OCT前房角形态学结合PLR比值对糖尿病视网膜病变的诊断价值

The Diagnostic Value of OCT Anterior Chamber Angle Morphology Combined With PLR Ratio for Diabetic Retinopathy

目的 研究光学相干断层扫描(OCT)前房角形态学结合血小板/淋巴细胞比值(PLR)对糖尿病视网膜病变的诊断价值。方法 选取2021年1月至2022年1月于河南省商丘市眼科医院就诊的糖尿病视网膜病变(DR)患者124例作为DR组、2型糖尿病(T2DM)患者80例作为T2DM组,所有研究对象均行OCT检查,测定前房角形态学参数及PLR比值。对比T2DM组、DR组一般资料及前房角形态学参数、PLR比值,分析影响DR发生的因素。将DR组患者分为非增生型糖尿病视网膜病变(NPDR)组、增生型糖尿病视网膜病变(PDR)组两个亚组,分析前房角形态学参数、PLR比值在两组中的表达差异。采用ROC曲线分析OCT前房角形态学结合PLR比值对糖尿病视网膜病变的诊断价值。结果 (1)T2DM组与DR组一般资料对比,差异无统计学意义(P> 0.05)。DR组病程、BMI、餐后2 h血糖(2hPG)、总胆固醇(TC)、低密度脂蛋白(LDL)血清肌酐(SCr)、血清尿素氮(SUN)、收缩压(SBP)、舒张压(DBP)均高于T2DM组,差异具有统计学意义(P <0.05)。DR组胰岛素、空腹C肽、2 h-C肽均、前房角形态学指标、PLR比值均低于T2DM组,差异具有统计学意义(P <0.05)。(2)将上述差异具有统计学意义的变量作为自变量,以DR发生为因变量(未发生=0,发生=1),行Logistic回归分析发现,病程、2hPG、空腹C肽、2 h-C肽、前房角形态学指标及PLR比值均为DR发生的影响因素,差异有统计学意义(P <0.05)。(3)前房角形态学指标、PLR比值与DR组患者疾病分期有关,PDR组前房角形态学指标均低于NPDR组,PLR比值高于NPDR组,差异具有统计学意义(P <0.05)。(4)经ROC曲线分析,前房角形态学指标结合PLR比值诊断DR的价值显示,相比于单个指标预测,前房角形态学指标结合PLR比值诊断价值最高,差异有统计学意义(AUC=0.912,P <0.001)。结论 OCT可反映出DR前房角形态学变化,前房角形态学参数降低,PLR比值升高,且均与疾病分期有关,前房角形态学参数结合PLR比值对DR的诊断价值较高,可用于此病的诊断。

Objective To study the value of optical coherence tomography(OCT) anterior chamber angle morphology combined with platelet/Lymphocyte ratio(PLR) in the diagnosis of diabetic retinopathy. Methods A total of 124 DR patients who were treated in our hospital from January 2021 to January 2022 were selected as the DR group and 80 T2DM patients were selected as the T2DM group. All study subjects underwent OCT to determine the morphological parameters of the anterior chamber angle and the PLR ratio. The general data, morphological parameters of the anterior chamber angle, and PLR ratio were compared between the T2DM group and the DR group, and the factors affecting the occurrence of DR were analyzed. Patients in the DR group were divided into two subgroups: the nonproliferative diabetic retinopathy(NPDR) group and the hyperproliferative diabetic retinopathy(PDR) group, the expression differences of anterior chamber angle morphological parameters and PLR ratio between NPDR group and PDR group were analyzed. The ROC curve was used to analyze the diagnostic value of OCT anterior chamber angle morphology combined with PLR ratio in the diagnosis of diabetic retinopathy. Results(1) The difference between the general information of the T2DM group and the DR group was not statistically significant(P > 0.05). Disease duration,BMI, 2hPG, TC, LDL, SCr, SUN, SBP and DBP in the DR group were higher than those in the T2DM group, and the differences were significant(P < 0.05). Insulin, fasting C-peptide, 2h-C-peptide, morphological indicators of the anterior chamber angle and the PLR ratio in the DR group were all lower than those in the T2DM group, with statistically significant differences(P <0.05).(2)Using the above variables with statistically significant differences as independent variables and DR occurrence as the dependent variable(not occurring = 0, occurring = 1), logistic regression analysis revealed that duration of illness, 2hPG,fasting C-peptide, 2h-C-peptide, morphological indicators of the anterior atrial horn and PLR ratio were all factors influencing DR occurrence, with statistically significant differences(P < 0.05).(3) The morphological indicators of the anterior atrial horn and the PLR ratio were related to the disease stage of the patients in the DR group. The morphological indicators of the anterior atrial horn in the PDR group were lower than those in the NPDR group, and the PLR ratio was higher than that in the NPDR group, and the differences were statistically significant(P < 0.05).(4)According to ROC curve analysis, the value of anterior chamber morphology indicators combined with PLR ratio to diagnose DR showed that compared with the single index prediction,the anterior chamber angle morphological index combined with PLR ratio has the highest diagnostic value, and the difference was statistically significant(AUC = 0.912, P < 0.001). Conclusion OCT can reflect the morphological changes of the anterior chamber angle in DR. The morphological parameters of the anterior chamber angle decrease and the PLR ratio increases, which are all related to the stage of the disease. The morphological parameters of the anterior chamber angle combined with the PLR ratio have higher diagnostic value for DR diagnosis, it can be used for the diagnosis of this disease.