Study on Risk Factors of Retinal Neovascularization in Type2Diabetes Mellitus
|School||Tianjin Medical University|
|Keywords||proliferative diabetic retinopathy type2diabetes mellitus RetinalNeovascularization risk factor reperfusion Color Doppler flow imaging ophthalmicartery hemodynamic|
ObjectiveTo discuss the risk factors of retinal neovascularization in type2diabetes mellitus (T2DM) and mechanism of reperfusion, so they can offer theoretical basis and new ideas for preventing and treating microangiopathy of T2DM.Methods1200patients with proliferative diabetic retinopathy who were in hospital and100normal persons were selected randomly. Comparison of the two sample T-test were conducted in clinical data of two groups.2Risk factors of retinal neovascularization in T2DM were analyzed by all-variable regression equation parameter estimation and parameter estimation of regression equations.3Principal component analysis, rotation of the factor analysis after and logistic regression analysis were conducted in clinical data of PDR group.456PDR(56eyes)were selected randomly, among them group A included30PDR(30eyes)with retinal detachment, group B included26PDR(26eyes)without retinal detachment; in group C14ischemic ophthalmopathy(26eyes)included7CRAO(7eyes)and7AION(7eyes); control group included15normal persons(30eyes).The hemodynamic parameters of ophthalmic artery(OA) in four groups were recorded.Results1The value of fasting blood glucose (FPG), triglyceride (TG), total cholesterol (TC), blood urea nitrogen (BUN), uric acid (UA), white blood cell (WBC), absolute neutrophil, Hematocrit (HCT), Mean Platelet Volume (MPV) in PDR group are higher than that of control group(P<0.05)respectively. There was no statistical difference(P>0.05) in Creatinineusea (CREA), red blood cell (RBC), hemoglobin (HGB), blood platelet (PLT), absolute value of intermediate cells, absolute lymphocyte between PDR group and control group.2All-variable regression equation parameter estimation in PDR group revealed that there were significant effects of duration of DM(P=0.004), TC(P=0.015), BUN (P=0.017), smoking (P=0.006), intermediate cells (P=0.016), Prothrombin Time (P=0.020), MPV (P=0.015) on the dependent variable of retinal neovascularization; Stepwise regression equation parameter estimate revealed that linear relationship exists between duration of DM(P=0.000), duration of hypertension(p=0.038), SBP(p=0.000), age(p=0.003), Absolute neutrophil(p=0.000), history of heart disease(p=0.000), Prothrombin Time (p=0.000) and retinal neovascularization of T2DM respectively.3Ten factors were extracted from original systemic variables by principal component factor analyses and rotation of the factor analysis after. Logistic regression analysis revealed that retinal neovascularization of T2DM was independently associated with systemic risk factors including duration of diabetes (OR=1.112, p=0.000), duration of hypertension (OR=1.064, p=0.000), SBP (OR=1.021, p=0.000), DBP(OR=1.030, p=0.000), CREA (OR=1.005, p=0.000)、FPG (OR=1.079, p=0.004)、PBG(OR=1.131, p=0.000)、BUN(OR=1.277, p=0.000)、smoking(OR=3.967, p=0.000), and it was independently associated with systemic protective factors including panretinal photocoagulation(OR=0.983, p=0.000).4There was statistical difference (P<0.01) in EDV between group A, B of PDR and group of other ischemic ophthalmopathy respectively, both in EDV and RI between group A, B and control group respectively. There was no statistical difference (P>0.05) both in PSV and RI between group A, B and other ischemic ophthalmopathy respectively, in PSV between group A, B and control group respectively.Conclusion1Duration of diabetes, duration of hypertension, SBP, DBP, CREA、FPG、PBG、 BUN and smoking were respective independent risk factors of retinal neovascularization in T2DM. Inflammatory cells, hemorrheology, hemodynamics, age, duration of heart disease, ocular axial length, psychological stress were also risk factors of retinal neovascularization in T2DM.2Linear relationship exists between duration of DM, duration of hypertension, SBP, age, absolute neutrophil, history of heart disease, Prothrombin Time and levels of retinal neovascularization in T2DM respectively.3Resistance of peripheral circulation increases and perfusion of distal tissue is insufficient in OA of patients with PDR which may be associated with ipsilateral internal carotid artery stenosis and ischemic cerebrovascular diseases when PSV of OA decreases. So ischemic changes of OA is a risk factor of retinal neovascularization of T2DM.4Risk factors of retinal neovascularization in T2DM may promote reperfusion through various ways, so that they lead to occurrence and development of retinal neovascularization.5From the point of combination of epidemiology and reperfusion, academic combination of Chinese and Western Medicine, this article opens up a new area and offers theoretical basis to prevent and treat retinal microangiopathy and RIR of DR.