2型糖尿病患者角膜神经病变与视网膜病变的关系

Relationship between diabetic corneal neuropathy and diabetic retinopathy in patients with type 2 diabetic mellitus

目的探讨2型糖尿病患者的角膜神经病变与视网膜病变的关系。方法选取2017年3月至2019年8月于我院就诊的2型糖尿病伴或不伴糖尿病视网膜病变患者58例(58眼)作为研究对象(病例组),其中无明显糖尿病视网膜病变(NDR)患者16例(16眼)、非增殖期糖尿病视网膜病变(NPDR)患者21例(21眼)、增殖期糖尿病视网膜病变(PDR)患者21例(21眼)。以无糖尿病且年龄相仿的健康人15例(15眼)作为对照(健康对照组)。病例组和健康对照组均进行角膜共聚焦显微镜检查,对所得图像进行量化分析,比较各组角膜神经纤维长度(CNFL)、角膜神经纤维主干密度(CNFD)及角膜神经纤维分支密度(CNBD)。结果与健康对照组比较,病例组中NDR、NPDR和PDR患者的CNFL、CNFD、CNBD均下降(P均<0.01)。病例组中,随着糖尿病视网膜病变病情进展,CNFL、CNFD逐步降低(P<0.01,P<0.05);CNBD在NDR患者与NPDR患者间差异无统计学意义(P>0.05),PDR患者CNBD低于NDR和NPDR患者(P<0.01,P<0.05)。结论在角膜共聚焦显微镜下,2型糖尿病患者的角膜神经纤维存在损害,它的出现早于糖尿病视网膜病变,并且与糖尿病视网膜病变程度存在相关性,可为糖尿病视网膜病变的诊断、治疗提供指导。

Objective To study the relationship between diabetic corneal neuropathy and diabetic retinopathy(DR)in patients with type 2 diabetic mellitus(T2DM).Methods A total of 58 T2DM patients(58 eyes)complicated with or without DR who were admitted to our hospital from Mar.2017 to Aug.2019 were selected for the study(case group),including 16 patients(16 eyes)with no diabetic retinopathy(NDR),21 patients(21 eyes)with non-proliferative diabetic retinopathy(NPDR),and 21 patients(21 eyes)with proliferative diabetic retinopathy(PDR).Fifteen healthy people(15 eyes)without diabetes mellitus with similar ages were selected as controls(healthy group).Both the case group and the healthy group were examined by corneal confocal microscopy,and the images were analyzed quantitatively to compare corneal nerve fiber length(CNFL),corneal nerve fiber density(CNFD),and corneal nerve branch density(CNBD).Results CNFL,CNFD and CNBD of NDR,NPDR and PDR patients in case group were significantly lower than those in healthy group(all P<0.01).In case group,with the progression of DR,CNFL and CNFD gradually decreased(P<0.01,P<0.05).There was no significant difference in CNBD between NDR patients and NPDR patients(P>0.05).CNBD in PDR patients was significantly lower than that in NDR and NPDR patients(P<0.01,P<0.05).Conclusion Under corneal confocal microscope,the corneal nerve fiber damage in patients with T2DM appears earlier than DR,and it is related to the degree of DR,which can provide guidance for the diagnosis and treatment of DR.