| With the progress in the contemporary society, people’s lifestyle has changed a lot when compared with the old., the rate of diabetes mellitus(DM) has been on the rise in recent decades within our country, which caused a bad effect on living quality and even endangered people’s life and health. With diabetic retinopathy(DR) being one of the serious micro vascular complications of DM, the international diabetes federation(IDF) research also suggests that DR is one of the leading causes of adult blindness. Therefore, through various methods of detection to diagnose DR and than using treatment method to early intervention will have advantageous to effectively cut down the occurrence probability of ablepsia that because by DR. Objective:The aim of the research is to Utilize color Doppler imaging(CDI) technology to measure arteriovenous hemodynamic parameters of eyes in all periods of T2 DM patients. Doing correlation analysis about the results and find reliable basis for DR forecast and diagnosis. In order to understand comprehensively and prevent DR, we will analyze correlation between the outcome obtained with ultrasound and the factors that may speed up the incidence of DR. Method:1. Patients are chosen in Baoding Second Hospital during December 2013 and January 2015. On the basis of the World Health Organization(WHO) which put forward the diagnostic criteria in 1999, the 83 cases(126 eyes) of diagnosed T2 DM patients are included in the study of diabetes(DM group), in which men for 45 cases, women for 38 cases. All subjects included in DM group were taken direct or indirect ophthalmoscope, fundus photography and fundus fluorescence angiography(FFA) inspection, and test results were classified on the basis of the DR international classification proposed on the annual meeting of the American academy of ophthalmology in 2002, of which, 32 cases(64 eyes)are of no Diabetic Retinopathy(NDR) group, 27 cases(54 eyes)of the fertile diabetic retinopathy(NPDR) group, and, 24 cases(48 eyes) of the fertile diabetic retinopathy(PDR) group. a healthy controls(HC) group are set up, 25 cases(50 eyes), the clinical excluded T2 DM. All the research objects were clinically to eliminate the effect of hemodynamics diseases, such as hypertension, glaucoma etc.2. All in objects of the study included are kept an account of the gender and age, and height and weight are also recorded as well to further calculate body mass index(BMI), duration of DM, fasting blood glucose(FBG) value and postprandial 2 hours blood glucose(PBG) value and glycated hemoglobin(GHbA1c) and blood lipids(including total cholesterol(TC, TG triglyceride, low density lipoprotein LDL) and high-density lipoprotein(HDL) readings.3. CDI technology has been applied to the determination of all the object of study of ophthalmic artery(OA), central retinal artery(CRA) blood flow parameters such as peak systolic velocity(PSV) end diastolic velocity(EDV) and largest resistance parameters such as flow, resistance index(RI) and pulse index(PI). Blood flow parameters of central retinal vein(CRV) are recorded, such as maximum blood flow velocity(Vmax), minimal blood flow.Recording the intima-media thickness.4. The ultrasonic-determined CRA on various parameters are chosen to do correlation analysis with the study object of other clinical parameters(DM duration, FBG, PBG, GHbA1 c, IMT, TC, TG, LDL, HDL).5.. Statistic and analysis for the figures by spss17.0 statistical software, the measurement data in the form of a(`x+s),, differences between groups in comparison employing single factor analysis of variance(One- way Anova) except that of gender differences which using the R*C.2 inspection table data, comparisons between the groups using LSD- t test, with P<0.05 being of statistical significance and P < 0.01 of great statistical significance. Besides Spearman are used to analyze the correlation between two variables. Results:1. In the HC group compared with DM group, the clinical parameters(FBG, GHb A1 c, PBG and TC, LDL, TG, HDL) were significantly different; but the IMT has no significant difference comparde with NDR group. In DM group, NDR group compared with NPDR group, except LDL, other parameters significantly. Comparison of NPDR group a nd PDR group, has the similar result with NDR group and PDR grou p, only a significant difference in FBG, PBG, IMT and GHbA1 c, no sign ificant difference between the other parameters. With the emergence and d evelopment of the disease, blood glucose, blood lipid level andcarotid artery intima media thickness was increased.2. Analysis and comparison of the results of OA blood flow parameter measurement in each group. In group NDR, change of OA blood flow is not obvious. In the NPDR group, there was a statistically significant change in the comparison between the date of PSV, RI,and control group, and some other parameters(EDV, PI) has no obvious diversity; In group PDR. Comparing group NDR with group NPDR, the parameters of the PSV, EDV, RI result difference is of no any statistical significance, but the value of PI is lower that that of group NPDR, and the change is obvious. There was palpable difference within each parameter, comparing with group NPDR and group PDR. The overall trend of the OA blood flow change is not obvious during NDR period, but after NPDR period,there’s a trend of decreasing in blood flow velocity and increasing in resistance.3. Analysis and comparison on the results of CRA blood flow parameter measurement between groups: For instance, the speed of blood, are higher than that of control group obviously. But the related vascular resistance parameters have no obviouse diversity; in group NPDR and PDR, the blood flow parameters values obviously changes comparing with control group. The changes are more obvious in PDR group. Overall, trend of CRA blood flow change is that blood flow velocity increased in the NDR period, but beating and resistance had no obvious changes. After entering the NPDR and PDR period, blood flow velocity decreased significantly and go downward along with the progression of illness,and PI, RI gone up.4. Comparative analysis between groups of CRV blood flow parameters measurements: Compared with HC group, all the parameters in NDR group had significant rise; but all the parameters in NPDR group and PDR group did not have significant differences. All the parameters in NPDR group was clearly different from those in NDR group, but was not obviously different from those in PDR group. The overall trend of changes of CRV blood flow speed significantly increased in NDR phase and it decreased in NPDR phase and it did not decrease obviously.5. Correlation analysis between CRA all hemodynamic parameters and other clinical characteristic parameters : related parameters of blood flow velocity such as PSV, EDV, FBG, PBG, IMT, duration of DM, GHbA1 c negatively correlated with the index of TC, TG and LDL in blood lipids blood lipid, and positively correlated with index of HDL; Related parameters such as blood flow resistance RI, PI and DM duration, FBG, PBG, IMT, GHbA1 c, positively correlated with index of TC, TG, LDL in lipid and main and negatively correlated with HDL. Conclusion:1. Before T2 DM patients developed DR, the main retrobulba arteriovenous hemodynamic has changed. This change is not reflected in the test results of every blood flow parameters of OA, which may be due to the relatively large vascular caliber OA, and early subtle changes in blood flow response is not obvious; But in the CRA and CRV, showed that PSV, EDV appeared blood flow velocity increasing which was opposite to the many research results.Maybe it’s a compensation performance, high perfusion of pathological state, which has some value in the early prediction of the occurrence of DR.2. The basic trend of blood flow changes in NPDR phase and PDR phase were similar.PSV and EDV slowing down,, PI and RI go up, so it’s visible that the retinal blood flow of patients with diabetic retinopathy takes on the status of high resistance and low flow velocity; But during NPDR period there’s no significant change in the OA, and OA may have a relatively large diameter.3. The longer the duration of DM is, the higher the FBG, PBG, GHbA1 c, IMT and index of blood lipidsTC, TG and LDL value, and the lower HDL value, the retinal vascular blood flow velocity, the higher the peripheral resistance and blood vessels will be.4. CDI technology has some advantage in retinal blood flow parameters detection of patients with diabetic retinopathy and has important value for the application of the progress of the DR, degree of evaluation and prognosis monitoring. Its non-invasive and repeatability are also easily accepted by patients, and can be used as important check item after DR has been clinical diagnosised. |
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