糖尿病无糖尿病视网膜病变患者的蛋白尿与视网膜血管密度：开滦眼病研究。
Albuminuria and retinal vessel density in diabetes without diabetic retinopathy: the Kailuan Eye Study.
机构信息
Beijing Ophthalmology and Visual Science Key Lab, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.
出版信息
Acta Ophthalmol. 2021 Aug;99(5):e669-e678. doi: 10.1111/aos.14670. Epub 2020 Dec 23.
BACKGROUND
Diabetic retinopathy and chronic kidney disease are both major complications of diabetes mellitus. We explored the relationship between retinal vessel density (VD) and albuminuria in diabetic patients without conventionally defined diabetic retinopathy.
METHODS
The cross-sectional community-based Kailuan Diabetic Retinopathy Study included patients with type 2 diabetes without diabetic retinopathy who participated in the community-based longitudinal Kailuan study and who had undergone ocular fundus photography, kidney function assessment, and optical coherence tomographic angiography (OCT-angiography) for the assessment the retinal perfusion density (PD) and retinal VD.
RESULTS
The study included 447 patients (mean age: 60.9 ± 9.7 years). Higher PD and VD were associated with a lower urinary albumin-creatinine ratio (uACR) (macular region: p = 0.007: standardized regression coefficient beta: -0.14; and p = 0.008, beta: -0.13, respectively; parafoveal region: p = 0.006, beta: -0.14; and p = 0.007, beta: -0.14, respectively) after adjusting for age and ocular axial length. In a reverse manner, higher uACR was associated with lower PD and VD (macular region: p = 0.009, beta: -0.14; and p = 0.01, beta: -0.14, respectively; parafoveal region: p = 0.008, beta: -0.14; and p = 0.01, beta: -0.14, respectively), after adjusting for diabetes duration, blood pressure, serum concentration of C-reactive protein and high-density lipoprotein cholesterol and ocular axial length. In a multivariable model, the prevalence of macroalbuminuria increased by 11% (95% CI: 2%, 18%) and 17% (95% CI: 3%, 30%), respectively, for each mm decrease in VD and each unit decrease in PD.
CONCLUSIONS AND RELEVANCE
After adjusting for systemic and ocular parameters, diabetic patients without diabetic retinopathy showed a reduction in OCT-angiographic retinal vascular measurements in association with systemic parameters indicating chronic kidney disease. Optical coherence tomographic (OCT)-angiographic retinal microvascular parameters may serve as markers for chronic kidney disease.
背景
糖尿病视网膜病变和慢性肾脏病都是糖尿病的主要并发症。我们探讨了无传统定义的糖尿病视网膜病变的糖尿病患者视网膜血管密度（VD）与白蛋白尿之间的关系。
方法
横断面社区为基础的开滦糖尿病视网膜病变研究纳入了参加社区为基础的开滦研究且接受过眼部眼底照相、肾功能评估和光学相干断层血管造影术（OCT-angiography）评估视网膜灌注密度（PD）和视网膜 VD 的 2 型糖尿病无糖尿病视网膜病变的患者。
结果
该研究纳入了 447 名患者（平均年龄：60.9±9.7 岁）。较高的 PD 和 VD 与较低的尿白蛋白/肌酐比值（uACR）相关（黄斑区：p=0.007，标准化回归系数β：-0.14；p=0.008，β：-0.13，分别；旁黄斑区：p=0.006，β：-0.14；p=0.007，β：-0.14，分别），校正年龄和眼轴长度后。相反，较高的 uACR 与较低的 PD 和 VD 相关（黄斑区：p=0.009，β：-0.14；p=0.01，β：-0.14，分别；旁黄斑区：p=0.008，β：-0.14；p=0.01，β：-0.14，分别），校正糖尿病病程、血压、血清 C 反应蛋白和高密度脂蛋白胆固醇浓度和眼轴长度后。在多变量模型中，VD 每降低 1mm 和 PD 每降低 1 个单位，宏观白蛋白尿的患病率分别增加 11%（95%CI：2%，18%）和 17%（95%CI：3%，30%）。
结论和相关性
在调整全身和眼部参数后，无糖尿病视网膜病变的糖尿病患者的 OCT-angiography 视网膜血管测量值降低，与全身参数指示慢性肾脏病相关。光学相干断层扫描（OCT）-angiography 视网膜微血管参数可能作为慢性肾脏病的标志物。
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