Mosier M A, Lopez K H, Noorbaksh K R, Charles M A
Department of Ophthalmology, University of California-Irvine 92717-4065, USA.
J Diabetes Complications. 1997 Jul-Aug;11(4):218-24. doi: 10.1016/s1056-8727(96)00039-6.
The integrity of the blood-retinal and blood-glomerular vascular barriers were investigated simultaneously in diabetic individuals to determine whether or not the early forms of diabetic retinopathy and nephropathy are temporally related. The blood-retinal barrier was assessed by the technique of vitreous fluorophotometry. Twenty-four hour urinary excretion of albumin was determined by radioimmunoassay before fluorescein measurement. Posterior vitreous fluorescein leakage was greater in the study cohort than in the control population after diabetes had been present 11-20 years (p < 0.05) and 21 years or more (p < 0.01). Albumin excretion was also increased in the diabetic subjects (p < 0.001) and correlated to duration of diabetes (r = 0.51, p < 0.005). Hypertension raised midvitreous fluorescein levels (p < 0.05), but it had no effect on posterior vitreous values. Hypertension was an independent predictive factor for urinary albumin excretion (p < 0.05). Partial correlation analysis showed that vitreous fluorescence and urinary protein were not significantly correlated when controlled for duration of diabetes and for age. Early proteinuria did not predict retinal vascular leakage, nor did increased fluorescein leakage predict renal decompensation in the diabetic subjects. The data suggest that during the early stages of retinal and renal abnormalities associated with insulin-dependent diabetes, the eye and kidney follow different temporal courses to abnormal function.
在糖尿病患者中同时研究血视网膜屏障和血肾小球屏障的完整性，以确定糖尿病视网膜病变和肾病的早期形式在时间上是否相关。通过玻璃体荧光光度测定技术评估血视网膜屏障。在测量荧光素之前，通过放射免疫测定法测定24小时尿白蛋白排泄量。糖尿病病程为11 - 20年（p < 0.05）和21年及以上（p < 0.01）的研究队列中，玻璃体后荧光素渗漏比对照人群更严重。糖尿病患者的白蛋白排泄量也增加（p < 0.001），且与糖尿病病程相关（r = 0.51，p < 0.005）。高血压会提高玻璃体中部荧光素水平（p < 0.05），但对玻璃体后部的值没有影响。高血压是尿白蛋白排泄的独立预测因素（p < 0.05）。偏相关分析表明，在控制糖尿病病程和年龄后，玻璃体荧光和尿蛋白无显著相关性。早期蛋白尿不能预测视网膜血管渗漏，荧光素渗漏增加也不能预测糖尿病患者的肾脏失代偿。数据表明，在与胰岛素依赖型糖尿病相关的视网膜和肾脏异常的早期阶段，眼睛和肾脏的功能异常遵循不同的时间进程。
