光学相干断层扫描对2型糖尿病患者视网膜神经变性的早期评估价值

The Value of Optical Coherence Tomography in Early Evaluation of Retinal Neurodegeneration in Patients with Diabetes Mellitus Type 2

目的采用光学相干断层扫描(OCT)检测无糖尿病性视网膜病变(DR)的2型糖尿病(T2DM)患者在糖尿病视网膜神经变性(DRN)早期的视网膜神经厚度变化。方法采用横断面研究,选取2022年1—10月医院收治的32例无DR的T2DM患者(共32眼)作为试验组,以年龄、性别匹配的32名健康者(32眼)作为对照组。将黄斑区分为9个区域(中央区、上方内环区、颞侧内环区、下方内环区、鼻侧内环区、上方外环区、颞侧外环区、下方外环区和鼻侧外环区),采用OCT检测以上区域的黄斑视网膜神经纤维层(mRNFL)、神经节细胞层(GCL)、内丛状层(IPL)、视网膜厚度,并进行比较;将视盘分为4个区域(上方、下方、鼻侧、颞侧),采用OCT检测视盘视网膜神经纤维层(pRNFL)厚度,以及全周pRNFL平均厚度,并对两组各指标比较。结果黄斑区9个区域中,试验组下方外环区、鼻侧外环区mRNFL厚度低于对照组,中央区、上方内环区、颞侧内环区、下方内环区、鼻侧内环区的GCL厚度低于对照组,上方内环区、颞侧内环区、下方内环区、鼻侧内环区的IPL厚度低于对照组,差异均有统计学意义(P<0.05);两组黄斑区9个区域的视网膜厚度比较,差异均无统计学意义(P>0.05)。视盘4个区域中,试验组视盘上方、下方、鼻侧的pRNFL厚度均低于对照组,差异有统计学意义(P<0.05);两组颞侧pRNFL厚度及全周pRNFL平均厚度比较,差异均无统计学意义(P>0.05)。结论DRN早期患者存在mRNFL、GCL、IPL、pRNFL区域性变薄现象,说明在出现临床血管变化之前已经发生DRN,GCL、IPL内环对DRN的预测价值最高。

Objective Optical coherence tomography(OCT)was used to detect the changes of retinal nerve thickness in the early stage of diabetes with retinal neurodegeneration(DRN)in diabetes mellitus type 2(T2DM)patients without diabetes retinopathy(DR).Methods By a cross-sectional study design,32 non-DR patients with T2DM(32 eyes)admitted to the hospital from January to October 2022 were selected as the experimental group,and 32 healthy individuals(32 eyes)matched by age and gender were selected as the control group.With the macular area divided into 9 areas(central area,upper inner ring area,temporal inner ring area,lower inner ring area,nasal inner ring area,upper outer ring area,temporal outer ring area,lower outer ring area,and nasal outer ring area),OCT was used to detect the macular retinal nerve fiber layer(mRNFL),ganglion cell layer(GCL),inner plexiform layer(IPL)and retinal thickness in the above areas were compared;Optic disc was divided into four regions(upper part,lower part,nasal part and temporal part),the thickness of retinal nerve fiber layer(pRNFL)and the average thickness of pRNFL around the optic disc were measured by OCT and they were compared.Results Among the 9 areas in the macular area,the thickness of mRNFL in the lower outer ring area and nasal outer ring area of the experimental group was lower than that of the control group,the thickness of GCL in the central area,upper inner ring area,temporal inner ring area,lower inner ring area,and nasal inner ring area was lower than that in the control group,and the thickness of IPL in the upper inner ring area,temporal inner ring area,lower inner ring area,and nasal inner ring area was lower than that in the control group,with statistically significant differences(P<0.05);There was no statistically significant difference in retinal thickness between the two groups of 9 regions(P>0.05).In the four regions of the optic disc,the pRNFL thickness of the upper,lower and nasal side of the optic disc in the experimental group was lower than that in the control group,with statistically significant differences(P<0.05).There was no statistically significant difference(P>0.05)between two groups in terms of temporal pRNFL thickness and around average pRNFL thickness.Conclusions Early DRN patients have regional thinning of mRNFL,GCL,IPL,and pRNFL,indicating that DRN has already occurred before clinical vascular changes occur.The predictive value of GCL and IPL inner rings for DRN is the highest.