Lim Laurence S, Ling Lieng H, Cheung Chui Ming Gemmy, Ong Peng Guan, Gong Lingli, Tai E Shyong, Mathur Ranjana, Wong Doric, Foulds Wallace, Wong Tien Yin
Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Gradate Medical School, Singapore, Singapore Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore Massachusetts Eye and Ear Infirmary, Harvard Medical School, MA, USA.
Cardiac Department, National University Heart Centre, Singapore, Singapore Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Br J Ophthalmol. 2015 Jun;99(6):837-41. doi: 10.1136/bjophthalmol-2014-306075. Epub 2014 Dec 8.
To investigate possible associations between diabetic retinopathy (DR) and systemic vascular endothelial function and arterial stiffness measured using reactive hyperaemia peripheral arterial tonometry.
This was a cross-sectional observational clinical study. Subjects with diabetes were recruited and DR was graded from retinal photographs. Systemic endothelial function was measured using reactive hyperaemia peripheral arterial tonometry (EndoPAT) and expressed as the reactive hyperaemia index (RHI). Peripheral arterial stiffness was measured using the same device and expressed as the augmentation index (AI).
In total, 164 eyes of 95 Chinese patients were evaluated. The mean age of the subject eyes was 60.1±8.2 years and 76.8% were men. The mean duration of diabetes was 15.5±9.8 years, and the mean HbA1c was 8.1±1.4%. In age-gender-adjusted models, increasing severity of DR was associated with increasing mean RHI (p=0.001) and increasing mean AI (p<0.001). In multivariate models, adjusting additionally for smoking, mean duration of diabetes, HbA1c and hypertension, the associations with RHI and AI persisted (p=0.011 and 0.001, respectively). In analyses of the dichotomous outcomes clinically significant macular oedema (CSME), moderate DR and vision-threatening DR, AI was a significant predictor of CSME and vision-threatening DR. In multivariate-adjusted models, for every SD increase in AI, the odds of having CSME was 1.78 times higher (95% CI 1.05 to 2.99; p=0.029). For every SD increase in AI, the odds of having vision-threatening DR was 1.73 times higher (95% CI 1.17 to 2.56; p=0.003).
Subjects with more severe DR have larger peripheral reactive hyperaemic responses and greater peripheral vascular stiffness. These findings support the link between the microvascular changes of diabetes and macrovascular disease.
探讨糖尿病视网膜病变（DR）与使用反应性充血外周动脉张力测量法测量的全身血管内皮功能和动脉僵硬度之间可能存在的关联。
这是一项横断面观察性临床研究。招募糖尿病患者，并根据视网膜照片对DR进行分级。使用反应性充血外周动脉张力测量法（EndoPAT）测量全身内皮功能，并表示为反应性充血指数（RHI）。使用同一设备测量外周动脉僵硬度，并表示为增强指数（AI）。
共评估了95例中国患者的164只眼。受检眼的平均年龄为60.1±8.2岁，男性占76.8%。糖尿病平均病程为15.5±9.8年，平均糖化血红蛋白（HbA1c）为8.1±1.4%。在年龄和性别调整模型中，DR严重程度增加与平均RHI升高（p=0.001）和平均AI升高（p<0.001）相关。在多变量模型中，进一步调整吸烟、糖尿病平均病程、HbA1c和高血压后，与RHI和AI的关联仍然存在（分别为p=0.011和0.001）。在对二分结局即临床显著性黄斑水肿（CSME）、中度DR和威胁视力的DR的分析中，AI是CSME和威胁视力的DR的显著预测因素。在多变量调整模型中，AI每增加1个标准差，发生CSME的几率高1.78倍（95%可信区间1.05至2.99；p=0.029）。AI每增加1个标准差，发生威胁视力的DR的几率高1.73倍（95%可信区间1.17至2.56；p=0.003）。
DR更严重的患者外周反应性充血反应更大，外周血管僵硬度更高。这些发现支持了糖尿病微血管变化与大血管疾病之间的联系。
