糖尿病视网膜病变不同分期视网膜神经纤维层、神经节细胞层及内丛状层厚度变化及其意义

Thickness changes of the retinal nerve fiber layer,ganglion cell layer and inner plexiform layer at different stages of diabetic retinopathy and clinical significance

目的利用频域相干光层析成像术(SD-OCT)测量不同阶段无明显糖尿病黄斑水肿的2型糖尿病患者黄斑区视网膜神经纤维层(mRNFL)、神经节细胞层(GCL)和内丛状层(IPL)的厚度变化,探讨其意义。方法回顾性病例研究。纳入2型糖尿病患者105例(105只眼),以40例(40只眼)正常眼作为对照组。根据国际临床糖尿病视网膜病变(DR)分级分为无糖尿病视网膜病变(NDR)组35只眼、非增生型糖尿病视网膜病变(NPDR)组40只眼,增生型糖尿病视网膜病变(PDR)组30只眼。使用SD-OCT测量4组受检者mRNFL、GCL及IPL的厚度,根据早期糖尿病视网膜病变治疗研究(ETDRS)对黄斑区进行分区,分析比较4组受检者mRNFL、GCL及IPL的厚度变化。结果NDR组、NPDR组、PDR组平均GCL厚度分别为(37.50±4.39)μm、(36.24±5.87)μm、(37.46±5.32)μm,与对照组(42.08±4.43)μm相比差异均有统计学意义(P<0.05),其中上方、鼻侧、下方区域明显变薄;NDR组、NPDR组、PDR组平均IPL厚度分别为(31.48±3.70)μm、(30.70±4.40)μm、(31.09±3.89)μm,与对照组(34.29±3.46)μm相比差异均有统计学意义(P<0.05),其中上方、鼻侧区域明显变薄;NDR组、NPDR组、PDR组平均mRNFL厚度分别为(26.18±3.33)μm、(26.37±4.29)μm、(26.50±3.89)μm,与对照组(27.20±3.47)μm相比差异均无统计学意义(P>0.05)。NDR组、NPDR组、PDR组组间两两比较,mRNFL、GCL及IPL的厚度差异均无统计学意义(P>0.05)。结论糖尿病患者中存在GCL、IPL变薄现象,甚至在可见的DR微血管病变出现之前,就已经发生明显的区域性缺失。

Objective To observe the thickness changes of macular retinal nerve fiber layer(mRNFL),ganglion cell layer(GCL)and inner plexiform layer(IPL)in macular area of patients with type II diabetes and without obvious diabetic macular edema at different stages by SD-OCT and to explore the relevant clinical significance.Methods This was a retrospective case-control study.A total of 105 patients(105 eyes)with type II diabetes were included as cases,and 40 cases(40 eyes)of normal eyes were included as control.The cases included 35 eye with non-diabetic retinopathy(NDR group),40 eyes with nonproliferative diabetic retinopathy(NPDR group)group,and 30 eyes with proliferative diabetic retinopathy(PDR group)based on the international clinical classification of diabetic retinopathy(DR).The thickness of mRNFL,GCL and IPL in the four groups were measured by SD-OCT.According to the early treatment of diabetic retinopathy study(ETDRS),the macular area was divided into different sections and the thickness changes of mRNFL,GCL and IPL in the 4 groups were compared and analyzed.Results The average GCL thickness in the NDR group,NPDR group and PDR group was(37.50±4.39)μm,(36.24±5.87)μm and(37.46±5.32)μm,respectively,which was significantly different from that of control group(42.08±4.43)μm,(P<0.05).The thickness in the superior,nasal and inferior quadrant was significantly lower.The average IPL thickness in the NDR group,NPDR group and PDR group was(31.48±3.70)μm,(30.70±4.40)μm and(31.09±3.89)μm,respectively,which was significantly different from the control group(34.29±3.46)μm,(P<0.05).Significant thinning was revealed in both the superior and nasal quadrants.The average mRNFL thickness in the NDR group,NPDR group and PDR group was(26.18±3.33)μm,(26.37±4.29)μm and(26.50±3.89)μm,respectively,showing no statistical significant difference compared with the control group(27.20±3.47)μm,(P>0.05).Moreover,there was no statistically significant difference in the thickness of mRNFL,GCL and IPL among the NDR group,NPDR group and PDR group(P>0.05).Conclusions We found thinning of GCL and IPL among patients with diabetes,and the regional thinning could occur even before the development of visible DR microvascular lesions.