University of California - San Francisco, Department of Ophthalmology, San Francisco, CA, USA.
Zuckerberg San Francisco General Hospital and Trauma Center, Department of Ophthalmology, San Francisco, CA, USA.
Transl Vis Sci Technol. 2023 Nov 1;12(11):30. doi: 10.1167/tvst.12.11.30.
Epidemiologically, men have a higher incidence, severity, and progression of diabetic retinopathy (DR) than women. We investigated microvascular differences between men and women with diabetes on optical coherence tomography angiography (OCTA).
Three × 3 mm OCTA macula scans of non-diabetic and patients with diabetes were obtained. Vascular parameters included parafoveal vessel density (VD), vessel length density (VLD), and flow index (FI) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) as well as foveal avascular zone (FAZ) area and perimeter. Multivariable linear regression was used for statistical analysis.
There were 1809 patients with diabetes and 217 non-diabetic participants that were included in this study. Diabetic individuals included those with no DR (n = 1356), mild non-proliferative DR (NPDR; n = 286), moderate NPDR (n = 126), and severe NPDR/proliferative DR (PDR; n = 41). Male sex was significantly associated with smaller FAZ area/perimeter and lower DCP VLD in both non-diabetic subjects and patients with diabetes. Male sex in the diabetic group was additionally associated with lower SCP VD/VLD and DCP VD. Addition of an interaction between male sex and diabetes status in the interaction analysis showed that being male and diabetic conferred increased reduction in DCP VD and VLD compared to sex-based changes in non-diabetics. Larger FAZ perimeter, lower SCP VD/VLD, and lower DCP VLD were associated with poorer visual acuity in diabetics.
On OCTA, male patients with diabetes may have more severe microvascular disease especially in the DCP compared to women.
Sex-based alterations in diabetic microvascular disease has the potential to influence future basic and clinical studies as well as the implementation of OCTA disease markers.
从流行病学角度来看，男性糖尿病患者的糖尿病视网膜病变（DR）发病率、严重程度和进展程度均高于女性。我们通过光学相干断层扫描血管造影（OCTA）研究了男性和女性糖尿病患者的微血管差异。
获取非糖尿病患者和糖尿病患者的 3×3mm OCTA 黄斑扫描。血管参数包括浅层毛细血管丛（SCP）和深层毛细血管丛（DCP）的黄斑中心凹旁血管密度（VD）、血管长度密度（VLD）和血流指数（FI）以及中心凹无血管区（FAZ）面积和周长。采用多变量线性回归进行统计学分析。
本研究共纳入 1809 例糖尿病患者和 217 例非糖尿病患者。糖尿病患者包括无 DR（n=1356）、轻度非增生性 DR（NPDR；n=286）、中度 NPDR（n=126）和重度 NPDR/增生性 DR（PDR；n=41）。男性与非糖尿病患者和糖尿病患者的 FAZ 面积/周长较小以及 DCP VLD 较低有关。在糖尿病组中，男性还与 SCP VD/VLD 和 DCP VD 降低有关。在交互分析中加入男性与糖尿病状态之间的交互作用，结果表明与非糖尿病患者基于性别的变化相比，男性和糖尿病患者的 DCP VD 和 VLD 降低更为明显。较大的 FAZ 周长、较低的 SCP VD/VLD 和 DCP VLD 与糖尿病患者的视力较差有关。
在 OCTA 上，与女性相比，男性糖尿病患者的微血管疾病可能更为严重，尤其是 DCP。
糖尿病微血管疾病的性别差异有可能影响未来的基础和临床研究以及 OCTA 疾病标志物的实施。
