당뇨망막병증을 동반하지 않은 당뇨환자에서 황반부 미세혈관의 변화와 연관된 전신인자 분석
The Changes of Macular Microvasculature and Related Systemic Parameters in Diabetic Patients without Diabetic Retinopathy
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목적: 당뇨망막병증을 동반하지 않은 당뇨환자에서 빛간섭단층혈관조영으로 측정한 황반부 미세혈관의 변화와 연관된 전신지표에 대해 알아보고자 하였다. 대상과 방법: 당뇨환자 중 당뇨망막병증을 동반하지 않고, 정상 안저를 보인 환자의 의무기록을 후향적으로 분석하였다. 빛간섭단층혈관조영(DRI OCT Triton; Topcon Corporation)을 시행하여 중심와를 중심으로 중심와부근 3 × 3 mm의 구역을 촬영하였다. 영상을 분석하여 표층 및 심부모세혈관총의 오목무혈관부위의 넓이와 혈관밀도를 측정하였다. 성별 나이, 당뇨유병기간, 당화혈색소, 총 콜레스테롤, 고혈압 유무, 수축기 및 이완기혈압의 전신인자들과 황반부 미세혈관 지표와의 연관성을 다중회귀분석을 이용하여 분석하였다. 결과: 35명의 35안을 대상으로 하였고, 평균 연령 55.7 ± 11.6세, 평균 당뇨유병기간 52.4 ± 88.7개월, 평균 당화혈색소 8.8 ± 2.3% 였다. 심부모세혈관총의 오목무혈관부위는 당화혈색소 수치가 높을수록 유의하게 넓었으나(p<0.001), 다른 전신인자들은 유의한 연관성을 보이지 않았다(p>0.05). 표층모세혈관총의 오목무혈관부위의 넓이와 유의하게 연관된 전신인자는 없었으며, 표층 및 심부모세혈관총의 혈관밀도와 통계적으로 유의한 연관성을 보인 전신인자는 없었다(p>0.05). 결론: 당뇨환자에서 당뇨망막병증이 동반되지 않았더라도, 당화혈색소 수치가 높으면 심부모세혈관총의 미세혈관의 손상은 시작되었을 수 있으므로, 임상의는 당뇨망막병증 검진 시 이에 유념해야 할 것이다.
Abstract
Purpose: To investigate the systemic parameters related to changes in the retinal microvasculature using optical coherence tomography angiography (OCTA) in diabetic patients without diabetic retinopathy. Methods: We retrospectively reviewed the medical records of diabetic patients without diabetic retinopathy. All patients showed normal fundus on dilated fundus examinations. OCTA (DRI OCT Triton, Topcon Corporation, Tokyo, Japan) was performed on a 3 × 3 mm area centered at the fovea. The foveal avascular zone (FAZ) area and vascular density (VD) of the superficial and deep capillary plexus (SCP/DCP) were measured. Multiple regression analysis was conducted to evaluate the relationship between microvascular indexes on OCTA and systemic parameters including sex, age, duration of diabetes mellitus (DM), hemoglobin A1c (HbA1c), total cholesterol, presence of hypertension (HTN) and systolic and diastolic blood pressure (SBP/DBP). Results: A total of 35 eyes of 35 patients were included in this study. The mean age was 55.7 ± 11.6 years, the mean duration of DM was 52.4 ± 88.7 months and the mean HbA1c was 8.8 ± 2.3%. The FAZ area of the DCP increased significantly as the HbA1c level increased (p < 0.001), but the other parameters, i.e., sex, age, duration of DM, total cholesterol, presence of HTN, SBP and DBP, did not exhibit significant relations in the DCP (p = 0.727, 0.280, 0.385, 0.816, 0.206, 0.055 and 0.092, respectively). There were no significant relationships between systemic parameters and the FAZ area in the SCP (p > 0.05). No systemic parameters exhibited significant relationships with VD in either the SCP or the DCP (p > 0.05). Conclusions: The FAZ area of the DCP detected via OCTA increased as the level of HbA1c increased, although the patients did not show diabetic retinopathy on dilated fundus examinations. Therefore, clinicians should consider this when screening diabetic patients for diabetic retinopathy.
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