Klein Ronald, Moss Scot E, Sinaiko Alan R, Zinman Bernard, Gardiner Robert, Suissa Samy, Donnelly Sandra M, Kramer Michael S, Goodyer Paul, Strand Trudy, Mauer Michael
Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53705-2397, USA.
Ophthalmology. 2006 Dec;113(12):2231-6. doi: 10.1016/j.ophtha.2006.06.003. Epub 2006 Sep 25.
To examine the association of ambulatory blood pressure (ABP) and ambulatory pulse rate (APR) with diabetic retinopathy (DR) in persons with type 1 diabetes in the Renin-Angiotensin System Study (RASS), a multicenter primary diabetic nephropathy (DN) prevention trial.
Cross-sectional study.
One hundred ninety-four normotensive RASS participants in 3 centers who are 16 years of age or older with type 1 diabetes mellitus (DM) of 2 to 20 years' duration.
Ambulatory blood pressure and APR were monitored using standardized protocols. Patients were defined as nondippers if the night-to-day ratios for both systolic and diastolic blood pressures were >0.9. Diabetic retinopathy was determined by masked grading of 30 degrees color stereoscopic fundus photographs of 7 standard fields using the Early Treatment Diabetic Retinopathy Study severity scale.
Severity of DR.
No DR was present in 32%, mild nonproliferative DR (NPDR) was present in 55%, and moderate to severe NPDR or proliferative DR was present in 13% of the cohort. Neither 24-hour systolic ABP or diastolic ABP, daytime systolic or diastolic ABP, nor nighttime diastolic ABP were related to severity of DR. Statistically significant associations were found between nighttime systolic ABP and mean ABP and DR. Among those with no DR, 19% were nondippers; for those with mild NPDR, 28% were nondippers; and for those with severe NPDR or proliferative DR, 36% were nondippers (P = 0.08). The ratio of nighttime to daytime APR, but not the 24-hour APR or daytime or nighttime APR, was related positively to the severity of DR. In multivariable analyses, only the nighttime systolic ABP was related to severity of DR (P<0.05).
These data suggest that ABP, especially during the night, may provide a better measure than clinical BP regarding the relationship of BP to the severity of retinopathy in normotensive persons with type 1 DM without clinical DN.
在肾素 - 血管紧张素系统研究（RASS）中，一项多中心原发性糖尿病肾病（DN）预防试验，研究1型糖尿病患者的动态血压（ABP）和动态脉搏率（APR）与糖尿病视网膜病变（DR）之间的关联。
横断面研究。
来自3个中心的194名血压正常的RASS参与者，年龄在16岁及以上，患有病程2至20年的1型糖尿病（DM）。
使用标准化方案监测动态血压和APR。如果收缩压和舒张压的夜间与日间比值均>0.9，则患者被定义为非勺型血压者。糖尿病视网膜病变通过使用早期治疗糖尿病视网膜病变研究严重程度量表，对7个标准视野的30度彩色立体眼底照片进行盲法分级来确定。
DR的严重程度。
队列中32%无DR，55%有轻度非增殖性DR（NPDR），13%有中度至重度NPDR或增殖性DR。24小时收缩压ABP或舒张压ABP、日间收缩压或舒张压ABP以及夜间舒张压ABP均与DR严重程度无关。夜间收缩压ABP和平均ABP与DR之间存在统计学显著关联。在无DR者中，19%为非勺型血压者；轻度NPDR者中，28%为非勺型血压者；重度NPDR或增殖性DR者中，36%为非勺型血压者（P = 0.08）。夜间与日间APR的比值与DR严重程度呈正相关，但24小时APR或日间或夜间APR与DR严重程度无关。在多变量分析中，仅夜间收缩压ABP与DR严重程度相关（P<0.05）。
这些数据表明，对于无临床DN的血压正常的1型糖尿病患者，ABP，尤其是夜间ABP，在血压与视网膜病变严重程度的关系方面，可能比临床血压提供更好的测量指标。
