Reduced response of retinal vessel diameters to flicker stimulation in patients with diabetes
Reduced response of retinal vessel diameters to flicker stimulation in patients with diabetes
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DOI：
10.1136/bjo.2003.033548
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发表时间：
2004-07-01
影响因子：
4.1
通讯作者：
Dorner, GT
中科院分区：
文献类型：
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作者：
Garhöfer, G;Zawinka, C;Dorner, GT
背景/目的：用闪烁的光刺激视网膜会增加动物和人类的视网膜动脉和静脉直径，表明神经活动和血流之间的紧密耦合。本研究的目的是调查胰岛素依赖型糖尿病患者的这种反应是否发生改变。方法：本研究纳入了 26 名无或轻度非增殖性视网膜病变的糖尿病患者和 26 名年龄和性别匹配的健康志愿者。使用蔡司视网膜血管分析仪连续测量视网膜血管直径。在这些测量过程中，通过血管分析仪的照明路径应用了三个方波闪烁刺激周期（16、32和64秒；8 Hz）。结果：在视网膜动脉中，与健康志愿者相比，糖尿病患者对弥散亮度闪烁刺激的反应显着减弱（方差分析，p < 0.0031）。在非糖尿病对照组中，在闪烁刺激 16、32 和 64 秒期间，闪烁刺激使视网膜动脉直径分别增加 +1.6% (1.8%)（平均值，p < 0.001 相对于基线）、+2.8% (SD 2.2%) (p < 0.001) 和 +2.8% (1.6%) (p < 0.001)。在糖尿病患者中，闪烁对动脉血管直径没有影响：+0.1% (3.1%) (16 秒，p = 0.9)、+1.1% (2.7%) (32 秒，p = 0.07)、+1.0% (2.8%) (64 秒，p = 0.1)。在视网膜静脉中，两组对闪烁光的反应没有显着差异。在闪烁刺激期间，对照组的视网膜静脉血管直径增加了 +0.7% (1.6%)（16 秒，p < 0.05）、+1.9% (2.3%)（32 秒，p < 0.001）和 1.7% (1.8%)（64 秒，p < 0.001）。同样，在患者组中也没有观察到增加：+0.6% (2.4%)、+0.5% (1.5%) 和 +1.2% (3.1%)（分别为 16、32 和 64 秒）。 结论：在没有或轻度非增殖性视网膜病变的 IDDM 患者中，视网膜动脉和静脉的闪烁反应异常降低。这种反应减弱是否归因于视网膜血管反应性改变或神经活动减少尚未明确。
Background/aim: Stimulation of the retina with flickering light increases retinal arterial and venous diameters in animals and humans, indicating a tight coupling between neural activity and blood flow. The aim of the present study was to investigate whether this response is altered in patients with insulin dependent diabetes mellitus.Methods: 26 patients with diabetes mellitus with no or mild non-proliferative retinopathy and 26 age and sex matched healthy volunteers were included in the study. Retinal vessel diameters were measured continuously with the Zeiss retinal vessel analyser. During these measurements three episodes of square wave flicker stimulation periods (16, 32, and 64 seconds; 8 Hz) were applied through the illumination pathway of the vessel analyser.Results: In retinal arteries, the response to stimulation with diffuse luminance flicker was significantly diminished in diabetic patients compared to healthy volunteers (ANOVA, p < 0.0031). In non-diabetic controls flicker stimulation increased retinal arterial diameters by +1.6% (1.8%) (mean, p < 0.001 v baseline), +2.8% (SD 2.2%) (p < 0.001) and +2.8% (1.6%) (p < 0.001) during 16, 32, and 64 seconds of flicker stimulation, respectively. In diabetic patients flicker had no effect on arterial vessel diameters: +0.1% (3.1%) (16 seconds, p = 0.9), +1.1% (2.7%) (32 seconds, p = 0.07), +1.0% (2.8%) ( 64 seconds, p = 0.1). In retinal veins, the response to flicker light was not significantly different in both groups. Retinal venous vessel diameters increased by +0.7% (1.6%) (16 seconds, p < 0.05), +1.9% (2.3%) (32 seconds, p < 0.001) and 1.7% (1.8%) (64 seconds, p < 0.001) in controls during flicker stimulation. Again, no increase was observed in the patients group: +0.6% (2.4%), +0.5% (1.5%), and +1.2% (3.1%) (16, 32, and 64 seconds, respectively).Conclusion: Flicker responses of retinal arteries and veins are abnormally reduced in patients with IDDM with no or mild non-proliferative retinopathy. Whether this diminished response can be attributed to altered retinal vascular reactivity or to decreased neural activity has yet to be clarified.