非增生性糖尿病视网膜病变视乳头旁视网膜神经纤维层改变及与视功能的相关研究  

Correlation of optic retinal nerve fiber layer thickness and visual function in patients with nonproliferative diabetic retinopathy

作　　者：马进[1] 张怡[2] 朱铁培[3] 徐剑 

机构地区：[1]中山大学中山眼科中心,广州510060 [2]浙江省中医院眼科 [3]温州医学院附属眼视光医院杭州院区 [4]宁波市第一人民医院眼科

出　　处：《中华眼科杂志》2013年第6期514-520,共7页Chinese Journal of Ophthalmology

基　　金：卫生部科学研究基金一浙江省医药卫生重大科技计划（WKJ2011-2-006）;浙江省科技厅公益类项目（2011C23090）

摘　　要：目的研究非增生性糖尿病视网膜病变（NPDR）视乳头旁视网膜神经纤维层（RNFL）的厚度变化及结构改变，以及与视功能变化的相关性。方法横断面研究。随机选取2009年12月至2012年10月就诊于浙江省中医院眼科、宁波市第一人民医院眼科和中山大学中山眼科中心的89例（89只眼）NPRD患者（NPDR组）的临床资料，另外选取同期3家医院收治的无视网膜病变的糖尿病患者（NRD）96例（96只眼）（NRD组）和健康人群115例（115只眼）（对照组）。3组患者均随机选取一只眼作为研究对象。所有研究对象年龄均为40～70岁，糖尿病患者病史均≥5年。研究对象均行视乳头旁RNFL厚度的频域相干光断层扫描测定，视功能检测包括多空间频率的对比敏感度（1．5、3．0、6．0、12．0、18．0e／d）、图形视网膜电图（PERG）检查和最佳矫正视力（BCVA）测定。对比分析3组视乳头旁各象限（鼻侧、颞侧、上方、下方）RNFL检测结果的差异；应用单因素线性相关分析NPDR组和NRD组视乳头旁各象限RNFL厚度测量与其BCVA、对比敏感度、PERG的P50波振幅和潜伏期等视功能结果的相关性。结果3组视乳头旁各象限（总平均、鼻侧、颞侧、上方、下方）RNFL厚度依次为：NPDR组：（97．7±13．0）、（71．7±10．3）、（70．9±13．3）、（118．3±19．7）、（123．1±20．8）¨”；NRD组：（98．6±15．3）、（74．8±13．1）、（71．8±14．6）、（119．5±17．2）、（125．6±19．9）斗m；对照组：（99．1±11．8）、（77．4±12．6）、（72．6±13．2）、（119．1±18．1）、（127．1±19．3）斗m。3组视乳头鼻侧象限RNFL厚度的差异有统计学意义（F=8．56，P=0．000），其中NPDR组与对照组、NRD组与对照组，以及NPDR组与NRD组间的差异均有统计学意义（SNK—q检验：q=3．16、3．11、3．07，P值均〈0．05）；3组视乳头下方RNFL厚度的�Objectives To investigate the change of optic retinal nerve fiber layer (RNFL) thickness in nonproliferative diabetic retinopathy (NPDR) and to evaluate the correlation between the optic RNFL structural change and visual function.Methods A cross-sectional study.All cases came from ophthalmology department of Zhejiang Province Traditional Chinese Medical Hospital,and the First People's Hospital of Ningbo,and Zhongshan Ophthalmic Center,Sun Yat-Sen University from December 2009 to October 2012.All the disease and control cases were coming from the same hospitals at the same period.Subjects were divided into 3 different groups:patients with NPDR (n =89,89 eyes),patients with diabetic mellitus but without diabetic retinopathy (NRD) (n =96,96 eyes) and disease-free controls (n =115,115 eyes).One eye of each subject was randomly selected for study.Participants aged from 40 to 70 years at baseline and all diabetic patients had a diabetic history of at least 5 years.Optic RNFL thickness of each subject was measured by spectral domain optical coherence tomography (SD-OCT).Visual function examinations including contrast sensitivity test in spatial frequencies of 1.5,3.0,6.0,12.0,18.0 cycles per degree (c/d),pattern electroretinograms (PERG) and best corrected visual acuity (BCVA) assay.The analysis of RNFL thickness in each group was performed at four preset locations of the optic disc (i.e.,temporally,superiorly,nasally,and inferiorly).To assess the structure-function relationship,the BCVA,contrast sensitivity,PERG-P50 amplitude and latency to optic RNFL thickness at each quadrant were analyzed in both NPDR and NRD groups.Results The RNFL thickness at four preset locations of the optic disc (meanly,nasally,temporally,superiorly,and inferiorly) were (97.7 ± 13.0),(71.7 ± 10.3),(70.9 ± 13.3),(118.3±19.7),and (123.1 ±20.8)μm in the NPDR group;(98.6 ±15.3),(74.8±13.1),(71.8±14.6),(119.5 ±17.2),and (125.6 ± 19.9) μm in the NRD group;and (99.1 ±11.8),(77.4±12.6),(72.6 ± 13.2),(119.1 ± 18.1),and (127.1 ± 19.3) �

关 键 词：糖尿病视网膜病变 视盘 视网膜 神经纤维 对比敏感度 

分 类 号：R77[医药卫生—眼科] R587[医药卫生—临床医学]