血清同型半胱氨酸水平与2型糖尿病患者的视网膜光感受器外界限膜和椭圆体带破坏的关系研究

To study the relationship between serum homocysteine level and retinal photoreceptor external limiting membrane and ellipsoidal zone destruction in type 2 diabetic patients

目的探讨2型糖尿病患者血清同型半胱氨酸水平与糖尿病视网膜病变视网膜光感受器外界膜(ELM)和椭圆体带(EZ)破坏之间的关系.方法选取2018年2月至2018年10月在本院眼科实施治疗的患者120例(120只眼)为研究对象,按照是否患有2型糖尿病(DM)分为实验组(n=90,90只眼)和对照组(n=30,30只眼).按照眼底表现和荧光素眼底血管造影(FFA)结果将实验组90例患者分为无视网膜病变的糖尿病组(NDR)、非增殖性糖尿病视网膜病变伴黄斑水肿组(NPDR)、增生性糖尿病视网膜病变组(PDR),每组30例(30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同型半胱氨酸水平;使用光谱域光学相干断层扫描评估ELM和EZ的破坏程度,分为0、1、2级,分析2型糖尿病患者的血清同型半胱氨酸水平与视网膜ELM和EZ破坏之间的关系.结果糖尿病各组的血清同型半胱氨酸水平均高于对照组,差异有统计学意义(P<0.05);NPDR组和PDR组血清同型半胱氨酸水平明显高于NDR组,差异有统计学意义(P<0.001);0、1、2级的血清同型半胱氨酸水平分别为(10.83±3.01)、(12.03±3.04)、(16.65±5.15)μmol/L,3个级别之间比较差异有统计学意义(P<0.05).结论血清同型半胱氨酸水平与糖尿病视网膜光感受器ELM和EZ的破坏程度有关,视网膜光感受器ELM和EZ的破坏程度增加,其血清同型半胱氨酸水平增高.

Objective To investigate the relationship between serum homocysteine level in patients with type 2 diabetes mellitus and the destruc- tion of retinal photoreceptor external limiting membrane (ELM) and ellipsoidalzone (EZ) in diabetic retinopathy. Methods 120 patients (120 eyes) with type 2 diabetes mellitus (DM) who were treated in ophthalmology department of our hospital from February 2018 to October 2018 were select- ed as the study subjects. They were divided into experimental group (n=90, 90 eyes) and control group (n=30, 30 eyes) according to whether they had type 2 diabetes mellitus (DM). According to the fundus performance and fluorescein fundus angiography (FFA) 90 patients in the experimental group were divided into diabetic group without retinopathy (NDR), non-proliferative diabetic retinopathy with macular edema (NPDR) and proliferative di- abetic retinopathy (PDR), with 30 cases in each group (30 eyes). All subjects underwent fasting venous blood to measure serum homocysteine levels using an automated biochemical analyzer. The spectral domain optical coherence tomography was used to evaluate the destruction of ELM and EZ. The classification was as follows: level 0, ELM and EZ were not interrupted;level 1, ELM interrupt, EZ intact;level 2, ELM and EZ interrupt. Final- ly, we analyzed the relationship between serum homocysteine levels in patients with type 2 diabetes and retinal ELM and EZ disruption. Results The serum homocysteine level in each group of diabetes was higher than that in the control group (P<0.05). Serum homocysteine levels in the NPDR and PDR groups were significantly higher than those in the NDR group (P<0.001). The serum homocysteine levels of grade 0, grade 1, and grade 2 were (10.83±3.01), (12.03±3.04), and (16.65±5.15)μmol/L, respectively, and the difference between the three grades was statistically significant (P<0.05). Conclusion The level of serum homocysteine is related to the destruction of diabetic retinal photoreceptors ELM and EZ. The damage of retinal photoreceptors ELM and EZ is increased, and the serum homocysteine level is increased.