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糖尿病视网膜病变及其并发大血管病变表明两者之间致病存在相关性。血管内皮细胞是糖尿病血管损伤的主要部位。糖尿病视网膜病变能并发全身动脉硬化和改变血管内皮的功能及结构。在黄斑,动静脉交叉处和在筛板区视神经中的视网膜血管内皮细胞不同与其余视网膜血管中内皮细胞。中央视网膜在视神经中动脉和静脉非常接近且共用同一外膜;因此,增加动脉壁的硬度和厚度可以影响该区域中的相邻中央视网膜静脉中的血流量。此外,小动脉床中的动脉硬化加剧与视网膜微血管扩张有关;这表明筛板中视网膜中央动脉压迫视网膜中央静脉的可能性,从而损害糖尿病患者视网膜中的小静脉流出。经观察发现糖尿病视网膜病变患者在后层流区的视网膜中央静脉中的血流量发生改变。在视网膜中央静脉中增加静水压可能在糖尿病视网膜病变的病情进展过程中起重要作用。这篇综述文章的主旨是强调这种常常被忽视的发病机制。
Diabetic retinopathy and its associated macrovascular disease suggest a correlation between the two. Vascular endothelial cells are a major site of vascular damage in diabetes. Diabetic retinopathy can be complicated by systemic arteriosclerosis and changes in vascular endothelial function and structure. The retinal vascular endothelial cells differed from those in the remaining retinal vessels at the macular, arteriovenous intersections and in the optic nerve of the lamina cribrosa. The central retina is very close and shares the same adventitia in the optic nerve with the arteries and veins; therefore, increasing the stiffness and thickness of the arterial wall can affect the blood flow in the adjacent central retinal vein in this area. In addition, increased atherosclerosis in the arteriolar bed correlates with retinal microvascular dilatation; this indicates the possibility of central retinal artery compression of the central retinal vein in the sieve plate, thereby compromising the venular outflow in the retina of diabetic patients. It has been observed in patients with diabetic retinopathy in the laminar flow in the central retinal vein blood flow changes. Increasing hydrostatic pressure in the central retinal vein may play an important role in the progression of diabetic retinopathy. The main thrust of this review article is to highlight the often overlooked pathogenesis.