| 王萍,汪晓瑜,王小莉,等.血浆胰岛素水平与视盘周围血管密度和视网膜神经纤维层厚度的关系[J].安徽医药,2023,27(10):1990-1994. |
| 血浆胰岛素水平与视盘周围血管密度和视网膜神经纤维层厚度的关系 |
| Relationship between plasma insulin level and circumpapillary vascular density and thickness of retinal nerve fiber layer |
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| DOI：10.3969/j.issn.1009-6469.2023.10.018 |
| 中文关键词: 糖尿病视网膜病变 视盘周围血管密度 视网膜神经纤维层 胰岛素水平 因果律 |
| 英文关键词: Diabetic retinopathy Circumpapillary vascular density Retinal nerve fiber layer Insulin level Causality |
| 基金项目:陕西省重点研发计划项目( 2021SF-336) |
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| 中文摘要: |
| 目的探讨视盘周围血管密度(cpVD)和视网膜神经纤维层( RNFL)厚度与血浆胰岛素水平的关系。方法选取 2020年 7月至 2021年 7月西安市人民医院收治的 2型糖尿病病人 123例(123只眼)进行回顾性研究，根据是否发生糖尿病视网膜病变( DR)将病人分为: 2型糖尿病非视网膜病变( NDR)组( 50只眼)和非增生性糖尿病视网膜病变( NPDR)组( 73只眼)，此外选取 58例( 58只眼)正常眼(于该院进行健康体检)作为对照组。收集研究对象一般资料，包括年龄、性别、身体质量指数( BMI)、总胆固醇(TC)、三酰甘油( TG)高密度脂蛋白胆固醇( HDL-C)低密度脂蛋白胆固醇( LDL-C)、收缩压( SBP)、舒张压( DBP)并进行比较；采用酶联免疫( ELISA)、法检测血浆胰岛素水平；应用光、学相干断层扫描血管成像(OCTA)观察cpVD和RNF，L厚度；受试者操作特征( ROC)曲线评价 cpVD与 RNFL厚度对 DR发生的预测价值。通过 logistic回归分析 DR发生的影响因素。结果与对照组比较， NDR组和 NPDR组病人 RNFL厚度显著变薄［( 96.66±10.47)比( 81.75±9.59)、(90.56±10.33)μm］cpVD显著降低，胰岛素水平显著降低(均 P<0.05)；与 NPDR组相比， NDR组病人糖尿病病程及 BMI、SBP、DBP水平均升高( P<0.0，5)； NDR组和 NPDR组病人血浆胰岛素水平与 cpVD呈正相关( r=0.26，P<0.05)，与 RNFL厚度呈正相关( r=0.24，P<0.05)，cpVD与 RNFL厚度呈正相关( r=0.30，P<0.05)； NDR组和 NPDR组病人 cpVD、RNFL厚度与糖尿病病程、 BMI、SBP、DBP均呈负相关( P<0.05)； logistic回归分析显示胰岛素水平、糖尿病病程是影响 DR发生的因素(P<0.05)； ROC结果显示，胰岛素、 cpVD与 RNFL厚度 NPDR发生的曲线下面积( AUC)及 95%CI分别为 0.71(0.62，0.79)、 0.62(0.53，0.71)、 0.86(0.78，0.79)，对应的灵敏度分别为83.56%、80.00%、88.00%，特异度分别为 56.00%、41.10%、71.23%。三者联合 NPDR发生的 AUC 95%CI为 0.89(0.83，0.94)灵敏度为 87.67%，特异度为 80.00%。结论 2型糖尿病病人血浆胰岛素水平与 cpVD和 RNFL厚度均呈正相关。血浆胰岛素水平，可能作为预测视网膜功能的早期指标， RNFL厚度以及 cpVD可作为诊断 DR的指标。 |
| 英文摘要: |
| Objective To investigate the relationship between circumpapillary vascular density (cpVD) and retinal nerve fiber layer(RNFL) thickness and plasma insulin level.Methods A total of 123 eyes (123 eyes) of type 2 diabetic patients admitted to Xi′an People′s hospital from July 2020 to July 2021 were retrospectively studied. According to the occurrence of diabetic retinopathy (DR), patients were assigned into Type 2 diabetic non-retinopathy (NDR) group (n=50) and non-proliferative diabetic retinopathy (NPDR) group (n=73). In addition, 58 normal eyes (n=58) were selected as the control group. The general information of the research subjects was collected and compared, including age, gender, body mass index (BMI), C peptide, total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP) and diastolic blood pressure (DBP); enzyme-linked immunoassay (ELISA) was used to detect plasma insulin level; optical coherence tomography (OCTA) was usedto observe the cpVD and thickness of RNFL; receiver operating characteristic curve (ROC) was used to evaluate the predictive value ofcpVD and RNFL thickness on the occurrence of DR. Logistic regression was used to analyze the influencing factors of DR. Results Compared with the control group, the thickness of RNFL in the NDR group and the NPDR group was significantly thinner[(96.66±10.47) vs. (81.75±9.59), (90.56±10.33)μm], the cpVD was significantly reduced, and the insulin level was significantly reduced (P< 0.05). Compared with the NPDR group, the duration of diabetes and the levels of BMI, SBP and DBP in the NDR group were increased(P<0.05). Plasma insulin levels in NDR group and NPDR group were positively correlated with cpVD (r=0.26, P<0.05), positively correlated with RNFL thickness (r=0.24, P<0.05), and cpVD was positively correlated with RNFL thickness (r=0.30, P<0.05); cpVD andRNFL thickness were negatively correlated with diabetes duration, BMI, SBP and DBP in NDR group and NPDR group (P<0.05). Logistic regression analysis showed that insulin level and duration of diabetes were the factors affecting the occurrence of DR (P<0.05). The ROC results showed that the area under the curve (AUC)95%CI of insulin, cpVD and RNFL thickness NPDR were 0.71(0.62,0.79), 0.62(0.53,0.71), 0.855 (0.78,0.79), the corresponding sensitivities were 83.56%, 80.00%, and 88.00%, and the specificities were 56.00%,41.10%, and 71.23%, respectively. The AUC 95%CI of the three combined NPDR was 0.89(0.83,0.94), the sensitivity was 87.67%, and the specificity was 80.00%. Conclusion Plasma insulin level was positively correlated with cpVD and RNFL thickness in patientswith type 2 diabetes. Plasma insulin level may be used as an early indicator of retinal function, RNFL thickness and cpVD may also beused as diagnostic indicators of DR. |
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