病(T2DM)视网膜神经纤维层(RNFL)厚度的相关性。方法选取2017年1月至2018年12月就诊于哈尔滨医科大学附属第一医院内分泌科的123例T2DM患者,根据荧光素眼底血管造影结果,按糖尿病性视网膜病变新的国际临床分级标准(2002年),将患者分为无糖尿病视网膜病变(NDR)组65例和非增殖期糖尿病视网膜病变(NPDR)组58例。收集入组患者的一般资料,记录糖化血红蛋白A1c(HbA1c)、空腹C肽等相关血化验结果。测量收缩压(SBP)、舒张压(DBP),计算平均动脉压(MAP)。光学相干断层成像(OCT)测量RNFL厚度。采用SPSS 22.0软件进行统计学分析,Spearman秩相关分析各象限RNFL厚度与血压之间的相关关系,采用单因素和多因素线性回归分析各象限RNFL厚度的独立影响因素。结果与NDR组相比,NPDR组SBP、MAP显著增高,差异有统计学意义(P<0.05)。相关分析显示,年龄与视网膜颞上(r=-0.184,P=0.041)、颞下(r=-0.224,P=0.013)象限RNFL厚度均显著负相关;体质量指数(BMI)与视网膜鼻下(r=-0.256,P=0.004)象限RNFL厚度显著负相关;SBP与视网膜鼻上(r=-0.203,P=0.024)、颞下(r=-0.272,P=0.002)、颞侧(r=-0.286,P=0.001)象限RNFL厚度均显著负相关;MAP与视网膜鼻上(r=-0.185,P=0.041)、颞下(r=-0.264,P=0.003)、颞侧(r=-0.253,P=0.005)象限RNFL厚度均显著负相关;HbA1c与视网膜颞上(r=-0.234,P=0.009)、颞下(r=-0.201,P=0.025)象限RNFL厚度均显著负相关,差异均有统计学意义(P<0.05)。单因素及多因素线性回归分析结果显示,SBP是视网膜鼻上、颞下、颞侧象限RNFL厚度的独立影响因素。结论血压升高加速视网膜神经退行性改变,提示尽早关注血压变化可能有利于避免早期视网膜神经退变。更多还原

【Abstract】 Objective To investigate the correlation between blood pressure and thickness of retinal nerve fiber layer(RNFL) in type 2 diabetes mellitus(T2 DM). Methods A total of 123 patients with T2 DM were selected for the study, who visited the Endocrinology Department of the First Hospital Affiliated to Harbin Medical University between January 2017 and December 2018. Based on the fluorescein fundus angiographic findings, the patients were divided into a group without diabetic retinopathy(NDR group, n=65) and a group with non-proliferative diabetic retinopathy(NPDR group, n=58) according to the International Clinical Grading Scale for Diabetic Retinopathy(2002). The general clinical data of the enrolled patients were collected, and the results of the blood tests, such as glycated hemoglobin A1 c(HbA1 c) and fasting C-peptide, were recorded. Systolic blood pressure(SBP), diastolic blood pressure(DBP) were measured, and mean arterial pressure(MAP) was calculated. RNFL thickness was measured with optical coherence tomography(OCT). SPSS statistics 22.0 was used for statistical analysis. The correlation between RNFL thickness and blood pressure in each quadrant was analyzed by Spearman rank correlation. Univariate and multivariate linear regression were performed to analyze the independent factors of RNFL thickness in each quadrant. Results SBP and MAP were significantly higher in the NPDR group than those in the NDR group(P<0.05). Correlation analysis revealed significantly negative correlation between age and RNFL thickness in both the supratemporal(r=-0.184, P=0.041) and infratemporal(r=-0.224, P=0.013) quadrants, between the body mass index(BMI) and the lower nasal retina(r=-0.256, P=0.004), between SBP and RNFL thickness in the upper nasal(r=-0.203,P=0.024), infratemporal(r=-0.272, P=0.002) and temporal(r=-0.286, P=0.001) quadrants, between MAP and RNFL thickness of the upper nasal(r=-0.185, P=0.041), infratemporal(r=-0.264, P=0.003) and temporal(r=-0.253, P=0.005) quadrants, and between HbA1 c and RNFL thickness of the supratemporal(r=-0.234, P=0.009) and infratemporal(r=-0.201, P=0.025) quadrants, the difference being statistically significant for all(P<0.05). The univariate and multivariate linear regression analysis showed SBP as an independent factor of RNFL thickness in the upper nasal, infratemporal, and temporal quadrants. Conclusion Elevated blood pressure accelerates degenerative change in the retina, suggesting early attention to changes in blood pressure may help to avoid early nervous degeneration of the retina.更多还原