血糖风险指数与无糖尿病视网膜病变患者 视网膜结构及血流的相关性研究

Correlation of Glycemic Risk Index with Retinal Structure and Blood Flow in Patients without Diabetic Retinopathy

摘要: 目的：通过光学相干断层扫描(Optical Coherence Tomography, OCT)及光学相干断层扫描血管成像(Optical Coherence Tomography Angiography, OCTA)检测佩戴动态血糖监测仪的无糖尿病性视网膜病变(NDR)患者视网膜厚度及血流灌注变化。同时比较血糖风险指数(GRI)与其他血糖波动指标对NDR患者视网膜改变的预测价值，为个体化血糖控制提供临床依据。方法：横断面分析研究，将2025年4月至2025年12月就诊于青岛大学附属医院的53例佩戴动态血糖监测仪的NDR患者的临床资料纳入研究，采用CGM系统连续监测不少于7天的血糖结果，根据导出的CGM数据计算血糖波动指标，按照GRI将患者分为Group 1组(GRI ≥ 20%)及Group 2组(GRI < 20%)。所有入组患者均进行OCTA、OCT检查。运用OCTA技术测量视网膜浅层毛细血管网(Superficial Capillary Plexus, SCP)、深层毛细血管网(Deep Capillary Plexus, DCP)的血管灌注密度(Perfusion Density, PD)，应用OCT技术量化视网膜厚度(Retinal Thickness, RT)。采用两独立样本的t检验比较两组间的差异。结果：两组在年龄、糖尿病病程、糖化血红蛋白(HbA1c)、空腹血糖(Fasting Blood Glucose, FBG)等方面的差异具有统计学意义(p < 0.05)。两组在除葡萄糖低于范围内时间(Below Range Time, TBR)外的其他血糖波动指标间的差异均有统计学意义(p < 0.05)。两组间各区域视网膜浅层毛细血管网、深层毛细血管网在血流灌注方面的差异均无统计学意义(p > 0.05)。结论：NDR患者中，高GRI组黄斑区部分区域视网膜厚度增加，提示视网膜增厚可能是机体对血糖波动的代偿性反应，而非显性病变标志。GRI作为综合评估高低血糖风险的指标，其预测价值与TIR、TAR、TITR相当。

Abstract: Objective: To assess changes in retinal thickness and perfusion in patients with no diabetic retinopathy (NDR) wearing continuous glucose monitors using Optical Coherence Tomography (OCT) and Optical Coherence Tomography Angiography (OCTA). Furthermore, to compare the predictive value of the Glycemic Risk Index (GRI) with other glycemic variability parameters for retinal alterations in NDR patients, thereby providing a clinical basis for individualized glycemic control. Methods: This cross-sectional analytical study included 53 patients with NDR who wore continuous glucose monitors and were treated at the Affiliated Hospital of Qingdao University between April 2025 and December 2025. Continuous glucose monitoring (CGM) data were collected for a minimum of seven consecutive days, and glycemic variability parameters were calculated from the exported data. Based on their GRI, patients were divided into two groups: Group 1 (GRI ≥ 20%) and Group 2 (GRI < 20%). All enrolled participants underwent OCTA and OCT examinations. OCTA was used to measure the perfusion density (PD) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP), while OCT was used to quantify retinal thickness (RT). Differences between the two groups were compared using independent samples t-tests. Results: Statistically significant differences were observed between the two groups in terms of age, diabetes duration, HbA1c, and fasting blood glucose (FBG) (p < 0.05). Regarding glycemic variability metrics, all parameters except for time below range (TBR) showed statistically significant differences between the groups (p < 0.05). No statistically significant differences were found in perfusion density for any of the measured retinal regions in either the SCP or DCP between the two groups (p > 0.05). Conclusion: In NDR patients, increased retinal thickness in specific macular areas observed in the high GRI group suggests that retinal thickening may represent a compensatory response to glycemic fluctuations rather than a marker of overt pathology. As a composite index that provides a weighted assessment of both hyperglycemia and hypoglycemia risk, the GRI offers predictive value comparable to that of time in range (TIR), time above range (TAR), and time in tight range (TITR).