【作者】 张莹；

【导师】 恽文伟；

【作者基本信息】 大连医科大学 ， 神经病学， 2022， 硕士

【摘要】 背景与目的:糖尿病视网膜病变(Diabetic retinopathy,DR)是糖尿病患者常见的微血管并发症之一。脑小血管病(cerebral small vessel disease,CSVD)在糖尿病患者中发病率较高。CSVD总MRI负荷可反应脑微血管病变的严重程度。然而,糖尿病相关的视网膜微血管系统变化与CSVD相关的脑微血管系统之间的联系尚不清楚。本研究旨在探讨2型糖尿病患者视网膜微血管病变与CSVD总MRI负荷的相关性。方法:连续性收集2019年12月—2020年11月在南京医科大学附属常州市第二人民医院住院治疗的2型糖尿病患者。所有患者均完成眼底照相及颅脑MRI检查。使用Image J软件半自动测量眼底血管直径,并计算得出视网膜中央动脉等效值(central retinal artery equivalent,CRAE)、视网膜中央静脉等效值(central retinal venous equivalent,CRVE)及动静脉比值(arteriole-to-venule ratio,AVR)。同时根据颅脑MRI计算CSVD总负荷评分。采用单因素、Logistic回归及Spearman相关分析的方法研究糖尿病患者视网膜微血管病变与CSVD总MRI负荷之间的关系。结果:共纳入2型糖尿病患者151例,无糖尿病视网膜病变(non-diabetic retinopathy,NDR)患者84(55.6%)例,轻度DR患者27(17.9%)例,中重度DR患者40(26.5%)例。在中重度DR组中,中高负荷CSVD比例为75%,高于轻度DR(48.1%)及NDR(26.2%)组。中高负荷CSVD组比低负荷CSVD组视网膜小动脉更窄(CRAE:105.24±8.42μm vs 109.45±7.93μm)、视网膜小静脉更宽(CRVE:201.67±16.25μm vs±193.54μm)及AVR(0.52±0.05 vs 0.57±0.04)更小,差异均有统计学意义(P<0.05)。多因素Logistic回归分析校正年龄、吸烟、饮酒、高血压等混杂因素后发现,中重度DR(OR=4.383,P=0.028)、CRAE(OR=0.490,P=0.031)、CRVE(OR=1.475,P=0.041)是中高负荷CSVD评分的独立相关因素。进一步Spearman相关分析发现,DR程度(r=0.465,P<0.001)和CRVE(r=0.366,P<0.001)与CSVD总MRI负荷呈正相关,CRAE(r=-0.306,P<0.001)与CSVD总MRI负荷呈负相关。结论:糖尿病患者视网膜微血管病变是发生脑小血管病变的重要相关因素,DR的程度和视网膜血管直径改变可以作为预测颅内微循环病变的有效指标。更多还原

【Abstract】 Background and Purpose: Diabetic retinopathy(DR)is one of the common microvascular complications in diabetes.Cerebral small vessel disease(CSVD)has a higher incidence in diabetic patients.The total magnetic resonance imaging(MRI)burden of CSVD can reflect the severity of cerebral microvascular disease.However,the relationship between the changes in retinal microvascular system associated with diabetes and the cerebral microvascular system related to CSVD is unclear.This study aimed to explore the relationship between retinal microvascular abnormalities and the total MRI burden of CSVD in patients with type 2 diabetes.Methods: Data were collected from patients with type 2 diabetes who were hospitalized between December 2019 and November 2020 in Changzhou Second People’s Hospital affiliated to Nanjing Medical University.All patients underwent retinal photography and cerebral MRI.The central retinal artery equivalent(CRAE),the central retinal venous equivalent(CRVE),and arteriole-to-venule ratio(AVR)were calculated using Image J software to determine the retinal vascular calibers for each patient.The total MRI burden score for CSVD was determined,and the relationship between retinal microvascular abnormalities and the total MRI burden of CSVD was analyzed.Results: Of the 151 diabetic patients included in the study,84(55.6%)had no diabetic retinopathy(NDR),27(17.9%)had mild DR,and 40(26.5%)had moderate,or severe nonproliferative DR.In patients with more than mild DR,the proportion of moderate to severe burden of CSVD was 75%,which was higher than in patients with mild DR(48.1%)or NDR(26.2%).Patients with moderate to severe burden of CSVD were more likely than those with mild burden of CSVD to have narrowed retinal arterioles(105.24 ± 8.42 μm vs 109.45 ± 7.93 μm),widened retinal venules(201.67 ± 16.25 μm vs 193.95 ± 13.54 μm),and lower arteriole-to-venule ratio(0.52 ± 0.05 vs 0.57 ± 0.04)(P <0.05 for all).The degree of DR(r = 0.465,P <0.001)and CRVE(r = 0.366,P <0.001)were positively correlated with the total MRI burden of CSVD.Multivariate logistic regression analysis indicated that,after adjustments were made for age,smoking,alcohol consumption,hypertension,and other factors,more than mild DR(OR,4.383;P = 0.028),CRAE(OR,0.490;P = 0.031),and CRVE(OR,1.475;P = 0.041)were independently associated with moderate to severe burden of CSVD.Further spearman correlation analysis showed that DR degree(r = 0.465,P<0.001)and CRVE(r = 0.366,P<0.001)were positively correlated with the total MRI burden of CSVD,and CRAE(r =-0.306,P<0.001)was negatively correlated with the total MRI burden of CSVD.Conclusion: Retinal microvascular abnormalities in patients with type 2 diabetes are associated with the presence of cerebral small vessel lesions.The degree of DR and retinal vessel changes can be used as predictors of intracranial microcirculation lesions.更多还原