Drinkwater J J, Chen F K, Brooks A M, Davis B T, Turner A W, Davis T M E, Davis W A
Medical School, The University of Western Australia, Fremantle Hospital, Fremantle, Australia.
Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, Australia.
Diabet Med. 2021 Apr;38(4):e14407. doi: 10.1111/dme.14407. Epub 2020 Sep 29.
To determine whether macrovascular disease assessed by carotid ultrasonography and arterial stiffness by pulse wave velocity are independently associated with diabetic retinopathy in type 2 diabetes.
A random subgroup of surviving participants with type 2 diabetes from the Fremantle Diabetes Study Phase II were invited to take part in this sub-study in 2018-2019. In addition to standardized questionnaires, a physical examination and fasting biochemical tests, each underwent dilated colour fundus photography, carotid arterial ultrasonography with measurement of the intima-media thickness (IMT) and quantification of the degree of stenosis, and pulse wave analysis calculation of the carotid-femoral pulse wave velocity (cfPWV). The cross-sectional association between arterial disease parameters and diabetic retinopathy was assessed using generalized estimating equation models which enabled both eyes to be included in the analysis.
Some 270 participants [mean ± sd age 72 ± 9 years, 153 (57%) men and median (IQR) diabetes duration 15 (11-22) years] were included in analysis. Of 524 assessable eyes, 82 (16%) had diabetic retinopathy. In multivariable analysis, significant independent associates of diabetic retinopathy were age at diabetes diagnosis (inversely), HbA , insulin treatment and urinary albumin to creatinine ratio (all P ≤ 0.022), as well as cfPWV [odds ratio (OR) 1.13, 95% confidence interval (CI) 1.03, 1.23 per 1 m/s increase; P = 0.008] and common carotid artery (CCA) IMT ≥1 mm (OR 2.95, 95% CI 1.21, 7.23; P = 0.018).
The association between diabetic retinopathy and CCA IMT suggests that carotid disease may share cardiovascular risk factors with diabetic retinopathy. The association between diabetic retinopathy and cfPWV may reflect the consequences of altered intravascular haemodynamics.
确定通过颈动脉超声评估的大血管疾病和通过脉搏波速度评估的动脉僵硬度是否与2型糖尿病患者的糖尿病视网膜病变独立相关。
2018 - 2019年，邀请弗里曼特尔糖尿病研究二期中存活的2型糖尿病参与者的一个随机亚组参加这项子研究。除了标准化问卷、体格检查和空腹生化检查外，每位参与者均接受散瞳彩色眼底照相、测量内膜中层厚度（IMT）并量化狭窄程度的颈动脉超声检查，以及计算颈股脉搏波速度（cfPWV）的脉搏波分析。使用广义估计方程模型评估动脉疾病参数与糖尿病视网膜病变之间的横断面关联，该模型能够将双眼纳入分析。
约270名参与者[平均±标准差年龄72±9岁，153名（57%）男性，糖尿病病程中位数（四分位间距）为15（11 - 22）年]纳入分析。在524只可评估眼中，82只（16%）患有糖尿病视网膜病变。在多变量分析中，糖尿病视网膜病变的显著独立相关因素包括糖尿病诊断时的年龄（呈负相关）、糖化血红蛋白、胰岛素治疗以及尿白蛋白肌酐比值（均P≤0.022），还有cfPWV[每增加1 m/s，比值比（OR）1.13，95%置信区间（CI）1.03，1.23；P = 0.008]和颈总动脉（CCA）IMT≥1 mm（OR 2.95，95% CI 1.21，7.23；P = 0.018）。
糖尿病视网膜病变与CCA IMT之间的关联表明，颈动脉疾病可能与糖尿病视网膜病变具有共同的心血管危险因素。糖尿病视网膜病变与cfPWV之间的关联可能反映了血管内血流动力学改变的后果。
