To Explore The Correlation Between Early Diabetic Retinopathy And Retinal Microcirculation Of Different TCM Syndromes

Object:Combining Optical Coherence Tomography Angiography（Optical Coherence Tomography Angiography,OCTA）with retinal blood oxygen saturation analyzer（Oxymap-T1,Reykjavik·Iceland）to establish a variety of quantitative indicators for retinal microcirculation;According to the quantitative indicators of OCTA and Oxymap-T1,explore the changes of retinal microcirculation in the development process of diabetic retinopathy from the structure and function of retinal microcirculation and between different TCM syndrome types.Methods:The clinical data of all the subjects were collected,and ophthalmic examination was performed on all the subjects.In addition,some blood biochemical tests were performed on diabetic patients.On the morning of the first day of treatment,blood samples were taken from the median cubital vein on an empty stomach.Blood biochemical items including glycosylated hemoglobin（Hb A1c）and FBG were detected by biochemical analyzer and supporting reagents.Ophthalmic examinations include international standard visual acuity chart,uncorrected visual acuity and corrected visual acuity,computer optometry,intraocular pressure,slit lamp examination,slit lamp fundus examination after mydriasis,optical coherence tomography angiography（OCT）and oxymap-t1.The general data,OCTA indicators,laboratory indicators and blood oxygen concentration index were compared and analyzed in two groups with or without early lesions of diabetic retina,different TCM-certified gas-yin and liver and kidney deficit.Results:The differences in OCTA3*3 mm and 6*6 mm indicators between the two groups with or without diabetes were statistically significant（P<0.05）,and the morphological indexes of VD,PD and FAZ were significantly higher in the control group than in the diabetic group;FAZ area,FAZ The circumferences of the diabetic group were significantly higher than those of the control group.Comparing the laboratory indexes between the two groups with or without diabetes,the visual acuity index was higher in the control group than in the diabetic group,and the difference was not statistically significant（P>0.05）;BMI and Hb A1c were significantly higher in the diabetic group than in the control group and the differences were statistically significant Academic significance（P<0.05）.Comparing the blood oxygen concentration and blood oxygen partial pressure between the two groups with or without diabetes,the difference in Sa O₂and Sv O₂between the two groups was statistically significant（P<0.05）,and both were significantly higher in the diabetic group In the control group,there was no statistically significant difference in Sa O₂-Sv O₂between the two groups（P>0.05）.Comparison of general data between the two groups with different syndrome types showed that the difference in the course of disease was statistically significant（P<0.05）,and the liver and kidney deficiency group was significantly higher than the Qi and Yin deficiency group.There was no statistically significant difference in other indicators between the two groups（P>0.05）;in the comparison of OCTA3*3 mmand 6*6 mm indicators between the two groups with different syndrome types,the differences in VD and PD were statistically significant（P<0.05）,And both Qi and Yin deficiency group were significantly higher than the liver and kidney deficiency group.The area of FAZ and the circumference of FAZ were both higher in the liver and kidney deficiency group than in the qi and yin deficiency group,and the FAZ morphological index was higher in the qi and yin deficiency group than in the liver and kidney deficiency group.There was no significant difference between the two groups（P>0.05）.There was no statistically significant difference in visual acuity between the two groups with different syndrome types in the laboratory indicators（P>0.05）.Both BMI and Hb A1c in the liver and kidney deficiency group were significantly higher than those in the qi and yin deficiency group,and the difference was statistically significant（P<0.05）.Comparing the indicators of blood oxygen concentration between the two syndrome groups,the difference in Sv O₂and Sv O₂between the two groups was statistically significant（P<0.05）,and both were significantly higher in the liver and kidney deficiency group than in the Qi There was no significant difference between the two groups in the deficiency of both Yin and Sa O₂-Sv O₂（P>0.05）.Correlation analysis between OCTA measurements,retinal blood oxygen saturation and various indicators in the DR group:OCTA 3*3mm and 6*6mm measurements,blood oxygen and the course of the disease,BMI,Hb A1c correlation analysis,and The course of the disease was significantly negatively correlated with 3*3 and 6*6 VD and PD（r<0,P<0.05）;with 3*3FAZ area,6*6 FAZ circumference,supratemporal Sa O₂,supratemporal Sv O₂There was a significant positive correlation between subtemporal Sv O₂（r>0,P<0.05）.;Hb A1c has a significant negative correlation with 3*3VD,3*3PD,3*3 morphological index,6*6VD,6*6PD,6*6 morphological index（r<0,P<0.05）;and 3*3FAZ area,3*3FAZ circumference,6*6 FAZ area,supratemporal Sv O₂,infratemporal Sa O₂showed a significant positive correlation（r>0,P<0.05）;BMI and 3*3VD,3*3PD,6*6VD,6*6PD,superior temporal and inferior temporal Sa O₂There is no correlation among indicators such as Sv O₂,supratemporal and infratemporal Sv O₂.Conclusion:1.For the early diagnosis of early diabetic retinopathy,OCTA can detect positive results earlier,and it can detect that the retinal microcirculation has been damaged,including changes in VP/PD,FAZ area,etc.;2.Retinal blood oxygen saturation can be measured It reflects information such as oxidation and metabolism of the retina,which can play an important role in the early diagnosis of early diabetic retinopathy;3.Among the different types of early diabetic retinopathy,as the pathogenesis of DR evolves,the condition of the liver and kidney deficiency group is worse than that of the qi and yin deficiency group;4.The course of diabetic patients,Hb A1c and the severity of diabetic retinopathy are positively correlated;BMI has no obvious relationship with the severity of diabetic retinopathy.