摘要目的 观察并分析2型糖尿病(T2DM)患者糖化血红蛋白(HbA1c)水平对黄斑区微循环的影响.方法 横断面研究.2017年9～12月月在苏州大学附属理想眼科医院经眼底彩色照相检查明确无糖尿病视网膜病变的T2DM患者124例124只眼纳入研究.其中,男性59例59只眼,女性65例65只眼;均为单眼.平均年龄(65.06±7.99)岁.均行BCVA、标准7视野眼底彩色照相、OCT血管成像(OCTA)检查;详细记录患者糖尿病病史、高血压病史、血脂异常病史.根据HbA1c水平,将患者分为HbA1c控制理想组(A组,HbA1c＜7％)、HbA1c控制一般组(B组,7％≤HbA1c≤9％)、HbA1c控制不佳组(C组,HbA1c＞9％),分别为67、44、13只眼.采用OCTA仪对黄斑区3 mm×3mm范围进行扫描,测量患眼黄斑区未分层视网膜(NRL)、浅层视网膜(SRL)、深层视网膜(DRL)的血管密度(VD)、血管骨架密度(SD)以及SRL的黄斑中心凹无血管区(FAZ)面积、非圆度指数(AI)、轴率(AR).HbA1c、BCVA与NRL、SRL、DRL的VD、SD的相关性采用Spearman相关性检验;全身因素与上述指标的相关性采用线性回归分析.结果 线性回归分析结果显示,HbA1c与NRL、SRL、DRL的VD(t=-3.237、-3.156、-2.050)、SD(t=-0.3.45、-3.034、-2.148)呈显著相关(P＜0.05);与FAZ(t=1.739)、AI(t=-0.429)、AR (t=1.155)无相关(P＞0.05).A、B、C组患眼间NRL、SRL、DRL的VD(F=6.349、5.981、3.709)、SD(F=7.275、6.085、1.904)以及AR(F=0.027)比较,差异有统计学意义(P＜0.05);FAZ(F=1.904)、AI(F=0.280)比较,差异无统计学意义(P＞0.05).组间两两比较,NRL的VD、SD,A组与B(t=1.987、2.201)、C组(t=3.365、3.572)、B组与C组(t=2.010、2.076,P＜0.05)差异均有统计学意义(P＜0.05).SRL的VD、SD,A组与B(t=2.087、2.168)、C组(t=3.197、3.194)差异有统计学意义(P＜0.05).DRL的VD、SD,A组与B组SD差异有统计学意义(t=2.239,P＜0.05),A组与C组VD(t=2.363)、SD(t=2.519)差异有统计学意义(P＜0.05).Spearman相关性分析结果显示,HbA1c与NRL、SRL、DRL的VD(r=-0.273、-0.255、-0.222,P=0.002、0.004、0.013)、SD(r=-0.275、-0.236、-0.254)均呈负相关(P＜0.05);与FAZ、BCVA呈正相关(r=0.221、0.183,P＜0.05).BCVA与NRL、SRL、DRL的VD(r=-0.210、-0.190、-0.245)、SD(r=-0.239、-0.207、-0.296)均呈负相关(P＜0.05);与FAZ无相关(r=0.099,P＞0.05).结论 T2DM患者HbA1c升高会伴随黄斑区血液灌注量下降和黄斑无血管区形态改变.

abstractsObjective To observe and analyze the effect of HbA1c level on macular microcirculation in patients with type 2 diabetes mellitus (T2DM).Methods A cross-sectional study.One hundred and twenty-four T2DM patients (124 eyes) without diabetic retinopathy who diagnosed by the examination of fundus color photography in Lixiang Eye Hospital Of Soochow University during September to December 2017 were enrolled in this study.There were 59 males (59 eyes) and 65 females (65 eyes),with the mean age of 65.06±7.99 years old.All patients underwent BCVA,fundus color photography,and OCT angiography (OCTA).The history of diabetes,hypertension and dyslipidemia were recorded in detail.According to the HbA 1 c level,patients were divided into three groups,HbA1c ideal control group (group A,HbA1c ＜7％,67 eyes),HbA1c control group (group B,7％≤HbA1c≤9％,44 eyes),and HbA1c poor control group (group C,HbA1c＞9％,13 eyes),respectively.The 3 mm × 3 mm range of the macular area was scanned by OCTA instrument.The vascular density (VD) and skeleton density (SD) of nonsegmented retinal layer (NRL),superficial retinal layer (SRL) and deep retinal layer (DRL) in the macular area and foveal avascular zone (FAZ) area,non-circularity index,axial rate (AR) of SRL were measured.The correlation between HbA1c,BCVA and VD,SD ofNRL,SRL,DRL was analyzed statistically with Spearman correlation test.The correlation between systemic factors and the above indicators was analyzed statistically with linear regression analysis.Results The results of linear regression analysis showed that HbA1 c was significantly correlated with VD (t=-3.237,-3.156,-2.050) and SD (t=-0.3.45,-3.034,-2.248) of NRL,SRL and DRL (P＜0.05);but no correlation with FAZ,non-circularity index and AR (t=1.739,0.429,1.155;P＞0.05).The differences of VD (F=6.349,5.981,3.709),SD (F=7.275,6.085,1.904) and AR (F=0.027) of NRL,SRL and DRL in group A,B and C were statistically significant (P＜0.05);but the differences of FAZ (F=1.904),non-circularity index (F=0.280) was not statistically significant (P＞0.05).Significant differences (P＜0.05) of VD and SD of NRL were found between group A and B (t=1.987,2.201),group A and C (t=3.365,3.572),group B and C (t=2.010,2.076).Significant differences (P＜0.05) of VD and SD of SRL were found between group A and B (t=2.087,2.168),group A and C (t=3.197,3.194).There were significant differences (P＜ 0.05) in SD of DRL between group A and B (t=2.239),group A and C (t=-2.519).There was significant difference in VD of DRL between group A and C (t=2.363).The results of Spearman correlation analysis showed that HbA1c was negatively correlated with VD (r=-0.273,-0.255,-0.222;P=0.002,0.004,0.013) and SD (r=-0.275,-0.236,-0.254;P＜0.05) ofNRL,SRL,DRL;positively correlated with FAZ and BCVA (r=0.221,0.183;P＜0.05).BCVA was negatively correlated with VD (r=-0.210,-0.190,-0.245) and SD (r=-0.239,-0.207,-0.296) of NRL,SRL,and DRL (P＜0.05),but not correlated with FAZ (r=0.099,P＞0.05).Conclusion The decrease of macular perfusion and the morphological change of FAZ accompanied by HbA1c increased.