Explore The Relationship Between DME Macular Microcirculation,Renal Function And TCM Syndrome Types

ObjectiveUsing OCTA to observe the macular retinal thickness and blood flow in the macular area of DR patients,and analyze the correlation with the ratio of urine microalbumin to urinary creatinine and the estimation of glomerular filtration rate,to investigate the change of retinal blood flow in the macular area and the risk factors of DME providing a reference basis for the early diagnosis,early prevention and intervention of DME.At the same time,we will discuss differences between DR patients with different TCM syndromes in the changes of incidence of DME,blood flow in the macular area and renal function,to provide a basis for early prevention of the progress of DME.MethodsUsing retrospective research methods,we collected 147 T2 DM patients diagnosed with DR during their hospitalization in the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from January2018 to December 2020,and collected their basic information,medical history,relevant laboratory indicators,and ophthalmic testing information.Analyze the risk factors of DME,compare the incidence of DME with different UACR level groups and different TCM syndrome types,as well as whether there is DME.Comparative analysis of the intact blood vessel density,intact blood flow density,and FAZ area indicators of the SCP layer in the macula with or without DME,different UACR level groups,and different TCM syndrome types.Results1.Risk factors for DME: The differences between the DME group and the no DME group in LDL(P=0.025),e GFR(P=0.034),UACR(P=0.000)and the presence or absence of high reflex points(P=0.000)are statistically significant.Further logistic regression analysis showed that UACR(OR=1.001;95%CI 1～1.002,P=0.046<0.05),and high reflection points(OR=36.142;95%CI 7.905～165.257,P=0.000<0.05)and The occurrence of DME is statistically significant.2.UACR level groups: The incidence of DME is statistically different in different UACR groups(P=0.000<0.05);pairwise comparison,the incidence of DME in the large albuminuria group is higher than that in the normal albuminuria group,and there is a statistical difference(P=0.000);the occurrence of DME in the large albuminuria group was higher than that in the microalbuminuria group,and there was a statistical difference(P=0.000).3.The density of complete blood vessels in the SCP layer of the macula:The density of complete blood vessels under different UACR levels(P=0.028)is statistically significant in comparison between groups;while there is no statistically significant difference in comparison between the two groups.Further grouping,the intact blood vessel density of the abnormal albuminuria group was lower than that of the normal abnormal albuminuria group,and the difference was statistically significant(P=0.008).And UACR is negatively correlated with intact blood vessel density(r=-0.229,P<0.01).There was no significant difference in the blood vessel density of the macular area between the DME group and the non-DME group.4.The complete blood flow density of the SCP layer in the macular area:The complete blood flow density(P=0.008)between groups under different UACR levels is statistically significant.Further pairwise comparisons indicate that the two groups of massive albuminuria and microalbuminuria are different from each other.The intact blood flow density(P=0.030)was lower than that of the normal albuminuria group,which was statistically significant.And UACR is negatively correlated with intact blood vessel density(r=-0.243,P<0.01).There was no significant difference in the blood flow density of the macular area between the DME group and the non-DME group.5.FAZ area: There is no significant difference in FAZ area with or without DME and different UACR levels.6.Different TCM syndrome types: The incidence of DME,the intact blood vessel density of the SCP layer in the macular area,and the intact blood flow density of different TCM syndrome types are different,and the difference is statistically significant,but the FAZ area is not statistically different.Further pairwise comparisons,it can be concluded that the incidence of DME with deficiency of both yin and yang,blood stasis and phlegm coagulation syndrome is higher than that of deficiency of both qi and yin,and stagnation of collaterals and collaterals,with statistical differences(P=0.007);deficiency of both qi and yin and stasis of collaterals Obstruction syndrome and liver and kidney deficiency,eye collateral deficiency syndrome(P=0.078),liver and kidney deficiency,eye collateral deficiency syndrome and yin and yang deficiency,blood stasis and phlegm coagulation syndrome(P=0.390)have no significant incidence of DME Statistical difference;Yin and Yang deficiency,blood stasis and phlegm coagulation syndrome,the complete blood vessel density level is lower than that of Qi and Yin deficiency,vein and collateral stasis syndrome,liver and kidney deficiency,and eye collateral deficiency syndrome;Yin and Yang deficiency,blood stasis and phlegm The complete blood flow density in the macular area of patients with coagulation is lower than that of patients with liver and kidney deficiency and dystrophy of the eye collaterals.Conclusion1.DR patients with macular edema have lower e GFR levels than without macular edema,while UACR levels are higher;UACR and high reflex points are risk factors for macular edema in DR patients.There is a positive correlation between UACR levels and the occurrence of DME.The prevalence of DME in people with high retina reflection points is 36.142 times that of those without high reflection points in the retina.2.There was no significant difference in the intact blood vessel density,intact blood flow density,and FAZ area of the SCP layer in the macula of DR patients with or without DME.3.The intact blood vessel density and the intact blood flow density of the SCP layer in the macular area of DR patients are negatively correlated with the UACR level,but there is no obvious correlation with the FAZ area.4.There are differences between DR patients with different TCM syndromes in the incidence of DME,the intact blood vessel density of the SCP layer in the macula,and the intact blood flow density,which is no different from the FAZ area.Among them,the retinal microvessels appear in patients with yin and yang deficiency and blood stasis and phlegm coagulation syndrome.Obviously abnormal,the probability of DME also increases.