血清肌酐和尿素氮水平与糖尿病视网膜病变神经纤维层厚度相关性观察

The correlation between serum creatinine and urea levels and retinal nerve fiber layer thickness in diabetic retinopathy

目的研究2型糖尿病患者血清肌酐和尿素氮水平与糖尿病视网膜病变(DR)视网膜神经纤维层(RNFL)厚度之间的相关性。方法选取2015年10月至2016年5月于天津市眼科医院就诊的年龄在45~60岁之间临床确诊的2型糖尿病患者60例(60只眼)作为实验组,在同一年龄范围内的健康志愿者20例(20只眼)作为对照组。按照检眼镜眼底表现和荧光素眼底血管造影(FFA)结果将实验组分为无DR者20例(20只眼)即NDR组,轻中度非增生性糖尿病视网膜病变(NPDR)组20例(20只眼),重度NPDR组20例(20只眼)。所有研究对象均空腹抽取静脉血采用全自动生化分析仪测量血清肌酐和尿素氮水平,频域相干光断层扫描(SD-OCT)测量视盘周围RNFL厚度。分析对照组及DR不同阶段各组血清肌酐和尿素氮水平与RNFL厚度之间的相关性。结果与对照组相比,NDR组、轻中度NPDR组及重度NPDR组血清肌酐、尿素氮均升高,差异有统计学意义(P<0.05);随DR严重程度增加,视盘周围平均RNFL厚度与四个象限RNFL厚度均变薄,差异有统计学意义(P<0.05);采用Pearson相关性检验发现,血清肌酐、尿素氮水平与各组RNFL厚度均呈负相关(P<0.05)。结论随着DR严重程度的增加,血清肌酐和尿素氮水平与RNFL厚度具有负相关性。

Objective Diabetic retinopathy（ DR） and diabetic nephropathy（ DN） is common microvascular complications of diabetes,and it＇s important to explore clinical indicators that help early diagnosis. This study was to investigate the correlations between serum creatinine and urea levels and retinal nerve fiber layer（ RNFL） thickness in diabetic retinopathy. Methods Sixty type 2 diabetes patients（ 60 eyes） from 45 to 60 years old were enrolled from Tianjin Eye Hospital between October 2015 and May 2016,and twenty healthy age-matched volunteers（ 20 eyes） were recruited as control.According to the fundus changes and sodium fluorescein fundus angiography（ FFA） patients were divided according to the degree of retinopathy： no DR（ NDR; n = 20 eyes）,mild to moderate non-proliferative diabetic retinopathy（ NPDR; n =20 eyes）,and severe NPDR（ n = 20 eyes）. All subjects were tested for fasting serum creatinine and urea. Parapapillary retinal nerve fiber layer thickness was measured with spectral domain optical coherence tomography（ SD-OCT）. The correlation between serum creatinine and urea levels and RNFL thickness were compared for patients and healthy subjects. Results Serum creatinine and urea levels increased in all diabetic patients. Average parapapillary RNFL thickness and RNFL thickness in four quadrants became thinner with the progression of DR and there were significant differences in these levels between patients with different severity of DR（ P〈0. 05）. Pearson correlation test showed that serum creatinine and urea levels were negatively correlated with RNFL thickness（ P〈0. 05）. Conclusions Serum creatinine and urea levels were negatively correlated with RNFL thickness in diabetic retinopathy.