Loukovaara Sirpa, Harju Mika, Kaaja Risto, Immonen Ilkka
Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland.
Invest Ophthalmol Vis Sci. 2003 Apr;44(4):1486-91. doi: 10.1167/iovs.02-0293.
To evaluate the response of retinal capillary circulation to pregnancy in women with diabetes and to correlate microcirculatory changes with progression of retinopathy during pregnancy.
A prospective follow-up study of 32 pregnant women with insulin-dependent diabetes and 11 nondiabetic pregnant women. Perimacular capillary blood flow measured noninvasively by retinal flowmetry in the inferior perimacular retina. Eleven nonpregnant diabetic women served as diabetic control subjects.
In diabetic women, blood flows, measured by small-box analysis, were 233 +/- 69 (mean +/- SD) arbitrary units (AU) during the first trimester, 248 +/- 55 AU during the third trimester, and 238 +/- 46 AU 3 months postpartum, compared with 204 +/- 32, 195 +/- 22, and 196 +/- 34 AU in nondiabetic pregnant women (P = 0.007 between groups). A difference of the same magnitude was evident between the two groups when the mean of the 50th (P = 0.032), 75th (P = 0.004), and 90th (P = 0.007) percentiles of the individual pixel flow values were used in point-wise analysis. In nonpregnant diabetic women, the small-box mean value was 201 +/- 36, and the mean of the 75th percentile value in point-wise analysis was 316 +/- 49. Blood flow was lower in nonpregnant than in pregnant diabetic women during the third trimester (P = 0.023 and P = 0.012, respectively).
Compared with nondiabetic pregnant women, retinal capillary blood flow was higher in diabetic women during pregnancy and after delivery. Together with the hormonal and metabolic changes occurring during pregnancy, hyperdynamic retinal capillary circulation may contribute to the progression of retinopathy in pregnant diabetic women.
评估糖尿病女性视网膜毛细血管循环对妊娠的反应，并将微循环变化与妊娠期间视网膜病变的进展相关联。
对32名胰岛素依赖型糖尿病孕妇和11名非糖尿病孕妇进行前瞻性随访研究。通过视网膜血流仪在下黄斑视网膜无创测量黄斑周围毛细血管血流。11名非妊娠糖尿病女性作为糖尿病对照受试者。
糖尿病女性中，通过小框分析测量的血流在孕早期为233±69（平均值±标准差）任意单位（AU），孕晚期为248±55 AU，产后3个月为238±46 AU，而非糖尿病孕妇分别为204±32、195±22和196±34 AU（组间P = 0.007）。当在逐点分析中使用各个像素血流值的第50百分位数（P = 0.032）、第75百分位数（P = 0.004）和第90百分位数（P = 0.007）的平均值时，两组之间也存在同样大小的差异。在非妊娠糖尿病女性中，小框平均值为201±36，逐点分析中第75百分位数的平均值为316±49。非妊娠期间糖尿病女性的血流低于孕晚期的糖尿病孕妇（分别为P = 0.023和P = 0.012）。
与非糖尿病孕妇相比，糖尿病女性在妊娠期间和产后视网膜毛细血管血流更高。连同妊娠期间发生的激素和代谢变化，高动力性视网膜毛细血管循环可能导致糖尿病孕妇视网膜病变的进展。
