糖尿病患者黄斑神经节细胞复合体、视盘周围视网膜神经纤维层厚度水平与视网膜病变的相关性分析

Correlation between thickness of macular ganglion cell complex,thickness of retinal nerve fiber layer around optic disc and retinopathy in patients with diabetes mellitus

目的分析糖尿病(diabetes mellitus,DM)患者黄斑神经节细胞复合体(ganglion cell complex,GCC)、视盘周围视网膜神经纤维层(retinal nerve fiber layer,RNFL)的厚度水平与视网膜病变(diabetic retinopathy,DR)的关系。方法选择2020年2月至2022年3月首都医科大学宣武医院收治的DM患者110例145眼作为研究对象,按照是否发生DR分为DR组(51例,69眼)和非DR组(59例,76眼),依据DR不同严重程度分期将DR组分为非增殖性DR组(NPDR组,38例,47眼)和增殖性DR组(PDR组,13例,22眼)。两组患者均进行光学相干断层扫描血管成像技术(optical coherence tomography angiography,OCTA)检查,比较不同分组DM患者黄斑部GCC和视盘周围RNFL厚度变化及与DR分期的关系。结果DR组GCC总体厚度(total GCC thickness,tGCC)、GCC上方厚度(superior GCC thickness,sGCC)和GCC下方厚度(inferior GCC thickness,iGCC)均低于非DR组(P<0.05);PDR组tGCC、sGCC和iGCC均低于轻中度NPDR组(mNPDR)和重度NPDR组(sNPDR),且sNPDR组tGCC、sGCC和iGCC均低于mNPDR(P<0.05);NPDR组视盘周围RNFL上方和下方以及平均厚度均低于非DR组和PDR组(P<0.05),PDR组视盘周围RNFL各部位厚度均高于非DR组和NPDR组(P<0.05);sNPDR组视盘周围上方、下方、颞侧、鼻侧及平均厚度均低于mNPDR组(P<0.05),PDR轻中度组和重度组视盘周围各部位RNFL厚度均高于mNPDR组和sNPDR组,且PDR重度组各部位RNFL厚度均高于轻中度组(P<0.05);Spearman相关性分析结果显示,DR患者黄斑tGCC、sGCC和iGCC厚度与DR严重程度呈负相关(r分别为-0.485、-0.496、-0.501,P<0.05),DR患者视盘周围各部位RNFL厚度与NPDR分期呈负相关(r分别为-0.519、-0.527、-0.498、-0.507、-0.511,P<0.05),与PDR严重程度呈正相关(r分别为0.531、0.514、0.501、0.512、0.499,P<0.05)。结论DR患者早期已经出现视网膜神经的损伤,黄斑GCC厚度随着DR进展明显下降;NPDR患者视盘周围RNFL厚度呈现下降趋势,随着DR进展至PDR,视盘周围RNFL厚度有所增加,黄斑GCC和视盘周围RNFL厚度的动态变化能够为糖尿病患者视网膜神经结构的损伤和DR的进展提供依据。

Objective To analyze the relationship between thicknesses of macular ganglion cell complex(GCC)and retinal nerve fiber layer(RNFL)around optic disc and diabetic retinopathy(DR)in patients with diabetes mellitus(DM).Method 110 patients with DM(145 eyes)who were treated in the Xuanwu Hospital from February 2020 to March 2022 were selected as the research subjects,and were divided into DR group(n=51,69 eyes)and non-DR group(n=59,76 eyes)according to whether DR occurred or not.The patients in DR group were classified into non-proliferative DR group(NPDR group,n=38,47 eyes)and proliferative DR group(PDR group,n=13,22 eyes)by means of different severity stages of DR.Optical coherence tomography angiography(OCTA)was performed on all patients,and the thickness changes in macular GCC and RNFL around optic disc in patients with DM in different groups and their relationship with DR staging were compared.Result The total GCC thickness(tGCC),superior GCC thickness(sGCC)and inferior GCC thickness(iGCC)in DR group were lower than those in non-DR group(P<0.05).The tGCC,sGCC and iGCC were lower in PDR group than those in mild-to-moderate NPDR group(mNPDR)and severe NPDR group(sNPDR),and were all lower in sNPDR group than those in mNPDR(P<0.05).The superior,inferior and average thicknesses of RNFL around the optic disc in NPDR group were thinner than those in non-DR group and PDR group(P<0.05),and the thickness of each part of RNFL around the optic disc was thicker in PDR group than that in non-DR group and NPDR group(P<0.05).The superior,inferior,temporal,nasal and average thicknesses around the optic disc in sNPDR group were thinner than those in mNPDR group(P<0.05),and the thicknesses of RNFL in different parts around the optic disc in mild-to-moderate and severe PDR groups were thicker than those in mNPDR group and sNPDR group,and the RNFL thicknesses in different parts were thicker in severe PDR group than mild-to-moderate PDR group(P<0.05).Spearman correlation analysis showed that thicknesses of macular tGCC,sGCC and iGCC in patients with DR were negatively correlated with DR severity(r=-0.485,-0.496,-0.501,P<0.05),RNFL thicknesses around the optic disc in patients with DR were negatively correlated with NPDR staging(r=-0.519,-0.527,-0.498,-0.507,-0.511,P<0.05),and were positively correlated with severity of PDR(r=0.531,0.514,0.501,0.512,0.499,P<0.05).Conclusion The retinal nerve damage had already occurred in DR patients in the early stage,and the macular GCC thickness decreased significantly with the progression of DR.The thickness of RNFL around the optic disc in NPDR patients showed a decreasing trend.As DR progresses to PDR,the thickness of RNFL around the optic disc increases.The dynamic changed of thicknesses of macular GCC and RNFL around optic disc could provide evidence for the damage of retinal nerve structure and the progression of DR in diabetic patients.