Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, 32 Gisborne Street, Melbourne, VIC 3002, Australia.
Diabetologia. 2011 Sep;54(9):2409-16. doi: 10.1007/s00125-011-2200-y. Epub 2011 May 29.
AIM/HYPOTHESIS: The aim of this hypothesis was to examine the association of retinal vessel tortuosity with diabetes and diabetic retinopathy (DR).
A clinic-based study of 327 participants (224 with diabetes and 103 non-diabetic controls) aged ≥ 18 years. DR was graded from fundus photographs according to the modified Airlie House Classification system and categorised into mild non-proliferative DR (NPDR), moderate NPDR and vision-threatening DR (VTDR). Retinal vessel tortuosity was measured from disc-centred retinal photographs. Measurements were taken, using a semi-automated computer program by a single grader, of arterioles and venules within 0.5 to 2 disc diameters away from the optic disc.
There were 114 (44%) participants with DR. In the multivariate analysis, retinal arteriolar and venular tortuosity were increased in participants with diabetes without DR (mean difference 12.4 × 10(-5) and 13.3 × 10(-5), respectively; both p < 0.05) and in those with DR (mean difference 15.4 × 10(-5) and 15.0 × 10(-5), respectively; both p < 0.01) compared with non-diabetic participants. Among participants with diabetes, increased arteriolar tortuosity was significantly associated with mild NPDR (OR 1.53, 95% CI 1.03-2.05, per SD increase in arteriolar tortuosity) and moderate NPDR (OR 1.67, 95% CI 1.10-2.55) but not VTDR (OR 0.91, 95% CI 0.54-1.54). No association with DR was found for venular tortuosity.
CONCLUSIONS/INTERPRETATION: Persons with diabetes had more tortuous retinal vasculature than persons without diabetes. In persons with diabetes, increased arteriolar tortuosity was associated with mild and moderate stages of DR. This suggests that retinal vascular tortuosity might be an early indicator of microvascular damage in diabetes; thus, further investigation is indicated.
目的/假设：本研究旨在探讨视网膜血管迂曲与糖尿病和糖尿病视网膜病变（DR）的相关性。
这是一项基于临床的研究，共纳入 327 名年龄≥18 岁的参与者（224 名糖尿病患者和 103 名非糖尿病对照者）。根据改良 Airlie House 分类系统对眼底照片进行 DR 分级，并分为轻度非增生性 DR（NPDR）、中度 NPDR 和威胁视力的 DR（VTDR）。使用半自动计算机程序，由一名评分员从视盘中心的视网膜照片上测量视网膜小动脉和小静脉的迂曲程度。
共有 114 名（44%）参与者患有 DR。多变量分析显示，无 DR 的糖尿病患者（平均差异 12.4×10(-5) 和 13.3×10(-5)，均 p<0.05）和有 DR 的糖尿病患者（平均差异 15.4×10(-5) 和 15.0×10(-5)，均 p<0.01）的视网膜小动脉和小静脉迂曲度均增加。在糖尿病患者中，小动脉迂曲度增加与轻度 NPDR（比值比 1.53，95%置信区间 1.03-2.05，每增加一个标准差的小动脉迂曲度）和中度 NPDR（比值比 1.67，95%置信区间 1.10-2.55）显著相关，但与 VTDR 无关（比值比 0.91，95%置信区间 0.54-1.54）。小静脉迂曲度与 DR 无相关性。
结论/解释：糖尿病患者的视网膜血管迂曲程度高于非糖尿病患者。在糖尿病患者中，小动脉迂曲度增加与轻度和中度 DR 相关。这表明视网膜血管迂曲可能是糖尿病微血管损伤的早期指标；因此，需要进一步研究。
