Diabetes Care：肾功能受损或与导致视网膜血流降低

日本学者的一项研究表明，肾功能受损可能与视网膜血流（RBF）降低具有相关性。论文于2012年11月30日在线发表于《糖尿病护理》（Diabetes Care）杂志。

此项研究共纳入169例（169只眼）平均年龄为59岁的2型糖尿病患者；受试者无或伴轻微糖尿病视网膜病变，并且无或伴微量蛋白尿。通过同时测定视网膜血管直径和血流速度获取RBF。利用通过年龄和血清肌酐计算的估计肾小球滤过率评估肾功能。

结果显示，无慢性肾病（CKD）以及1、2和3期CKD患者分别为99、22、27和21例。与无CKD患者相比，3期CKD患者的RBF随血管直径减小而显着降低，但血流速度与之无相关性。多重回归分析显示，CKD分期与RBF降低呈显着独立相关（P=0.02）。

与肾功能相关的拓展阅读：

• Am J Cardiol：肾功能不全与房颤抗凝患者不良转归相关
• Diabetes Care:肾功能受损或与视网膜血流降低相关
• Circulation：肾功能不全独立预测房颤卒中风险
• Arch Intern Med：在中度肾功能不全患者中 用依诺肝素须警惕大出血风险
• AJKD:地中海饮食不能改善心血管疾病高危老年人肾功能 更多信息请点击：有关肾功能更多资讯

Relationship between retinal blood flow and renal function in patients with type 2 diabetes and chronic kidney disease.
OBJECTIVE
To study the relationship between retinal microcirculation and renal function in patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS
Using a laser Doppler velocimetry system, we obtained the retinal blood flow (RBF) values by simultaneously measuring the retinal vessel diameter and blood velocity. To determine if the RBF is affected in the presence of renal dysfunction, we also evaluated the renal function using the estimated glomerular filtration rate calculated by age and serum creatinine level.
RESULTS
We recruited 169 eyes of 169 consecutive Japanese patients with type 2 diabetes, no or minimal diabetic retinopathy, and normo/microalbuminuria (mean age ± SD, 59.0 ± 11.1 years). We divided the patients into four groups based on the stage of chronic kidney disease (CKD) (non-CKD, n = 99; CKD stage 1, n = 22; stage 2, n = 27; stage 3, n = 21). We found significant (P = 0.035) decreases in RBF with decreased vessel diameter (P = 0.017) but no difference in blood velocity (P = 0.54) in stage 3 CKD compared with the non-CKD group. Multiple regression analysis showed that the CKD stage was significantly (P = 0.02) and independently associated with decreased RBF.
CONCLUSIONS
Our results indicated that the vessel diameter and RBF in the retinal arterioles decrease in patients with type 2 diabetes with stage 3 CKD, suggesting that impaired renal function might be associated with decreased RBF, probably via constriction of the retinal arterioles, in early-phase diabetic retinopathy.