Mandecka Aleksandra, Dawczynski Jens, Blum Marcus, Müller Nicolle, Kloos Christoph, Wolf Gunter, Vilser Walthard, Hoyer Heike, Müller Ulrich Alfons
Department of Internal Medicine III, Friedrich-Schiller University, Bachstrasse 18, 07743, Jena, Germany.
Diabetes Care. 2007 Dec;30(12):3048-52. doi: 10.2337/dc07-0927. Epub 2007 Aug 29.
Stimulation of the retina with flickering light increases retinal vessel diameters in humans. Nitric oxide is a mediator of the retinal vasodilation to flicker. The reduction of vasodilation is considered an endothelial dysfunction. We investigated the response of retinal vessels to flickering light in diabetic patients in different stages of diabetic retinopathy.
We studied 53 healthy volunteers, 68 type 1 diabetic patients, and 172 type 2 diabetic patients. The diameter of retinal vessels was measured continuously online with the Dynamic Vessel Analyzer (DVA). Diabetic retinopathy was classified using Early Treatment Diabetic Retinopathy Study criteria. Changes in vasodilation are expressed as percent change over baseline values.
After adjustments for age, sex, and antihypertensive treatment, the response of retinal arterioles to diffuse luminance flicker was significantly diminished in patients with type 1 diabetes compared with healthy volunteers. The vasodilation of retinal arterioles and venules decreased continuously with increasing stages of diabetic retinopathy. The retinal arterial diameter change was 3.6 +/- 2.1% in the control group, 2.6 +/- 2.5% in the no diabetic retinopathy group, 2.0 +/- 2.7% in the mild nonproliferative diabetic retinopathy (NPDR) group, 1.6 +/- 2.2% in the moderate NPDR group, 1.8 +/- 1.9% in severe NPDR group, and 0.8 +/- 1.6% in proliferative diabetic retinopathy group.
Flicker responses of retinal vessels are abnormally reduced in diabetic patients. This decreased response deteriorated with increasing stages of retinopathy. The response was already reduced before clinical appearance of retinopathy. The noninvasive testing of retinal autoregulation with DVA might prove to be of value in early detection of diabetic vessel pathological changes.
用闪烁光刺激视网膜会增加人类视网膜血管直径。一氧化氮是视网膜对闪烁光血管舒张的介质。血管舒张的减弱被认为是一种内皮功能障碍。我们研究了不同糖尿病视网膜病变阶段的糖尿病患者视网膜血管对闪烁光的反应。
我们研究了53名健康志愿者、68名1型糖尿病患者和172名2型糖尿病患者。使用动态血管分析仪（DVA）在线连续测量视网膜血管直径。根据早期糖尿病视网膜病变研究标准对糖尿病视网膜病变进行分类。血管舒张的变化以相对于基线值的百分比变化表示。
在对年龄、性别和抗高血压治疗进行调整后，与健康志愿者相比，1型糖尿病患者视网膜小动脉对漫射亮度闪烁的反应明显减弱。随着糖尿病视网膜病变阶段的增加，视网膜小动脉和小静脉的血管舒张持续下降。对照组视网膜动脉直径变化为3.6±2.1%，无糖尿病视网膜病变组为2.6±2.5%，轻度非增殖性糖尿病视网膜病变（NPDR）组为2.0±2.7%，中度NPDR组为1.6±2.2%，重度NPDR组为1.8±1.9%，增殖性糖尿病视网膜病变组为0.8±1.6%。
糖尿病患者视网膜血管的闪烁反应异常降低。这种降低的反应随着视网膜病变阶段的增加而恶化。在视网膜病变临床出现之前反应就已经降低。用DVA对视网膜自动调节进行无创检测可能在早期发现糖尿病血管病理变化方面具有价值。
