Rasmussen M L, Broe R, Frydkjaer-Olsen U, Olsen B S, Mortensen H B, Peto T, Grauslund J
Department of Ophthalmology, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense C, Denmark.
The Clinical Research Institute, University of Southern Denmark, Odense, Denmark.
Graefes Arch Clin Exp Ophthalmol. 2017 Feb;255(2):293-299. doi: 10.1007/s00417-016-3454-3. Epub 2016 Aug 12.
To examine associations between retinal vascular geometry (tortuosity, branching coefficient [BC] and length-diameter ratio [LDR]) and diabetic proliferative retinopathy (PDR), nephropathy, and peripheral neuropathy in patients with type 1 diabetes mellitus (T1DM).
A cohort of patients with T1DM participated in a clinical examination in 2011. Blood and urine analyses were done and retinal images taken. PDR was defined as Early Treatment Diabetic Retinopathy Study level 61 or above, nephropathy as albumin-creatinin ratio ≥300 mg/g, and neuropathy as vibration perception threshold >25 Volt. Retinal vessel parameters were measured using semi-automated software. Multiple logistic regressions were performed to investigate correlations between retinal vascular parameters and outcomes. Models were adjusted for other variables (sex, age, duration of diabetes, systolic and diastolic blood pressure, HbA1c, and presence of microvascular complications). Odds ratios were given per standard deviation in retinal vascular parameter.
Retinal vascular analyses were performed in 181 patients. Mean age and duration of diabetes were 37.0 years and 29.4 years respectively, and 50.8% were male. Prevalence of PDR, nephropathy, and neuropathy were 26.5%, 6.8%, and 10.1% , respectively. Patients with increased arteriolar BC had a higher risk of nephropathy (OR: 3.10, 95% CI: [1.01-9.54]). Patients with increased venular BC had a higher risk of neuropathy (OR: 2.11, 95% CI: [1.11-4.03]). No associations were found in patients with PDR.
By analyzing the retinal vascular tree in patients with T1DM, we found a higher risk of complications in kidneys and nerves when BC was increased. This might indicate a suboptimal construction of the vascular tree in these patients.
研究1型糖尿病（T1DM）患者视网膜血管几何形态（迂曲度、分支系数[BC]和长度直径比[LDR]）与糖尿病增殖性视网膜病变（PDR）、肾病和周围神经病变之间的关联。
一组T1DM患者于2011年参加了临床检查。进行了血液和尿液分析，并拍摄了视网膜图像。PDR定义为糖尿病视网膜病变早期治疗研究61级及以上，肾病定义为白蛋白肌酐比值≥300mg/g，神经病变定义为振动觉阈值>25伏特。使用半自动软件测量视网膜血管参数。进行多因素逻辑回归分析以研究视网膜血管参数与结局之间的相关性。模型针对其他变量（性别、年龄、糖尿病病程、收缩压和舒张压、糖化血红蛋白A1c以及微血管并发症的存在情况）进行了调整。视网膜血管参数每增加一个标准差给出比值比。
对181例患者进行了视网膜血管分析。平均年龄和糖尿病病程分别为37.0岁和29.4年，男性占50.8%。PDR、肾病和神经病变的患病率分别为26.5%、6.8%和10.1%。小动脉BC增加的患者患肾病的风险更高（比值比：3.10，95%置信区间：[1.01 - 9.54]）。小静脉BC增加的患者患神经病变的风险更高（比值比：2.11，95%置信区间：[1.11 - 4.03]）。在PDR患者中未发现关联。
通过分析T1DM患者的视网膜血管树，我们发现当BC增加时，肾脏和神经出现并发症的风险更高。这可能表明这些患者的血管树结构欠佳。
