Progressive Retinal Vasodilation in Patients With Type 1 Diabetes: A Longitudinal Study of Retinal Vascular Geometry
Progressive Retinal Vasodilation in Patients With Type 1 Diabetes: A Longitudinal Study of Retinal Vascular Geometry
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DOI：
10.1167/iovs.16-21015
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发表时间：
2017-05-01
影响因子：
4.4
通讯作者：
Donaghue, Kim
中科院分区：
文献类型：
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作者：
Liew, Gerald;Benitez-Aguirre, Paul;Donaghue, Kim
目的。视网膜血管可用于无创监测微脉管系统的变化。视网膜血管几何形状（RVG）的这些变化可以预测慢性糖尿病并发症。我们评估了 1 型糖尿病青少年的纵向 RVG 变化。方法。我们对 102 名青少年（基线：47.1% 为男性，平均 [SD] 年龄 14.4 [1.6] 岁，糖尿病病程 7.2 [3.1] 年，HbA1c 8.1% [1.3%] [65 (9.3) mmol/mol]）进行了 3 次随访，平均随访时间为 2.6 年。每次就诊时，使用标准化计算机辅助方案根据视网膜照片测量视网膜血管几何形状。使用多变量线性混合模型和逻辑回归来检查 RVG 和糖尿病视网膜病变的预测因素。 结果。随访期间，平均小动脉管径、小静脉管径和小静脉迂曲度增加，从 156.0 (SD, 14.5) 增加到 164.9 (14.0) lm、215.9 (22.5) 增加到 230.3 (20.6) lm、从 1.096 (0.014) 增加到 1.099 （0.016）（所有 P < 0.005）。其他 RVG 测量（分形维数、分支角度、长径比）保持稳定。高于基线的 HbA1c 和较长的糖尿病病程与较大的小静脉血管舒张相关。 24% 的受试者在任何时间点出现视网膜病变，最高三分位小动脉分形维数与视网膜病变的累积发生率相关（多变量比值比 3.2，95% 置信区间 1.0-9.6；P = 0.04）。结论。青春期早期较高的 HbA1c 和较长的糖尿病病程预示着随着时间的推移，小静脉血管舒张程度会更大。小动脉分形维数可预测随后的视网膜病变的发展，表明其作为糖尿病并发症的潜在生物标志物的价值。
PURPOSE. Retinal vessels can be used to noninvasively monitor changes in microvasculature. These changes in retinal vascular geometry (RVG) may predict chronic diabetes complications. We evaluated longitudinal RVG changes in adolescents with type 1 diabetes.METHODS. We followed 102 adolescents (baseline: 47.1% male, mean [SD] age 14.4 [1.6] years, diabetes duration 7.2 [3.1] years, HbA1c 8.1% [1.3%] [65 (9.3) mmol/mol]) over three visits, with a mean follow-up of 2.6 years. Retinal vascular geometry was measured using a standardized computer-assisted protocol from retinal photographs at each visit. Multivariable linear mixed-models and logistic regression were used to examine predictors of RVG and diabetic retinopathy.RESULTS. During follow-up, mean arteriolar caliber, venular caliber, and venular tortuosity increased, from 156.0 (SD, 14.5) to 164.9 (14.0) lm, 215.9 (22.5) to 230.3 (20.6) lm, and 1.096 (0.014) to 1.099 (0.016), respectively (all P < 0.005). Other RVG measurements (fractal dimension, branching angle, length to diameter ratio) remained stable. Higher than baseline HbA1c and longer diabetes duration were associated with greater venular vasodilation. Retinopathy developed at any time-point in 24% of subjects, and the highest tertile arteriolar fractal dimension was associated with cumulative incidence of retinopathy (multivariable odds ratio 3.2, 95% confidence interval 1.0-9.6; P = 0.04).CONCLUSIONS. Higher HbA1c and longer diabetes duration in early adolescence predicts greater venular vasodilation over time. Arteriolar fractal dimension predicts subsequent retinopathy development, suggesting value as a potential biomarker for diabetic complications.