强化胰岛素治疗对2型糖尿病患者视网膜微血管的影响：一项前瞻性观察研究。
Effects of intensive insulin therapy on the retinal microvasculature in patients with type 2 diabetes mellitus: a prospective observational study.
作者信息
Yang Ning, Li Ming-Xin, Peng Xiao-Yan
机构信息
Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Science Key Laboratory, No.17 Hougou Lane, Chongnei Street, Beijing, 100005, China.
Department of Ophthalmology, The Affiliated Hospital of Xuzhou Medical University, Quanshan District, 99 West Huaihai RdJiangsu, Xuzhou, 221002, China.
出版信息
BMC Ophthalmol. 2022 Apr 22;22(1):187. doi: 10.1186/s12886-022-02397-9.
BACKGROUND
We examined the retinal microvascular changes and associated factors in type 2 diabetes mellitus (T2DM) before and after intensive insulin therapy.
METHODS
This prospective observational study recruited patients with T2DM and divided them into intensive insulin therapy and oral hypoglycemic agent groups. All patients enrolled in this study had diabetes without retinopathy or non-proliferative diabetic retinopathy. Optical coherence tomography angiography (OCTA) was used in all patients before treatment and at 1, 3, and 6 months after treatment. Vessel density (VD) and thickness changes in the macular and optic disc areas were assessed.
RESULTS
The study included 36 eyes in the intensive insulin therapy group and 36 in the oral hypoglycemic agent group. One month after treatment, VD in the deep capillary plexus (DCP) and peripapillary capillary VD (ppVD) were significantly decreased by intensification (P = 0.009, 0.000). At three months after treatment, decreases in VD induced by intensification were found in the superficial capillary plexus (SCP), DCP, foveal density in a 300-μm-wide region around the foveal avascular area (FD-300), and ppVD (P = 0.032, 0.000, 0.039, 0.000). Six months after treatment, decreases in VD by intensification were observed in the DCP and ppVD groups (P = 0.000, 0.000). Vessel density showed no significant change in the oral hypoglycemic agent group after treatment. The amount of DCP-VD reduction was correlated with macular thickening (r = 0.348, P = 0.038; r = 0.693, P = 0.000 and r = 0.417, P = 0.011, respectively) after intensive insulin therapy.
CONCLUSIONS
Insulin-intensive treatment caused a transient reduction in vessel density in the macular and optic disc areas. DCP-VD and ppVD were more susceptible at an earlier stage. Retinal microvasculature monitoring using OCTA is vital for patients with type 2 diabetes receiving intensive insulin therapy.
背景
我们研究了2型糖尿病（T2DM）患者强化胰岛素治疗前后的视网膜微血管变化及相关因素。
方法
这项前瞻性观察性研究招募了T2DM患者，并将他们分为强化胰岛素治疗组和口服降糖药组。本研究纳入的所有患者均患有糖尿病但无视网膜病变或非增殖性糖尿病视网膜病变。所有患者在治疗前以及治疗后1、3和6个月均接受光学相干断层扫描血管造影（OCTA）检查。评估黄斑区和视盘区的血管密度（VD）和厚度变化。
结果
强化胰岛素治疗组纳入36只眼，口服降糖药组纳入36只眼。治疗1个月后，强化治疗使深层毛细血管丛（DCP）的VD和视乳头周围毛细血管VD（ppVD）显著降低（P = 0.009，0.000）。治疗3个月后，强化治疗导致浅层毛细血管丛（SCP）、DCP、黄斑无血管区周围300μm宽区域的黄斑密度（FD-300）和ppVD的VD降低（P = 0.032，0.000，0.039，0.000）。治疗6个月后，DCP组和ppVD组的强化治疗导致VD降低（P = 0.000，0.000）。口服降糖药组治疗后VD无显著变化。强化胰岛素治疗后，DCP-VD降低量与黄斑增厚相关（r分别为0.348，P = 0.038；r = 0.693，P = 0.000和r = 0.417，P = 0.011）。
结论
强化胰岛素治疗导致黄斑区和视盘区的血管密度短暂降低。DCP-VD和ppVD在早期更易受影响。对于接受强化胰岛素治疗的2型糖尿病患者，使用OCTA监测视网膜微血管至关重要。
Zotero 插件