糖尿病周围神经病变与视网膜神经纤维层厚度相关性研究

Relationship between diabetic peripheral neuropathy and retinal nerve fiber layer thinning

目的测量不同程度糖尿病周围神经病变（DPN）的非增生期糖尿病视网膜病变（NP—DR）患者视网膜神经纤维层（RNFL）厚度，探讨RNFL厚度与DPN程度的相关性。方法临床病例对照研究。对2011年4月至2012年8月在天津市眼科医院经荧光素眼底血管造影（FFA）检查确诊为非增生期糖尿病视网膜病变（NPDR）的78例患者为研究组，同时选取50名正常人作为对照组。用多伦多临床评分系统（TCSS）评估研究组78例受试者DPN程度，分为4组：无、轻度、中度、重度DPN组。采用光相干断层扫描（OCT）以视盘为中心作直径为3．4mm的环形扫描，测量视网膜全周平均及上方、下方、鼻侧、和颞侧象限平均RNFL厚度。分析不同程度DPN各组间RNFL厚度差异以及糖尿病视网膜病变（DR）对RNFL厚度的影响。结果按DPN程度分析，与正常对照组相比，轻、中、重度DPN组全周平均、上方和下方RNFL厚度差异均有统计学意义（P〈0．05）；无DPN组与正常对照组下方象限RNFL厚度存在差异有统计学意义（P〈0．05）。按视网膜病变程度分析，与正常对照组相比，中度与重度NPDR组全周平均、上方、下方RNFL厚度差异有统计学意义（均为P〈0．05）；轻度NPDR组与正常对照组比较，下方象限RNFL厚度差异有统计学意义（P〈0．05）。结论RNFL厚度的变化与DPN程度存在一定相关性，随着DPN症状的出现和加重，RNFL厚度亦明显变化，提示可通过对DPN的简单评估推测RNFL厚度变化，进而有效指导临床诊疗。

Objective To measure the retinal nerve fiber layer （RNF） thickness in patients with non-proliferative diabetic retinopathy （NPDR） of different severity peripheral neuropathy, and explore the correlation between RNFL thickness and severity of diabetic peripheral neuropathy. Methods Seventy-eight patients with NPDR diagnosed by fundus fluorescein angiography （FFA） were included in this study. Normal control group containing 50 cases, The level of neuropathy was assessed in 78 participants using Toronto clinical scoring system （TCSS）. Participants were stratified into four neu- ropathy groups： none, mild, moderate, and severe. The mean RNFL thickness and the superior, inferi- or, nasal and temporal retinal nerve fiber layer thicknesses were measured at 3.45 mm diameter around, the optic nerve head using optical coherence tomography （OCT）. RNFL thickness difference was estimate according to the analysis of DPN degree between the teams, and analysis evaluation ret- inopathy to the influence of RNFL thickness. Results Compared normal control group with mild,moderate, and severe DPN group, there were statistical differences in the mean and superior, inferior of quadrant of RNFL （P 〈0.05 for all）; No DPN group and normal control group comparison, only inferior quadrant RNFL thickness had statistical difference （P 〈0.05）. According to the degree of reti- nopathy, compared with normal control group, moderate and severe NPDR group mean, superior, infe- rior of quadrant RNFL thickness difference had statistical significance （P 〈0.05 for all）; Mild NPDR group and normal control group comparison, inferior quadrant RNFL thickness had statistical differ- ence（P 〈0.05）. Conclusions RNFL thinning is associated with peripheral neuropathy in NPDR pa- tients. With DPN symptoms appear and aggravating, RNFL thickness obviously thin. This is a sim- ple method to speculation RNFL thickness change based on simple assessment of DPN, bring conve- nience for clinical work.