Hwang Jodi, Karanam Veena, Wang Jianhua, Feuer William J, Garg Rajesh K, Tamariz Leonardo, Galor Anat
University of Miami Miller School of Medicine, Miami, FL.
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL.
Cornea. 2021 Aug 1;40(8):950-957. doi: 10.1097/ICO.0000000000002623.
This study used functional slit lamp biomicroscopy (FSLB) to quantify conjunctival microvessel parameters in individuals with and without diabetes and examined whether these metrics could be used as surrogate markers of diabetes-related complications.
A cross-sectional study of 98 controls (C), 13 individuals with diabetes without complications (D-C), and 21 with diabetes and related complications (D+C), which included retinopathy, nephropathy, neuropathy, and cardiovascular-, peripheral vascular-, and cerebrovascular diseases, was performed. Bulbar conjunctival metrics (venule diameter, length, axial velocity [Va], cross-sectional velocity [Vs], flow [Q], and branching complexity) were measured using FSLB (digital camera mounted on traditional slit lamp).
The mean age was 60 ± 11 years, and demographics were similar across the groups. Va and Vs significantly differed between groups. Va was 0.51 ± 0.17 mm/s, 0.62 ± 0.17 mm/s, and 0.45 ± 0.17 mm/s in the C, D-C, and D+C groups, respectively (P = 0.025). Similarly, Vs was 0.35 ± 01.12, 0.43 ± 0.13, and 0.32 ± 0.13 mm/s in the C, D-C, and D+C groups, respectively (P = 0.031). Black individuals had increased Va, Vs, and Q compared with White individuals (P < 0.05), but differences in velocities persisted after accounting for race. Among patients with diabetes, Va and Vs correlated with number of organ systems affected (Va: ρ = -0.42, P = 0.016; Vs: ρ = -0.41, P = 0.021). Va, Vs, and Q significantly (P ≤ 0.005) discriminated between diabetic patients with and without complications (area under the receiver operating curve for Va = 0.81, Vs = 0.79, Q = 0.81).
Bulbar conjunctival blood flow metrics measured by FSLB differed between controls, diabetic patients without complications, and diabetic patients with complications. FSLB is a quick, easily accessible, and noninvasive alternative that might estimate the burden of vascular complications in diabetes.
本研究采用功能性裂隙灯生物显微镜检查（FSLB）对糖尿病患者和非糖尿病患者的结膜微血管参数进行量化，并探讨这些指标是否可作为糖尿病相关并发症的替代标志物。
对98名对照者（C）、13名无并发症的糖尿病患者（D-C）和21名有糖尿病及相关并发症（D+C）的患者进行了横断面研究，其中糖尿病相关并发症包括视网膜病变、肾病、神经病变以及心血管疾病、外周血管疾病和脑血管疾病。使用FSLB（安装在传统裂隙灯上的数码相机）测量球结膜指标（小静脉直径、长度、轴向速度[Va]、横截面积速度[Vs]、血流量[Q]和分支复杂性）。
平均年龄为60±11岁，各组的人口统计学特征相似。各组之间Va和Vs存在显著差异。C组、D-C组和D+C组的Va分别为0.51±0.17mm/s、0.62±0.17mm/s和0.45±0.17mm/s（P = 0.025）。同样，C组、D-C组和D+C组的Vs分别为0.35±0.12、0.43±0.13和0.32±0.13mm/s（P = 0.031）。与白人相比，黑人的Va、Vs和Q更高（P < 0.05），但在考虑种族因素后，速度差异仍然存在。在糖尿病患者中，Va和Vs与受影响的器官系统数量相关（Va：ρ = -0.42，P = 0.016；Vs：ρ = -0.41，P = 0.021）。Va、Vs和Q在有并发症和无并发症的糖尿病患者之间有显著差异（P≤0.005）（Va的受试者操作特征曲线下面积 = 0.81，Vs = 0.79，Q = 0.81）。
通过FSLB测量的球结膜血流指标在对照者、无并发症的糖尿病患者和有并发症的糖尿病患者之间存在差异。FSLB是一种快速、易于操作且无创的替代方法，可能有助于评估糖尿病血管并发症的负担。
