糖尿病患者微量白蛋白尿对其脉络膜厚度的影响

目的　分析糖尿病患者微量白蛋白尿对其脉络膜厚度（ｃｈｏｒｏｉｄａｌｔｈｉｃｋｎｅｓｓ，ＣＴ）的影响。方法　将经内分泌科医师确诊的２型ＤＭ患者３０例（６０眼）纳入本研究，选取眼底未发现明显异常或轻度非增生型糖尿病视网膜病变（ｎｏｎ-ｐｒｏｌｉｆｅｒａｔｉｖｅｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ，ＮＰＤＲ）患眼，每例患者均根据尿中白蛋白量的不同分为正常白蛋白尿组（１５例）与微量白蛋白尿组（１５例）。应用ＥＤＩ-ＳＤＯＣＴ检测受检者双眼黄斑中心凹下及鼻侧、颞侧、上方和下方各１ｍｍ、２ｍｍ及３ｍｍ处共１３个位点的ＣＴ。分析两组患者黄斑中心凹下脉络膜厚度（ｓｕｂｆｏｖｅａｌｃｈｏｒｏｉ-ｄａｌｔｈｉｃｋｎｅｓｓ，ＳＦＣＴ）及其各位点ＣＴ值变化以及尿白蛋白量、糖尿病病程、糖化血红蛋白、年龄、眼轴长度、眼压与ＳＦＣＴ的相关性。结果　正常白蛋白尿组ＳＦＣＴ为（３５２．４３±５３．１７）μｍ，与微量白蛋白尿组ＳＦＣＴ（２６７．２７±５６．６０）μｍ比较，差异有统计学意义（ｔ＝６．００７，Ｐ＜０．０５）；两组间距中心凹２ｍｍ处的鼻侧ＣＴ（ｔ＝３．６２４，Ｐ＝０．２５４）、两组间距中心凹３ｍｍ处的鼻侧ＣＴ（ｔ＝－０．７７０，Ｐ＝０．４４５）差异均无统计学意义，两组间其他各位点ＣＴ差异均有统计学意义（均为Ｐ＝０．０００）。ＳＦＣＴ与尿白蛋白量、眼轴长度有相关性（β１＝－０．６２８，Ｐ＝０．０００；β６＝－４０．７４１，Ｐ＝０．０００），而与眼压（Ｐ＝０．１１４）、糖化血红蛋白（Ｐ＝０．３５３）、糖尿病病程（Ｐ＝０．７２６）、年龄（Ｐ＝０．０９５）均无相关性。结论　ＤＭ患者伴微量白蛋白尿者ＣＴ变薄，尤其是在黄斑中心凹下、颞侧、上方及下方区域ＣＴ变薄更加显著。

Effects of microalbuminuria on choroidal thickness in diabetic patients

Objective To evaluate the effects of microalbuminuria on choroidal thickness in patients with diabetes. Methods A cross-sectional observational study was designed. A total of 60 eyes ( 30 patients) of type 2 diabetes mellitus ( DM) were included in this study , including non-diabetic retinopathy ( NDR ) , mild non-proliferative diabetic retinopathy( NPDR) eyes. Participants were divided into two groups ( normoalbuminuria vs microalbuminuria ) . The choroidal thickness ( CT ) was measured in the subfoveal area and I mm ,2 mm and 3 mm away from the fovea in the nasal,temporal, superior and inferior region by enhanced depth imaging spectral-domain optical coherence tomography ( EDI-SDOCT). The relationship between subfoveal choroidal thickness ( SFCT) and all other parts of the CT , albununuria. DM duration, glycayed hemoglobin , age , intraocular pressure , axial length was analyzed , respectively. Results The mean SFCT in normoalbuminuria group and microalbununuric group were ( 352. 43 + 53. 17 ) ym and ( 267. 27 + 56. 60 ) ym , respectively , there was significant difference ( t = 6. 007 .P < 0. 05 ) .but there was no difference in the nasal CT near to macular fovea of 2 mm( t = 3. 624 ,P = 0. 254 ) and 3 mm ( t = - 0. 770 .P = 0. 445 ) between the two groups. Mean CT in other parts were also significantly different between the two groups ( all P =0. 000) . SFCT of all patients were associated with albununuria and axial length (P, = - 0. 628 .P = 0. 000 ;pc) = - 40. 741 .P = 0. 000 ) . but SFCT was not associated with DM duration ( P = 0. 726 ) . intraocular pressure ( P = 0. 114 ) , glycayed hemoglobin ( P = 0. 353) and age(P = 0. 095 ) . Conclusion CT is thinner in diabetic patients with microalbuminuria, especially at the subfoveal region,temporal, superior and inferior of the fovea.