从甲襞微循环探讨糖尿病视网膜病变与糖尿病肾病的对应关系

摘要

目的：：通过甲襞微循环积分值分析,探讨2型糖尿病视网膜病变(DR)与糖尿病肾病(DN)之间的对应关系。方法：353例2型糖尿病患者均进行眼底检查及尿微量白蛋白(UMA)测定,根据两项检查结果按各自临床分期进行对应分组,即眼底正常组(NDR 组,n=110)、正常白蛋白尿组(SDM 组,n=185)、非增殖性 DR 组(NPDR组,n=192)、微量白蛋白尿组(EDN 组,n=11 7)、增殖性 DR 组(PDR 组,n=51)、临床期 DN 组(CDN 组,n=51),观测各组甲襞微循环,并计算形态积分值、流态积分值、袢周积分值和总积分值,界定甲襞微循环轻、中、重度异常。比较对应组别的甲襞微循环积分值差异,以及不同程度微循环异常在各对应组别的分布。结果：各对应组别微循环积分值比较,除 NPDR 组与 EDN 组之形态积分差异有统计学意义(P <0.05)外,其余对应各组各项积分差异均无统计学意义(P >0.05)；微循环轻度异常和重度异常在各对应组别的积分值差异均无统计学意义(P >0.05),在微循环中度异常的 PDR 组与 CDN 组流态积分分布差异具有统计学意义(P <0.05),其余组别积分值比较亦无统计学差异(P >0.05)。结论：相同分期 DR 与 DN 患者甲襞微循环障碍程度基本一致,有一定的对应关系。%Objective:To discuss the corralationship between diabetic retinopathy and diabetic nephropathyin patients with type 2 diabetes mellitus by analyzing the integral values of nailfold microcirculation.Method:353 cases of patients with type 2 diabetes were confirmed they were all performed fundus examination and determinated urine microalbuminuria (UMA).We divided all patients into three groups according to examination results and their clini-cal staging subgroup correspondences ,namely normal fundus group (NDR,n=1 10)-albumin normal group (SDM, n=185),non-proliferative retinopathy (NPDR,n=1 92)-microalbuminuria group (EDN,n=1 1 7),proliferative ret-inopathy (PDR,n=5 1)-clinical stage diabetic nephropathy group (CDN,n=5 1).Then we observed nailfold micro-circulation,and calculated the morphological integral values,flow integral values,perivascular integral values and the total integral values;defined the nailfold microcirculation which was mild,moderate and severe .Compared differences of the corresponding integral values of nailfold microcirculation groups and distributions in different de-grees of abnormal microcirculation in each group.Results:In the comparison of corresponding groups of microcirculation integral values,ecxcept for of the difference of NPDR-EDN group was statistically significant (P <0.05),the rest of the corresponding points had no significant (P >0.05).The integral values of microcirculation mild abnormalities and severe ab-normalities in the corresponding group had no significant (P >0.05).The flow integral value of moderate abnormalities in PDR-CDN group had statistically significant (P <0.05),and the other integral values had no significant (P >0.05). Conclusion:There is positively correlation betweeen the same stage of diabetic retinopathy and diabetic nephropathy patients and they have same extent of nailfold microcirculation.