The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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The Relationship between Diabetic Retinopathy and Macrovascular Complication in Patients with Type 2 Diabetes

제2형 당뇨병 환자에서의 당뇨병성 망막증과 대혈관

  • Hong, Sang-Mo (Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Park, Jung-Hwan (Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Lim, Young-Hyo (Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Park, Yong-Soo (Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Kim, Dong-Sun (Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Choi, Woong-Hwan (Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Ahn, You-Hern (Department of Internal Medicine, Hanyang University College of Medicine)
  • 홍상모 (한양대학교 의과대학 내과학교실) ;
  • 박정환 (한양대학교 의과대학 내과학교실) ;
  • 임영효 (한양대학교 의과대학 내과학교실) ;
  • 박용수 (한양대학교 의과대학 내과학교실) ;
  • 김동선 (한양대학교 의과대학 내과학교실) ;
  • 최웅환 (한양대학교 의과대학 내과학교실) ;
  • 안유헌 (한양대학교 의과대학 내과학교실)
  • Published : 2011.09.01
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Abstract

Background/Aims: Type 2 diabetes with microvascular complications is often accompanied by macrovascular complications. However, the relationship between the two complications is unclear. In this study, we determined the relationship between diabetic retinopathy and morphological changes of the carotid artery. Methods: We analyzed the presence of plaque and mean carotid intima-media thickness (CIMT) in patients with type 2 diabetes (n = 133) using high-resolution ultrasound. The presence and severity of retinopathy were graded according to fundus photographs. Results: The mean CIMT of the diabetic retinopathy (DR) group (0.111 ${\pm}$ 0.048 cm) was significantly greater than that of the nondiabetic retinopathy (No DR) group (0.074 ${\pm}$ 0.039 cm, p = 0.007). An abnormal mean CIMT (> 0.08 cm) was more frequently observed in the DR group (76%) than that in the No DR group (23.1%; odds ratio, 10.609; 95% confidence interval, 3.072-36.639; adjusted by age, body mass index, hypertension, and diabetes duration). Although the mean CIMT in patients with plaque was significantly greater than that of patients without plaque, no significant difference was observed between the DR (36%, 17 patients) and NoDR (18.5%, 20 patients) groups in the presence of plaque. Conclusions: Diabetic retinopathy was associated with an increased CIMT but not with atherosclerotic plaques. However, the increases in IMT were associated with the presence of plaques, which predispose patients to cardiovascular disease. These results imply that the microvascular complications of diabetes have indirect relationships with the cardiovascular complications of diabetes.

목적: 당뇨병 환자에서 흔히 대혈관 합병증과 미세혈관 합병증이 동시에 관찰된다. 또한 두 합병증 모두 비슷한 발생 위험인자를 공유하고 있다. 그러나 두 합병증 간의 연관관계는 뚜렷하지 않다. 본 연구에서는 당뇨병성 망막증의 유무가 동맥 경화와 어떤 연관 관계를 가지는지를 살펴보았다. 방법: 한양대병원에서 지난 1년간 내분비내과에서 경부 도플러 초음파 검사를 시행한 환자 당뇨 환자 133명을 대상으로 연구를 진행하였다. 환자의 안저 검사 사진과 안과 전문의의 소견을 바탕으로 당뇨병성 망막증의 유무를 정의하였다. 죽상반 유무와 경동맥 내중막 두께(CIMT)는 고해상도 초음파를 사용하여 측정하였다. 결과: 환자의 평균 연령은 당뇨병성 망막증 유무에 따른 차이는 없었다. DR군에서 평균 CIMT는 0.111 ${\pm}$ 0.039 cm로 NoDR군에서의 CIMT (0.074 ${\pm}$ 0.039 cm)보다 통계적으로 의미 있게 두꺼웠다(p = 0.007). CIMT가 0.08 cm 이상인 환자는 DR군에서 75% (35명)으로 NoDR군 23.1% (25명)에 비하여 많았다(OR = 10.609 %CI: 4.379-10.471). 비록 죽상경화반이 있는 환자에서의 평균 CIMT는 그렇지 않은 환자에 비하여 높았으나 죽상경화반은 DR군(17명/36%)과 NoDR군(20명/28%) 사이에 통계적인 차이가 없이 관찰되었다. 결론: 당뇨병성 망막증은 당화혈색소가 증가하면 더 증가하였고 당뇨병성 망막증은 CIMT의 두께 증가와 연관이 있었으나 죽상반과는 연관이 없었다. 그러나 IMT의 증가는 죽상반 발생의 중요한 위험인자였다. 따라서 이는 당뇨병의 미세 혈관 합병증이 직접적으로 심혈관 질환과 연관 있는 죽상반과는 연관이 없으나 간접적으로는 연관이 있다는 점을 시사한다.

Keywords

References

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