Yoon Jooyoung, Kang Hyo Joo, Lee Joo Yong, Kim June-Gone, Yoon Young Hee, Jung Chang Hee, Kim Yoon Jeon
Department of Ophthalmology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea.
Asan Diabetes Center, Asan Medical Center, Seoul, South Korea.
Front Med (Lausanne). 2022 Mar 4;9:843176. doi: 10.3389/fmed.2022.843176. eCollection 2022.
To investigate the associations between the macular microvasculature assessed by optical coherence tomography angiography (OCTA) and subclinical atherosclerosis in patients with type 2 diabetes.
We included patients with type 2 diabetes who received comprehensive medical and ophthalmic evaluations, such as carotid ultrasonography and OCTA at a hospital-based diabetic clinic in a consecutive manner. Among them, 254 eyes with neither diabetic macular edema (DME) nor history of ophthalmic treatment from 254 patients were included. The presence of increased carotid intima-media thickness (IMT) (>1.0 mm) or carotid plaque was defined as subclinical atherosclerosis. OCTA characteristics focused on foveal avascular zone (FAZ) related parameters and parafoveal vessel density (VD) were compared in terms of subclinical atherosclerosis, and risk factors for subclinical atherosclerosis were identified using a multivariate logistic regression analysis.
Subclinical atherosclerosis was observed in 148 patients (58.3%). The subclinical atherosclerosis group were older ( < 0.001), had a greater portion of patients who were men ( = 0.001) and who had hypertension ( = 0.042), had longer diabetes duration ( = 0.014), and lower VD around FAZ ( = 0.010), and parafoveal VD (all < 0.05). In the multivariate logistic regression analysis, older age ( ≤ 0.001), male sex ( ≤ 0.001), lower VD around FAZ ( = 0.043), lower parafoveal VD of both superficial capillary plexus (SCP) ( = 0.011), and deep capillary plexus (DCP) ( = 0.046) were significant factors for subclinical atherosclerosis.
The decrease in VD around FAZ, and the VD loss in parafoveal area of both SCP and DCP were significantly associated with subclinical atherosclerosis in patients with type 2 diabetes, suggesting that common pathogenic mechanisms might predispose to diabetic micro- and macrovascular complications.
研究光学相干断层扫描血管造影（OCTA）评估的黄斑微血管与2型糖尿病患者亚临床动脉粥样硬化之间的关联。
我们纳入了在一家医院糖尿病门诊接受全面医学和眼科评估（如颈动脉超声检查和OCTA）的2型糖尿病患者。其中，纳入了254例患者的254只既无糖尿病性黄斑水肿（DME）也无眼科治疗史的眼睛。颈动脉内膜中层厚度（IMT）增加（>1.0 mm）或存在颈动脉斑块被定义为亚临床动脉粥样硬化。根据亚临床动脉粥样硬化情况比较了OCTA特征，重点是中心凹无血管区（FAZ）相关参数和黄斑旁血管密度（VD），并使用多因素逻辑回归分析确定亚临床动脉粥样硬化的危险因素。
148例患者（58.3%）观察到亚临床动脉粥样硬化。亚临床动脉粥样硬化组患者年龄更大（<0.001），男性患者比例更高（=0.001），高血压患者比例更高（=0.042），糖尿病病程更长（=0.014），FAZ周围VD更低（=0.010），黄斑旁VD更低（均<0.05）。在多因素逻辑回归分析中，年龄较大（≤0.001）、男性（≤0.001）、FAZ周围VD较低（=0.043）、浅表毛细血管丛（SCP）（=0.011）和深层毛细血管丛（DCP）（=0.046）的黄斑旁VD较低是亚临床动脉粥样硬化的显著因素。
FAZ周围VD降低以及SCP和DCP黄斑旁区域的VD丧失与2型糖尿病患者亚临床动脉粥样硬化显著相关，提示共同的致病机制可能易导致糖尿病微血管和大血管并发症。
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