2型糖尿病患者尿微量白蛋白含量与黄斑区视网膜微循环相关性分析

目的应用光学相干断层扫描血管成像技术(optical coherence tomography angiography,OCTA)观察有或无微量白蛋白尿的糖尿病(DM)患者黄斑中心凹无血管区(foveal avascular zone,FAZ)面积和黄斑区血流密度(macular vascular density,MVD)的变化及其临床意义。方法横断面研究。确诊无视网膜病变的2型DM患者60例60眼纳入本研究,每例患者均根据尿中白蛋白的含量分为正常白蛋白尿组(30例)与微量白蛋白尿组(30例),同时取健康人30人30眼作为对照组。所有受试者均应用OCTA对黄斑区视网膜行3 mm×3 mm范围的模式扫描,获得浅层视网膜、深层视网膜、脉络膜毛细血管层3个层面的MVD图,同时测量黄斑FAZ面积和MVD指标。结果正常白蛋白尿组、微量白蛋白尿组及对照组的黄斑FAZ面积分别为(0.34±0.02)mm²、(0.39±0.02)mm²、(0.29±0.03)mm²,三组间黄斑FAZ面积相比,差异均有统计学意义(均为P<0.05)...

Correlation analysis between microalbumin changes and macular retinal microcirculation in type 2 diabetic patients

Objective　To observe the changes in the area of the foveal avascular zone (FAZ) and macular vascular density (MVD) in diabetic patients with or without microalbuminuria using optical coherence tomography angiography (OCTA) and its clinical significance.Methods　This was a cross-sectional study. A total of 60 patients （60 eyes）of type 2 diabetes mellitus (DM) without diabetic retinopathy (DR) were included in this study, and they were divided into two groups: normoalbuminuric group (30 patients) and microalbuminuric group (30 patients) according to the content of albumin in the urine. Meanwhile, 30 eyes of 30 healthy people were collected as the control group. All subjects underwent the 3 mm×3 mm scanning of macular retina by OCTA to obtain MVD images of the superficial retina, deep retina, and choroid capillary layer. At the same time, the macular FAZ area and MVD indicators were measured.Results　The area of FAZ was （0.34±0.02）mm2 in the normoalbuminuric group and （0.39±0.02）mm² in the microalbuminuric group, respectively, and the differences were statistically significant compared with the control group (0.29±0.03) mm² (both P<0.05). The MVD in the superficial retinal layer, deep retinal and choroidal capillary layer was (49.63±2.61)%, (50.48±2.61)%, and (53.85±2.03)% in the normoalbuminuric group, and (47.60±2.63)%, (49.50±2.49)%, and (53.10±1.98)% in the microalbuminuric group, respectively, and the difference was statistically significant compared with the control group ［(51.02±2.08)%, (53.48±2.32)%, and (56.56±2.15)%, respectively ］ (all P＜0.05). There was statistically significant difference in MVD between the normoalbuminuric group and microalbuminuric group in the superficial retinal layer（P＜0.05), but not significant differences in the deep retinal and choroidal capillary layer (both P>0.05). Duration of diabetes, glycosylated hemoglobin and urinary albumin levels were significantly correlated with mean vessel densities of the superficial retinal layer in diabetic patients（r=0.934， 0.896, 0.717，all P<0.05）.Conclusion　Diabetic eyes without clinically detectable DR show impaired retinal microcirculation. Microalbuminuria is associated with alterations of retinal microcirculation in the early stage of DM. Evaluation of retinal microcirculation is likely useful for detecting early changes related to microvascular complications in type 2 diabetic patients.