基于眼底影像的糖尿病视网膜病变患者视网膜微细结构的研究

Study on retinal microstructures of diabetic retinopathy patients based on fundus image

目的:探讨糖尿病视网膜病变(DR)患者视网膜微细结构的变化情况。方法:120例2型糖尿病患者分为无DR组(n=65)和DR组(n=55),另选60例健康体检者为对照组。光相干断层扫描(OCT)各组黄斑中心凹区、旁中心凹区和中心凹周围区神经纤维层(RNFL)、神经节细胞层(GCL)、内丛状层(IPL)、内核层(INL)、外丛状层(OPL),外核层(ONL);视网膜色素上皮细胞层(RPE),内层视网膜(IRL),外层视网膜(ORL);神经节细胞-内丛状层复合体(GCIPL)及感光细胞层(PR)的变化情况。结果:黄斑中心凹区各组RNFL、GCL、IPL、INL、OPL、ONL、RPE、IRL、ORL、GCIPL及PR比较,差异无统计学意义(P>0.05);而IPL、GCIPL和OPL在旁中心凹区和中心凹周围区比较,差异有统计学意义(P<0.05)。Pearson相关性分析表明,IPL和GCIPL与年龄和糖尿病病程呈明显负相关(P<0.05),OPL与年龄和糖尿病病程呈明显正相关(P<0.05);ROC曲线分析表明IPL、GCIPL和OPL联合检测AUC值为0.805。结论:2型糖尿病患者视网膜内层厚度存在改变,视网膜内部IPL、GCIPL和OPL可作为早期诊断DR的形态学观察指标之一。

Objective:To investigate the changes of retinal microstructures in patients with diabetic retinopathy(DR).Methods:120 patients with type 2 diabetes were divided into patients with no significant diabetic retinopathy(no DR group,n=65)and patients with mild non-proliferative diabetic retinopathy(DR group,n=55),and 60 healthy subjects were selected as control group.Using optical coherence tomography groups of macular center concave area,near the center around the concave area and the center area of nerve fiber layer(RNFL)and ganglion cell layer(GCL),inner plexiform layer(IPL),kernel layer(INL),outer plexiform layer(OPL),outer nuclear layer(ONL),retinal pigment epithelium(RPE)cells layer,the inner retina(IRL),outer retina(ORL),ganglion cells,inner plexiform layer complex(GCIPL)and the photoreceptor cell layer(PR).Results:RNFL,GCL,IPL,INL,OPL,ONL,RPE,IRL,ORL,GCIPL and PR were not significantly different in macular fovea(P>0.05).IPL,GCIPL and OPL were significantly different in para-fovea and perifovea(P<0.05).Pearson correlation analysis showed that IPL and GCIPL were significantly negatively correlated with age and diabetic course(P<0.05),OPL was positively correlated with age and diabetic course(P<0.05).ROC curve analysis showed that the AUC values of IPL,GCIPL and OPL were 0.805.Conclusion:There are changes in the thickness of retinal inner layer in patients with type 2 diabetes mellitus.The changes of IPL,GCIPL and OPL thickness in the retina can be used as one of the morphological observation index for the early diagnosis of DR.