Clinical Research Unit, Khoo Teck Puat Hospital, Singapore.
Diabetes Centre, Khoo Teck Puat Hospital, Singapore.
Diab Vasc Dis Res. 2019 Nov;16(6):498-505. doi: 10.1177/1479164119845904. Epub 2019 May 3.
Arterial stiffness has been associated with diabetic retinopathy; however, the information is limited in Asians. We aim to examine the association of central arterial stiffness with the presence and severity of diabetic retinopathy in type 2 diabetes mellitus patients in Singapore.
Arterial stiffness was estimated by carotid-femoral pulse wave velocity and augmentation index using applanation tonometry method. Digital colour fundus photographs from 1,203 patients were assessed for diabetic retinopathy. Diabetic retinopathy severity was categorized into non-proliferative diabetic retinopathy and proliferative diabetic retinopathy. Logistic regression model was used to evaluate the associations of diabetic retinopathy with pulse wave velocity and augmentation index.
Diabetic retinopathy was diagnosed in 391 (32.5%) patients, including 271 non-proliferative diabetic retinopathy and 108 proliferative diabetic retinopathy. Diabetic retinopathy have higher pulse wave velocity (11.2 ± 3.3 vs 9.5 ± 2.6 m/s, < 0.001) and augmentation index (28.4 ± 9.4 vs 26.1 ± 10.6%, < 0.001) than non-diabetic retinopathy. After adjustment, pulse wave velocity [odds ratio = 1.11 (95% confidence interval = 1.05-1.17), < 0.001] and augmentation index [odds ratio = 1.03 (95% confidence interval = 1.01-1.04), = 0.009] was associated with diabetic retinopathy. In severity analyses, pulse wave velocity was associated with non-proliferative diabetic retinopathy [odds ratio = 1.10 (95% confidence interval = 1.03-1.17), = 0.002] and proliferative diabetic retinopathy [odds ratio = 1.15 (95% confidence interval = 1.06-1.25), = 0.001] (-trend < 0.001). Augmentation index showed significant associations with non-proliferative diabetic retinopathy [odds ratio = 1.02 (95% confidence interval = 1.01-1.04), = 0.008], but not with proliferative diabetic retinopathy [odds ratio = 1.01 (95% confidence interval = 0.98-1.04), = 0.36] (-trend = 0.03).
Central arterial stiffness was associated with the presence and severity of diabetic retinopathy in type 2 diabetes mellitus patients, suggesting its etiologic implication in diabetic retinopathy.
动脉僵硬度与糖尿病性视网膜病变有关；然而，亚洲人群的相关信息有限。本研究旨在探讨新加坡 2 型糖尿病患者中心动脉僵硬度与糖尿病性视网膜病变的发生和严重程度的关系。
采用平板张力法测量颈动脉-股动脉脉搏波速度和增强指数来评估动脉僵硬度。对 1203 例患者的数字彩色眼底照片进行糖尿病性视网膜病变评估。糖尿病性视网膜病变严重程度分为非增殖性糖尿病性视网膜病变和增殖性糖尿病性视网膜病变。使用 logistic 回归模型评估糖尿病性视网膜病变与脉搏波速度和增强指数的相关性。
391 例（32.5%）患者被诊断为糖尿病性视网膜病变，其中 271 例为非增殖性糖尿病性视网膜病变，108 例为增殖性糖尿病性视网膜病变。糖尿病性视网膜病变患者的脉搏波速度（11.2±3.3 比 9.5±2.6 m/s， <0.001）和增强指数（28.4±9.4 比 26.1±10.6%， <0.001）均较高。经调整后，脉搏波速度[比值比（OR）=1.11（95%置信区间（CI）：1.05-1.17）， <0.001]和增强指数[OR=1.03（95%CI：1.01-1.04）， =0.009]与糖尿病性视网膜病变相关。在严重程度分析中，脉搏波速度与非增殖性糖尿病性视网膜病变[OR=1.10（95%CI：1.03-1.17）， =0.002]和增殖性糖尿病性视网膜病变[OR=1.15（95%CI：1.06-1.25）， =0.001]相关（-趋势 <0.001）。增强指数与非增殖性糖尿病性视网膜病变显著相关[OR=1.02（95%CI：1.01-1.04）， =0.008]，但与增殖性糖尿病性视网膜病变无关[OR=1.01（95%CI：0.98-1.04）， =0.36]（-趋势 =0.03）。
中心动脉僵硬度与 2 型糖尿病患者糖尿病性视网膜病变的发生和严重程度相关，提示其在糖尿病性视网膜病变发病机制中的作用。
