目的：利用彩色多普勒超声检测2型糖尿病视网膜病变(diabetic retinopathy，DR)患者的滑车上动脉(supratrochlear artery，STCA)与球后相关动脉的血流动力学变化，并分析影响2型糖尿病DR发生发展的因素，以为糖尿病患者早期发现DR发病趋势、预防DR发生、采取有效干预措施阻止DR进展提供依据。

方法：选取2型糖尿病患者106例106眼，区分为糖尿病视网膜病变组(DR组)56例56眼右眼、糖尿病无视网膜病变组(NDR组)50例50眼右眼，选取同期于我院门诊体检的健康志愿者40例40眼右眼作为对照组(HC组)； 彩色多普勒超声检测所有研究对象的STCA、视网膜中央动脉(central retinal artery，CRA)、睫状后动脉(posterior ciliary artery，PCA)的血流动力学变化，观察糖尿病患者血流频谱形态与血流动力学参数收缩期峰值血流速(peak systolic blood flow velocity，PSV)、舒张末期血流速度(end diastolic blood flow velocity，EDV)与血管阻力指数(vascular resistance index，RI)的改变情况； 检测所有研究对象空腹血糖(fasting blood glucose，FBG)、血清总胆固醇(total cholesterol，TC)、甘油三酯(Triglyceride，TG)、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol，LDL-C)、高密度脂蛋白胆固醇(high density lipoprotein-cholesterol，HDL-C)； 记录DR组与NDR组的糖尿病病程、体重指数(body mass index，BMI)、既往病史(高血压、糖尿病、高血脂等)、家族遗传病史、吸烟饮酒史，对相关因素做非条件Logistic多因素回归分析。

结果：在血流频谱形态方面，DR组与NDR组均发生了较明显的频谱形态改变； 在血流动力学参数方面，STCA、CRA、PCA的PSV、EDV在CH组、NDR组、DR组依次下降，RI依次上升； NDR组、DR组眼部动脉各血流参数值与HC组相比差异均有统计学意义(P<0.05)，DR组STCA、CRA、PCA的PSV、EDV、RI与NDR组相比较，差异有统计学意义(P<0.05)； 在DR发生发展相关因素方面，DR组与NDR组相比较，糖尿病病程、高血压病史与高血脂病史例数、舒张压、FBG、TG、LDL-C的差异有统计学意义(P<0.05)。

结论：对于糖尿病患者，超声检测血流动力学可作为早期预防DR、早期发现DR的主要手段，视网膜发生明显病变之前眼部血管血流动力学即可发生异常改变，且其改变程度与视网膜病变程度呈正相关，DR的发生发展与血糖、血压、血脂水平以及糖尿病病程等相关因素有密切关系。

AIM:To observe hemodynamic changes of supratrochlear artery(STCA)and posterior ball related artery in type 2 diabetic retinopathy(DR)by color Doppler ultrasound detection, analyze the occurrence and development of related factors, and provide the evidences to find the DR incidence trends at early stage, prevent the occurrence of DR and adopt effective interventions to prevent progression of DR.

METHODS: A total of 106 cases(106 eyes)with type 2 diabetes mellitus were divided into DR group(56 eyes of 56 cases ), non-diabetic retinopathy group(NDR group, 50 eyes of 50 cases), healthy volunteers were selected in our hospital outpatient medical examination in 40 cases(40 eyes)as control group(HC group). Color Doppler ultrasound was used to detect the hemodynamic changes of STCA, central retinal artery(CRA), posterior ciliary artery(PCA)of all research subjects. The changes of blood spectrum morphology and hemodynamics parameters including peak systolic diastolic blood flow velocity(PSV), end diastolic blood flow velocity(EDV)and vascular resistance index(RI)in diabetics were observed. Fasting blood glucose(FBG), serum total cholesterol(TC), triglyceride(TG), low density lipoprotein-cholesterol(LDL-C), high density lipoprotein-cholesterol(HDL-C)in all research subjects were detected. The duration of diabetes, body mass index(BMI), past medical history(hypertension, diabetes, hyperlipidemia, etc.), family genetic history, smoking and drinking history were recorded. Non-conditional Logistic regression analysis was used to analyze the related factors.

RESULTS: The results showed that the changes of blood spectrum morphology in DR and NDR group were significant. In terms of hemodynamic parameters, STCA, CRA, PCA, PSV, EDV decreased sequentially and RI increased sequentially in the CH and NDR, DR group. Compared the eye artery hemodynamic parameters of DR and NDR group with HC group, the differences were statistically significant(P<0.05). The differences on STCA, CRA PCA, PSV, EDV, RI between DR and NDR group had statistical significance(P<0.05). In aspect of the occurrence and development of related factors, diabetes duration, hypertension history, the number of cases with hyperlipidemia history, diastolic blood pressure, fasting blood glucose, triglyceride, and low density lipoprotein cholesterol of DR group were statistically different with NDR group(P<0.05).

CONCLUSION: For patients with diabetes, hemodynamics ultrasonic detection can be used as the principal means of early prevention and detection of DR. Hemodynamic ocular vascular abnormalities can occur before the retina obvious lesions, and its change degree is positively correlated with retinal lesions. Blood glucose, blood pressure, blood lipid level and duration of diabetes and other related factors are closely related to the occurrence and development of DR.