【作者】 刘巨平；

【导师】 李筱荣；

【作者基本信息】 天津医科大学 ， 眼科学（专业学位）， 2014， 博士

【摘要】 目的:高血压、糖尿病等全身系统性疾病以及不同程度的视网膜病变对视网膜血管直径有不同程度的影响。不同的人群研究对视网膜血管直径的影响趋势及程度报道却不同。本研究旨在了解中国北方农村人群中视网膜血管直径与血糖水平、糖尿病以及视网膜病变之间的相关关系方法:邯郸眼病研究是以人群为基础的研究,在河北省邯郸市永年县随机抽取13个村的30岁以上人群共6830人进行全面的眼科和全身检查。采用眼底数码照相并对眼底照片进行视网膜病变程度的读片,采用计算机辅助的软件对视网膜血管直径进行测量。结果:共2897人为正常空腹血糖,1923人为空腹血糖受损,109人有糖尿病视网膜病变体征,另218例糖尿病患者尚未有视网膜病变。经多元回归分析,血糖正常组、空腹血糖受损组和糖尿病组视网膜动脉直径分别为157.6 μm、153.9μm和153.7 μm(P<0.001);视网膜静脉直径分别为239.4 μm、236.3μm和242.1μm(P<0.001)。视网膜动脉直径每增加一个标准差发生糖尿病的危险减少(OR=0.67,95%CI:0.52～0.86),糖尿病患者发生视网膜病变的危险减少(OR=0.46,95%CI:0.28～0.76)。视网膜静脉直径每增加一个标准差,发生糖尿病的风险增加(OR=1.38,95%CI:1.08～1.76),糖尿病患者发生视网膜病变的风险增加(OR=2.02,95%CI:1.24～17.15)。结论:糖尿病患者视网膜动脉直径较小、静脉直径较大,同时糖尿病患者有视网膜病变者视网膜动脉直径较小、静脉直径较大。视网膜血管直径与糖尿病、糖尿病视网膜病变之间的相关关系可能反应在糖尿病视网膜病变早期微血管损害的病理生理过程。更多还原

【Abstract】 Purpose:Retinal vascular caliber can be effected by systemic diseases such as hypertension and diabetes.But a variety of population-based studies revealed different results on the changes of retinal vascular caliber.The purpose of the study is to examine the relationship of retinal vascular caliber with diabetes,glycemia,and diabetic retinopathy in a Chinese rural population.Methods:The Handan Eye Study(HES)is a population-based study,which comprising 6830 Han Chinese aged 30 years and older from 13 villages of Yongnian County,Handan city,Hebei province,China.Digital retinal photographs were taken of all participants and graded for the presence of retinopathy.Retinal vascular calibre was measured from photographs by a computer-assisted method.Results:There were 2897 individuals with normal fasting glucose(NFG),1923 with impaired fasting glucose(IFG),109 with diabetes accompanying retinopathy signs,and 218 with diabetes without retinopathy signs.After multivariate analysis,retinal arteriolar caliber increased from 157.6 μm in subjects with NFG to 153.9 μm in IFG and 153.7 μm in diabetes(P<0.001).Retinal venular caliber increased from 239.4μm in NFG to 236.3 μm in IFG and 242.1 p,m in diabetes(P<0.001).One SD increase in mean arteriolar calibre was associated with lower odds of diabetes compared with NFG(odds ratio[OR]=0.67,95%CI:0.52-0.86),and was associated with lower odds of having retinopathy in persons with diabetes(OR=0.46,95%CI:0.28-0.76).After multivariable adjustment,each SD increase in venular calibre was associated with higher odds ratio of diabetes compared with NFG(OR=1.38,95%CI:1.08-1.76),and was associated with higher odds ratio of having retinopathy in persons with diabetes(OR=2.02,95%CI:1.24-17.15).Conclusions:Retinal arteriolar calibers are smaller and retinal venular calibers are larger in individuals with diabetes,while retinopathy in persons with diabetes is also associated with smaller retinal arteriolar calibers and larger retinal venular calibre.These associations may reflect the underlying pathophysiological processes in the early diabetic microvascular damage.更多还原