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目的 探究糖化血红蛋白(HbA1c)水平与黄斑区血流参数之间的相关性。方法 选取2023年4月至2024年5月在吉林大学第二医院内分泌科就诊且双眼明确诊断为无糖尿病视网膜病变(DR)的2型糖尿病患者35例65眼为无DR组，31例60眼健康成年人且年龄与无DR组匹配者为对照组。所有参与者均在基线时测量双眼黄斑区3 mm×3 mm区域的血流情况。获取视网膜浅层毛细血管丛(SCP)和深层毛细血管丛(DCP)的血流密度(VD),中心凹无血管区(FAZ)的面积、周长以及非圆度指数(AI);无DR组分别于初始，血糖控制达标后(HbA1c<8%)1个月、3个月、6个月时测量双眼黄斑区各项血流参数。结果 无DR组初始SCP整体、旁中心凹及其上方和下方的VD显著低于对照组(P<0.05),DCP整体、旁中心凹、旁中心凹的上方、颞侧、下方和鼻侧的VD均显著低于对照组(P<0.05);FAZ面积及周长与对照组相比无明显差异(P=0.440、P=0.066),AI显著大于对照组(P<0.01)。在血糖控制良好的6个月内，从初始至3个月，SCP及DCP各区域VD呈减少趋势，从3个月至6个月，SCP及DCP各区域VD呈增加趋势，上述变化无统计学差异(P>0.05),FAZ各参数在不同时间点的测量值无显著差异；血糖控制6个月时HbA1c与初始之间的变化值与SCP旁中心凹VD与初始之间的变化值呈负相关(r=-0.326,P=0.008),与SCP其余各区域VD、DCP各区域VD及FAZ各参数的变化值均无明显相关性(P>0.05)。结论 与健康对照相比，无DR患者SCP VD及DCP VD显著降低。血糖控制良好的6个月内，SCP及DCP各区域VD呈现先减少再增加的变化趋势，HbA1c变化水平与SCP旁中心凹VD的变化水平有相关性。
Abstract：Objective To investigate the correlation between glycated hemoglobin(HbA1c) levels and blood flow parameters in the macular region.Methods A total of 35 patients with type 2 diabetes and no diagnosed diabetic retinopathy(DR) in both eyes were selected from the endocrinology department of the Second Hospital of Jilin University between April 2023 and May 2024,comprising 65 eyes(no-DR group).The control group consisted of 31 healthy adults with matched ages to the no-DR group, totaling 60 eyes.All participants underwent baseline measurements of blood flow in the 3 mm×3 mm macular region of both eyes.The blood flow density(VD) of the retinal superficial capillary plexus(SCP) and deep capillary plexus(DCP),as well as the area, perimeter, and roundness index(AI) of the foveal avascular zone(FAZ),were recorded.The no-DR group had their macular blood flow parameters measured at baseline, and one month, three months, and six months after achieving glycemic control targets(HbA1c<8%).Results Compared with the control group, VD of the SCP in the whole image, parafovea, its superior and inferior regions was significantly lower in non-DR group(P<0.05);Similarly, the VD of the DCP in the whole image, parafovea, its superior, temporal, inferior, and nasal regions was also significantly lower in the non-DR group(P<0.05).The FAZ area and perimeter showed no significant differences compared with the control group(P=0.440、P=0.066).AI was increased in the non-DR group compared with the control group(P<0.01).Within the 6-month period of good glycemic control, in the non-DR group, the VD of SCP and DCP in all regions showed a decreasing trend from baseline to 3 months.From 3 months to 6 months, the VD of SCP and DCP in all regions showed an increasing trend.However, none of these changes reached statistical significance(P>0.05).There were no difference in FAZ area, perimeter and AI between different time points.In patients without DR.Value of change in HbA1c after 6 months of glycemic control was negatively correlated with the value of change in VD in the parafovea region of the SCP(r=-0.326,P=0.008),while there were no correlation between value of change in VD in other regions of SCP,all regions of DCP and FAZ parameters with value of change in HbA1c.Conclusion VD of the SCP and DCP was significantly lower in the non-DR group compared with the control group.Within the 6-month period of glycemic control, the VD of SCP and DCP in all regions of non-DR group showed a trend of decreasing before increasing.Value of change in HbA1c after 6 months of glycemic control was correlated with the value of change in VD in the parafovea region of the SCP in non-DR patients.
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基本信息:
中图分类号:R774.1;R587.2
引用信息:
[1]凌悦,金燕.血糖控制对无视网膜病变的2型糖尿病患者黄斑区血流的影响[J].中国实验诊断学,2025,29(12):1395-1401.
基金信息:
吉林省卫生专项项目(20181731154); 吉林大学横向项目(2022YX0160)
2025-12-24
2025-12-24