Neurovascular Dysfunction Precedes Neural Dysfunction in the Retina of Patients with Type 1 Diabetes
Neurovascular Dysfunction Precedes Neural Dysfunction in the Retina of Patients with Type 1 Diabetes
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DOI：
10.1167/iovs.12-10873
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发表时间：
2013-01-01
影响因子：
4.4
通讯作者：
Schmetterer, Leopold
中科院分区：
文献类型：
--
作者：
Lasta, Michael;Pemp, Berthold;Schmetterer, Leopold
目的.各种研究表明，闪烁引起的血管舒张在糖尿病患者中减少。然而，目前还不清楚是否减少神经活动或异常的神经血管耦合是这种现象的原因。在本研究中，我们假设早期1型糖尿病患者视网膜神经血管功能障碍先于神经功能障碍。在本研究中，50例1型糖尿病患者无视网膜病变和50名健康的年龄和性别匹配的对照组。使用动态视网膜血管分析仪测量视网膜血管对闪烁刺激的反应。此外，视网膜血流速度闪烁刺激的反应，激光多普勒测速仪进行了评估，在一个亚组的患者进行了研究。图形视网膜电图（ERG）用于测量神经视网膜功能。糖尿病患者视网膜动、静脉闪烁反应均明显减弱（糖尿病组静脉：3.5 +/- 2.3%，健康对照组：4.6 +/- 2.0%;组间P = 0.022，而糖尿病组动脉：2.0 +/- 2.7%，健康对照组：3.8 +/- 1.7%;组间P < 0.001）。同样，糖尿病患者的视网膜血流速度反应降低，尽管仅在一个受试者亚组中获得了足够的读数（糖尿病组[n = 22]：19 +/- 7%;健康对照组[n = 24]：43 +/-19%P < 0.001）。两组间图形ERG参数无差异。该研究证实，闪烁反应在1型糖尿病患者的早期减少。这是在模式ERG改变之前看到的，表明神经血管耦合异常。（临床试验。政府编号，NCT 00712842。）（Invest Ophthalmol维斯科学。2013;54：842-847）DOI：10.1167/iovs.12-10873
PURPOSE. A variety of studies have shown that flicker-induced vasodilatation is reduced in patients with diabetes. It is, however, unclear whether reduced neural activity or abnormal neurovascular coupling is the reason for this phenomenon. In the present study, we hypothesized that retinal neurovascular dysfunction precedes neural dysfunction in patients with early type 1 diabetes.METHODS. In the present study, 50 patients with type 1 diabetes without retinopathy and 50 healthy age-and sex-matched control subjects were included. The retinal vascular response to flicker stimulation was measured using the dynamic Retinal Vessel Analyzer. In addition, the response in retinal blood velocity to flicker stimulation as assessed with laser Doppler velocimetry was studied in a subgroup of patients. Pattern electroretinography (ERG) was used to measure neural retinal function.RESULTS. The flicker responses of both retinal arteries and veins were significantly reduced in patients with diabetes (veins in the diabetic group: 3.5 +/- 2.3% versus healthy control group: 4.6 +/- 2.0%; P = 0.022 between groups, whereas arteries in the diabetic group: 2.0 +/- 2.7% versus healthy control group: 3.8 +/- 1.7%; P < 0.001 between groups). Likewise, the response of retinal blood velocity was reduced in patients with diabetes, although adequate readings could only be obtained in a subgroup of subjects (diabetic group [n = 22]: 19 +/- 7%; healthy control group [n = 24]: 43 +/- 19% P < 0.001 between groups). The parameters of pattern ERG were not different between the two groups.CONCLUSIONS. The study confirms that flicker responses are reduced early in patients with type 1 diabetes. This is seen before alterations in pattern ERG indicating abnormal neurovascular coupling. (ClinicalTrials. gov number, NCT00712842.) (Invest Ophthalmol Vis Sci. 2013;54:842-847) DOI: 10.1167/iovs.12-10873