无糖尿病视网膜病变的2型糖尿病患者黄斑区视网膜厚度变化:基于SD-OCT的观察

Spectral domain optical coherence tomography quantifies the macular thickness in patients with type 2 diabetes mellitus without significant diabetic retinopathy

目的观察无糖尿病视网膜病变(diabetic retinopathy,DR)的2型糖尿病患者黄斑区视网膜厚度变化。方法选择2017年8月至10月在我院检查确诊无DR的2型糖尿病患者40例(40眼,无DR组)和健康志愿者70名(70眼,正常对照组)纳入研究。采用频域光学相干断层扫描成像(spectral domain optical coherence tomography,SD-OCT)以及自动化分层技术分别测量黄斑区视网膜全层(retina,R)、视网膜内层(inner retinal layer,IRL)和视网膜外层即感光细胞层(photoreceptor layer,PL)厚度,将黄斑区以中心凹为中心点,分别以直径为1 mm、3 mm和6 mm的3个同心圆进行分区(R总、R-1、R-3、R-6、IRL-1、IRL-3、IRL-6、PL-1、PL-3及PL-6),对比两组间视网膜厚度差异。结果无DR组患者PL-1、PL-3厚度分别为(71±4)μm、(66±2)μm,较正常对照组(73±3)μm、(67±2)μm明显变薄(均为P<0.05)。正常对照组中除IRL-6和PL-1外,其余测量区域不同性别间视网膜结构厚度差异显著(均为P<0.05)。无DR组男性患者PL-3、PL-6厚度分别为(67±2)μm、(65±2)μm,较正常对照组的(68±2)μm、(66±2)μm明显变薄(均为P<0.05)。无DR组女性患者PL-3、PL-6厚度分别为(65±2)μm、(63±2)μm,较正常对照组的(67±2)μm、(64±2)μm明显变薄(均为P<0.05)。其余测量区域组间差异均无统计学意义(均为P>0.05)。结论无DR组黄斑旁中心凹及中心凹周围视网膜PL厚度较正常对照组明显变薄,SD-OCT测量视网膜PL厚度有助于DR早期病变研究,并成为早期监测DR的重要生物学标志。

ObjectiveTo observe the retinal thickness of macular in type 2 diabetic mellitus(T2DM)patients without clinical features of diabetic retinopathy(DR).MethodsTotally 40 patients(40 eyes)with T2DM without DR and 70 healthy volunteers(70 eyes)from August 2017 to October 2017 were enrolled in this study.Usage of spectral domain optical coherence tomography(SD OCT)and the software of automatic segmentation to measure the average thickness of total retinal(R),inner retinal layer(IRL)and outer retinal layer namely photoreceptor layer(PL)in macular.The foveal center was divided according to three concentric circle with the diameter of 1 mm,3 mm and 6 mm(including the partition of R total,R 1,R 3,R 6,IRL 1,IRL 3,IRL 6,PL 1,PL 3 and PL 6),and the average retinal thicknesses of these partitions between these two group were compared and analyzed.ResultsThe thickness of PL 1 and PL 3 in no DR group was significantly thinner than that in the normal control group[(71±4)μm vs.(73±3)μm and(66±2)μm vs.(67±2)μm,respectively](both P<0.05).In the normal control group,except the IRL 6 and PL 1,the difference of the thickness was significant in the other macular regions between various genders(all P<0.05).In the male subjects,the thickness of PL 3 and PL 6 in no DR group was significantly thinner than that in the normal control group[(67±2)μm vs.(68±2)μm and(65±2)μm vs.(66±2)μm,respectively](both P<0.05).In the female subjects,the mean thicknesses of PL 3 and PL 6 in no DR group was significant thinner than those in normal control group[(65±2)μm vs.(67±2)μm and(63±2)μm vs.(64±2)μm,respectively](both P<0.05).There was no obviously difference in the other parts between these two groups.ConclusionThe mean retinal thicknesses of the parafovea and perifovea are significantly thinner in no DR group than that of the normal control group.The measurement of the PL thickness of macular by SD OCT may promote the study of early stage of DR,and become an important biological marker for early monitoring of DR.