망막병증을 동반하지 않은 초기 제2형 당뇨병 환자에서 망막혈관 직경의 변화
Retinal Vascular Caliber Changes in Early Type 2 Diabetic Patients without Retinopathy
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 망막병증이 동반되지 않은 초기 제2형 당뇨병 환자에서 망막혈관의 직경을 측정하고, 정상안과 비교하여 그 변화를 알아보고자 하였다. 대상과 방법: 제2형 당뇨병으로 진단받은 지 10년 이내의 환자 85명과 나이와 성별이 유사한 건강한 대조군 48명의 의무기록을 후향적으로 분석하였다. 모든 환자들은 산동 후 안저검사를 통해 당뇨망막병증이 동반되지 않음을 확인하였고, 안저카메라를 이용하여 안저촬영을 시행하였다. 망막혈관의 직경을 반자동으로 측정해주는 프로그램을 이용하여 중심망막동맥대응치, 중심망막정맥대응치, 동정맥비 값을 구하였다. 대조군도 환자군과 같은 방법으로 검사를 시행하고, 두 군을 비교 분석하였다. 결과: 환자군과 대조군의 중심망막동맥대응치는 각각 149.92 ± 21.29 μm, 144.85 ± 17.14 μm로 두 군 간에 유의한 차이가 없었고(p=0.137), 중심망막정맥대응치도 환자군과 대조군에서 각각 195.85 ± 22.94 μm, 196.69 ± 18.43 μm로 차이가 없었다(p=0.829). 그러나, 동정맥비는 환자군에서 0.768 ± 0.088이었고, 대조군은 0.737 ± 0.061로 두 군 사이에 유의한 차이가 있었다(p=0.031). 환자군에서 동정맥비는 당화혈색소와 유의한 상관관계가 있었으나(r=0.325, p=0.006), 체질량지수와는 관련이 없었다(p=0.478). 결론: 시신경유두 주위 동정맥비의 상승은 제2형 당뇨병 환자에서 관찰되는 망막혈관의 초기 변화로 생각되며, 이는 혈당의 증가와 밀접한 관련이 있다.
Abstract
Purpose: To evaluate the retinal vascular caliber in early type 2 diabetic patients without retinopathy. Methods: This retrospective study reviewed the medical records of 85 patients who were diagnosed with type 2 diabetes (age, 10-48 years) and sex-matched healthy controls. Dilated fundus examinations were performed to confirm the absence of diabetic retinopathy. Fundus photographs were acquired and analyzed using software that semi-automatically measured retinal vascular caliber. Central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE), and arteriovenous ratio (AVR) were determined using the revised Parr-Hubbard formula. Healthy controls were examined using the same approach. Results: There were no significant differences between patients and controls in terms of CRAE (149.92 ± 21.29 μm and 144.85 ± 17.14 μm, respectively; p = 0.137) or CRVE (195.85 ± 22.94 μm and 196.69 ± 18.43 μm, respectively; p = 0.829). However, AVR was significantly higher in the patient group (0.768 ± 0.088 vs. 0.737 ± 0.061; p = 0.031). In the patient group, AVR was significantly correlated with hemoglobin A1c (r = 0.325, p = 0.006), but not with body mass index (p = 0.478). Conclusions: An increase in peripapillary AVR may be an early feature of retinal vessels observed in patients with type 2 diabetes, which is closely related to elevated blood sugar.
참고문헌 (26)
- 김보연, "Diabetes Fact Sheets in Korea, 2018: An Appraisal of Current Status", Diabetes and Metabolism Journal, 43(4), pp.487~494 (2019), 대한당뇨병학회[DOI]
- 김미경, "2019 Clinical Practice Guidelines for Type 2 Diabetes Mellitus in Korea", Diabetes and Metabolism Journal, 43(4), pp.398~406 (2019), 대한당뇨병학회[DOI]
- Engelgau MM, "Screening for type 2diabetes", Diabetes Care, 23, pp.1563~1580 (2000)
- Tooke JE, "Microvascular function in human diabetes. A physiological perspective", Diabetes, 44, pp.721~726 (1995)
- Hubbard LD, "Methods for evaluation of retinal microvascular abnormalities associated with hypertension", sclerosis in the Atherosclerosis Risk in Communities Study, 1999, pp.106, 2269~2280
- Knudtson MD, "Revised formulas for summarizing retinal vessel diameters", Curr Eye Res, 27, pp.143~149 (2003)
- Heitmar R, "Comparison of subjective and objective methods to determine the retinal arterio-venous ratio using fundus photography", J Optom, 8, pp.252~257 (2015)
- French C, "Comparison of static retinal vessel caliber measurements by different commercially available platforms", Optom Vis Sci, 98, pp.1104~1112 (2021)
- Wong TY, "Retinal arteriolar narrowing and risk of diabetes mellitus in middle-aged persons", JAMA, 287, pp.2528~2533 (2002)
- Nguyen TT, "Retinal arteriolar narrowing predicts incidence of diabetes : the Australian Diabetes, Obesity and Lifestyle(AusDiab)study", Diabetes, 57, pp.536~539 (2008)
- Nguyen TT, "Relationship of retinal vascular caliber with diabetes and retinopathy : the Multi-Ethnic Study of Atherosclerosis(MESA)", Diabetes Care, 31, pp.544~549 (2008)
- Kifley A, "Retinal vascular caliber and the long-term risk of diabetes and impaired fasting glucose : the Blue Mountains Eye Study", Microcirculation, 15, pp.373~377 (2008)
- Ikram MK, "Retinal vessel diameters and risk of impaired fasting glucose or diabetes : the Rotterdam study", Diabetes, 55, pp.506~510 (2006)
- Sabanayagam C, "Retinal microvascular calibre and risk of diabetes mellitus : a systematic review and participant-level meta-analysis", Diabetologia, 58, pp.2476~2485 (2015)
- Blindbæk SL, "Noninvasive retinal markers in diabetic retinopathy : advancing from bench towards bedside", J Diabetes Res, 2017, pp.2562759~ (2017)
- 장민욱, "녹내장과 정상안의 중심망막혈관 직경 비교", 대한안과학회지, 50(5), pp.738~742 (2009), 대한안과학회
- Arnold JV, "Possible errors in the measurement of retinal lesions", Invest Ophthalmol Vis Sci, 34, pp.2576~2580 (1993)
- Wong TY, "Computer-assisted measurement of retinal vessel diameters in the Beaver Dam Eye Study : methodology, correlation between eyes, and effect of refractive errors", Ophthalmology, 111, pp.1183~1190 (2004)
- Dirani M, "Association of retinal vessel calibre with diabetic retinopathy in an urban Australian indigenous population", Clin Exp Ophthalmol, 38, pp.577~582 (2010)
- Kifley A, "Retinal vascular caliber, diabetes, and retinopathy", Am J Ophthalmol, 143, pp.1024~1026 (2007)
- Tsai AS, "Differential association of retinal arteriolar and venular caliber with diabetes and retinopathy", Diabetes Res Clin Pract, 94, pp.291~298 (2011)
- Tikellis G, "The relationship of retinal vascular calibre to diabetes and retinopathy : the Australian Diabetes, Obesity and Lifestyle(AusDiab)study", Diabetologia, 50, pp.2263~2271 (2007)
- Klein R, "Retinal vascular caliber in persons with type 2 diabetes : the Wisconsin Epidemiological Study of Diabetic Retinopathy : XX", Ophthalmology, 113, pp.1488~1498 (2006)
- Brooks SE, "Modulation of VEGF production by pH and glucose in retinal Müller cells", Curr Eye Res, 17, pp.875~882 (1998)
- Nguyen TT, "Retinal vascular manifestations of metabolic disorders", Trends Endocrinol Metab, 17, pp.262~268 (2006)
- Ungvari Z, "Increased myogenic tone in skeletal muscle arterioles of diabetic rats. Possible role of increased activity of smooth muscle Ca2+ channels and protein kinase C", Cardiovasc Res, 43, pp.1018~1028 (1999)