不同血压水平糖尿病肾病患者黄斑区视网膜厚度特征分析

doi:10.11958/20252128

天津医药 ›› 2025, Vol. 53 ›› Issue (9): 923-926.doi: 10.11958/20252128

不同血压水平糖尿病肾病患者黄斑区视网膜厚度特征分析

马良¹(), 胡立影², 石羽², 赵永安³, 孙雅斯⁴, 孙广东¹^,^△()

1 天津市人民医院，南开大学第一附属医院肾脏病科（邮编300121）
2 天津医科大学眼科医院临床研究中心
3 天津市和平区小白楼街社区卫生服务中心
4 天津市和平区南营门街社区卫生服务中心

收稿日期:2025-06-03 修回日期:2025-07-22 出版日期:2025-09-15 发布日期:2025-09-16
通讯作者: ^△E-mail：392247111@qq.com
作者简介:马良（1984），男，主治医师，主要从事糖尿病肾病及慢性肾脏病发病机制的研究。E-mail：rmyymaliang@163.com
基金资助:
天津市教委科研计划项目(2022KJ258)

Analysis of macular retinal thickness characteristics in diabetic kidney disease patients with different blood pressure levels

MA Liang¹(), HU Liying², SHI Yu², ZHAO Yongan³, SUN Yasi⁴, SUN Guangdong¹^,^△()

1 Department of Nephrology, Tianjin Union Medical Center, the First Affiliated Hospital of Nankai University, Tianjin 300121, China
2 Clinical Research Center Department of Ophthalmology, Tianjin Medical University Eye Hospital
3 Xiaobailou Street Community Health Service Center, Heping Distric
4 Nanyingmen Street Community Health Service Center, Heping District

Received:2025-06-03 Revised:2025-07-22 Published:2025-09-15 Online:2025-09-16
Contact: ^△E-mail: 392247111@qq.com

马良, 胡立影, 石羽, 赵永安, 孙雅斯, 孙广东. 不同血压水平糖尿病肾病患者黄斑区视网膜厚度特征分析[J]. 天津医药, 2025, 53(9): 923-926.

MA Liang, HU Liying, SHI Yu, ZHAO Yongan, SUN Yasi, SUN Guangdong. Analysis of macular retinal thickness characteristics in diabetic kidney disease patients with different blood pressure levels[J]. Tianjin Medical Journal, 2025, 53(9): 923-926.

摘要/Abstract

摘要：

目的比较不同血压水平的糖尿病肾病（DKD）患者黄斑区视网膜厚度特征，探讨DKD患者血压与黄斑区视网膜损害的关系。方法选取435例DKD患者，根据病史资料及血压情况将患者分为非高血压组（NH组）100例、有效控制血压组（G0组）176例、高血压1级组（G1组）118例及高血压2级组（G2组）41例。比较4组患者一般资料，常规实验室检查结果，双眼黄斑区视网膜神经纤维层（RNFL）、神经节细胞层（GCL）、节细胞复合层（GCC）、脉络膜层（CL）厚度及黄斑中心凹视网膜厚度（CMT）差异。分析患者双眼黄斑区视网膜厚度与临床资料的相关性。结果与G1、G2组比较，G0组患者高血压病程长。与NH组相比，G2组空腹血糖（FPG）升高；与G0组相比，G1组及G2组FPG升高，G2组糖化血红蛋白（HbA1c）升高，G2组估算肾小球滤过率（eGFR）降低。与NH组相比，G0组GCL和GCC厚度下降（P<0.05）。患者双眼黄斑区视网膜GCL、GCC厚度与舒张压呈负相关（r分别为-0.158和-0.195，P<0.05）。结论黄斑区视网膜厚度有助于评估长期高血压对DKD患者的视神经与微血管损伤。

关键词: 糖尿病肾病, 视网膜, 视网膜节细胞, 血压, 断层扫描, 光学相干性

Abstract:

Objective To compare the macular retinal thickness characteristics of diabetic kidney disease (DKD) patients with different blood pressure levels and explore the relationship between blood pressure and macular retinal damage in DKD patients. Methods A total of 435 DKD patients were selected and divided into four groups based on medical history and blood pressure: the non-hypertensive group (NH group, n=100), the well-controlled blood pressure group (G0 group, n=176), the grade 1 hypertension group (G1 group, n=118) and the grade 2 hypertension group (G2 group, n=41). General information, routine laboratory test results as well as the average thickness of the macular retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), ganglion cell complex (GCC), choroidal layer (CL) and central macular retinal thickness (CMT) were compared between the four groups. The correlation between macular retinal thickness in both eyes and clinical data was analyzed. Results Compared with the G1 group and the G2 group, the G0 group had a longer duration of hypertension. Compared to the NH group, the G2 group had higher fasting plasma glucose (FPG). Compared to the G0 group, the G1 group and the G2 group had higher FPG, and the G2 group had higher glycated hemoglobin (HbA1c) and lower estimated glomerular filtration rate (eGFR). Compared to the NH group, the G0 group had decreased thickness in the GCL and GCC (P < 0.05). The macular retinal thickness of the GCL and GCC in both eyes was negatively correlated with diastolic blood pressure (r = -0.158 and -0.195, respectively, P < 0.05). Conclusion Macular retinal thickness is helpful in assessing the long-term effects of hypertension on optic nerve and microvascular damage in DKD patients.

Key words: diabetic kidney disease, retina, retinal ganglion cells, blood pressure, tomography, optical coherence

中图分类号:

R544.1，R774

图/表 4

参考文献 21

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组别		n	性别				年龄/岁
组别		n	男		女		年龄/岁
NH组		100	36（36.0）		64（64.0）		68.87±7.07
G0组		176	57（32.4）		119（67.6）		69.60±6.88
G1组		118	49（41.5）		69（58.5）		69.32±5.61
G2组		41	19（46.3）		22（53.7）		69.55±6.84
χ²或F			4.221				0.271
组别	BMI/（kg/m²）			糖尿病病程/年		高血压病程/年
NH组	26.22±3.40			9.91±5.86		-
G0组	26.94±3.59			11.16±6.17		15.31±6.18
G1组	27.17±3.77			12.41±5.16		10.42±6.68^a
G2组	27.16±3.15			11.32±6.71		11.21±5.42^a
F	1.519			1.811		23.563^＊＊

组别		n	性别				年龄/岁
组别		n	男		女		年龄/岁
NH组		100	36（36.0）		64（64.0）		68.87±7.07
G0组		176	57（32.4）		119（67.6）		69.60±6.88
G1组		118	49（41.5）		69（58.5）		69.32±5.61
G2组		41	19（46.3）		22（53.7）		69.55±6.84
χ²或F			4.221				0.271
组别	BMI/（kg/m²）			糖尿病病程/年		高血压病程/年
NH组	26.22±3.40			9.91±5.86		-
G0组	26.94±3.59			11.16±6.17		15.31±6.18
G1组	27.17±3.77			12.41±5.16		10.42±6.68^a
G2组	27.16±3.15			11.32±6.71		11.21±5.42^a
F	1.519			1.811		23.563^＊＊

组别			n	FPG/（mmol/L）		HbA1c/%		Cr/（μmol/L）
NH组			100	7.05±2.19		7.38±1.33		77.11±31.24
G0组			176	6.70±3.07		7.11±1.13		77.98±31.14
G1组			118	7.39±1.28^b		7.39±1.28		72.52±32.59
G2组			41	7.67±1.52^ab		7.67±1.52^b		78.26±39.19
F				6.729^＊＊		4.130^＊＊		0.762
组别	eGFR/ mL/（min·1.73 m²）						TC/（mmol/L）			TG/（mmol/L）
NH组	88.48±31.81						5.16±1.36			2.19±0.78
G0组	94.76±35.93						5.24±1.52			2.06±0.93
G1组	84.70±20.39						5.41±1.47			1.99±0.72
G2组	79.43±29.79^b						5.31±1.28			2.36±0.95
F	2.685^＊						0.574			0.609
组别		LDL-C/（mmol/L）			HDL-C/（mmol/L）				Hb/（g/L）
NH组		3.03±1.03			1.37±0.41				138.58±14.27
G0组		2.98±1.06			1.44±0.43				135.02±15.30
G1组		3.19±0.98			1.38±0.35				136.81±14.14
G2组		3.11±1.14			1.47±0.56				1.47±0.56
F		0.990			1.019				0.548

组别			n	FPG/（mmol/L）		HbA1c/%		Cr/（μmol/L）
NH组			100	7.05±2.19		7.38±1.33		77.11±31.24
G0组			176	6.70±3.07		7.11±1.13		77.98±31.14
G1组			118	7.39±1.28^b		7.39±1.28		72.52±32.59
G2组			41	7.67±1.52^ab		7.67±1.52^b		78.26±39.19
F				6.729^＊＊		4.130^＊＊		0.762
组别	eGFR/ mL/（min·1.73 m²）						TC/（mmol/L）			TG/（mmol/L）
NH组	88.48±31.81						5.16±1.36			2.19±0.78
G0组	94.76±35.93						5.24±1.52			2.06±0.93
G1组	84.70±20.39						5.41±1.47			1.99±0.72
G2组	79.43±29.79^b						5.31±1.28			2.36±0.95
F	2.685^＊						0.574			0.609
组别		LDL-C/（mmol/L）			HDL-C/（mmol/L）				Hb/（g/L）
NH组		3.03±1.03			1.37±0.41				138.58±14.27
G0组		2.98±1.06			1.44±0.43				135.02±15.30
G1组		3.19±0.98			1.38±0.35				136.81±14.14
G2组		3.11±1.14			1.47±0.56				1.47±0.56
F		0.990			1.019				0.548

组别		n	RNFL	GCL
NH组		100	34.70±7.98	69.65±8.47
G0组		176	32.83±7.58	65.85±9.53^a
G1组		118	33.73±5.61	68.69±7.02
G2组		41	34.41±6.52	67.60±7.94
F			1.672	4.573^＊＊
组别	GCC		CL	CMT
NH组	104.35±14.62		170.54±41.31	253.78±49.75
G0组	98.58±15.93^a		173.52±31.95	263.03±22.93
G1组	103.34±11.12		171.03±23.43	265.01±19.69
G2组	101.04±9.34		183.96±45.14	266.28±19.79
F	4.011^＊＊		0.518	1.593

不同血压水平糖尿病肾病患者黄斑区视网膜厚度特征分析

Analysis of macular retinal thickness characteristics in diabetic kidney disease patients with different blood pressure levels

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指标	GCL厚度	GCC厚度	指标	GCL厚度	GCC厚度
SBP	-0.108	-0.109	HbA1c	0.022	0.026
DBP	-0.158^＊	-0.195^＊	eGFR	0.079	0.083
年龄	-0.074	0.052	糖尿病病程	-0.063	-0.042
BMI	0.021	0.010	高血压病程	-0.035	-0.034
FPG	0.036	0.034

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