近视与糖尿病人群黄斑区节细胞-内丛状层厚度纵向变化的关联研究

Association of myopia with the macular ganglion cell layer and inner plexiform layer in diabetic patients: A longitudinal study

目的:探讨无糖尿病性视网膜病变(diabetic retinopathy,DR)的糖尿病人群中,糖尿病与近视对黄斑区节细胞-内丛状层(ganglion cell layer and inner plexiform layer,GCIPL)厚度纵向变化的影响。方法:纳入广州糖尿病眼病研究中1165名基线无视网膜病变的糖尿病和正常对照者,纵向随访2年。根据是否存在近视[等效球镜(spherical equival ent,SE)≤-3屈光度(diopter,D)]和糖尿病分为健康组(n=508)、糖尿病组(n=525)及糖尿病合并近视组(n=132)。扫频光学相干断层成像(sweptsource-opticalcoherencetomography,SS-OCT)技术测量并比较三组间GCIPL厚度的变化,以确定糖尿病和近视的影响,三组间差异使用协方差分析,采用线性混合模型分析评估GCIPL厚度与相关因素的关系。结果:对照组的SE为(1.07±1.06)D,糖尿病组为(1.02±1.00)D,糖尿病合并近视组为(-5.36±2.30)D,组间差异有统计学意义(P<0.001)。对照组基线GCIPL厚度为(71.1±0.3)μm,糖尿病组为(74.4±0.2)μm,糖尿病合并近视组为(71.7±0.5)μm。在2年随访过程中,对照组GCIPL厚度下降-0.10(95%CI:-2.03~0.05)μm/年,糖尿病组GCIPL厚度下降的速度为对照组的12倍[-1.21(95%CI:-24.04~0.05)μm/年,P<0.001],糖尿病合并近视组GCIPL厚度下降的速度为对照组的22倍[-2.17(95%CI:-21.63~0.10)μm/年,P<0.001]。结论:近视是无DR的糖尿病患者中GCIPL加速变薄的危险因素,糖尿病和近视在GCIPL损伤中可能存在协同作用。

Objective:To investigate the association between myopia and ganglion cell layer and inner plexiform layer(GCIPL) in diabetic population without diabetic retinopathy(DR).Methods:In this Guangzhou Diabetic Eye study,a total of 1 165 patients aged 30-80 years were recruited followed up longitudinally for 2 years.According to the presence or absence of myopia [spherical equivalence(SE)≤-3 diopter(D)] and diabetics,the patients were divided into a healthy group(n=508),a diabetes mellitus group(n=525),and a diabetes mellitus+myopia group(n=132).GCIPL was measured via swept-source optical coherence tomography.Univariable and multivariable mixed models were used to show the association of GCIPL change and baseline parameters.Results:SE was(1.07±1.06) D in the healthy group,(1.02±1.00) D in the diabetes mellitus group and(-5.36±2.30) D in the diabetes mellitus+myopia group(P<0.001).The baseline GCIPL thickness were(71.1 ±0.3),(74.4±0.2),and(71.7±0.5) μm,respectively.The slope of GCIPL thickness was-0.10(95% CI:-2.03 to 0.05) μm/year in the healthy group,which was 12 folds faster than those in the diabetes mellitus group [-1.21(95% CI:-24.04 to 0.05 μm/year,P<0.001)] and 22 folds higher among those in diabetes mellitus+myopia group [-2.17(95% CI:-21.63 to 0.10) μm/year,P=0.009].Conclusion:Both myopia and diabetes status accelerate macular ganglion cell layer and inner plexiform layer thinning in diabetic patients without diabetic retinopathy.