2型糖尿病早期和糖耐量受损患者眼黄斑部视网膜厚度分析  

Preliminary analysis of the macular retinal thickness in early stage of type 2 diabetes mellitus and impaired glucose tolerance patients

作　　者：严良[1] 魏丽[1] 贾丽丽[1] 李雯[1] 穆晶[1] 李世玮[1] 魏蓉 Yah Liang Wei Li Jia Lili Li Wen Mu Jing Li Shiwei Wei Rong(Department of Ophthalmology ＆ Endocrinology, Shanghai Jiao Tong University Affiliated Sixth People＇s Hospital, Shanghai 201306, China)

机构地区：[1]上海交通大学附属第六人民医院,上海市201306

出　　处：《中国实用眼科杂志》2017年第7期672-676,共5页Chinese Journal of Practical Ophthalmology

基　　金：上海市浦东新区卫生与计划生育委员会重点学科群建设基金项目（PW-Zxq2014-07）

摘　　要：目的分析2型糖尿病早期和糖耐量受损患者眼黄斑部视网膜厚度变化。方法社区45—70岁糖尿病流行病学调查对象中，在排除一系列全身和眼部异常指标后，对按照WHO标准确定为单纯2型糖尿病（type2 diabetic mellitus，T2DM）、糖耐量受损（impaired glucose tolerance，IGT）和无糖尿病的正常人（normal control，CTR），行眼频域光学相干断层扫描（spectral—domain ocular coherence tomography，SD—OCT）检查，采用6mmETDRS模式扫描并分别测量黄斑部视网膜各层厚度，采用SAS8．2统计学软件行三组间视网膜各层厚度比较。结果与CTR组比较，T2DM组视网膜厚度有变薄趋势，而IGT组有增加趋势。T2DM组内核层（inner nuclear layer，INL）、内层视网膜（inner retinal Layer，IRL）和外层视网膜（outer retinal layer，ORL）变薄较CTR组的差异有统计学意义（P〈0．05）；IGT内层视网膜厚度较CTR组有逐步增厚趋势；与T2DM组比较，IGT组中IPL、RPEL增厚的差异有统计学意义（P〈0．05），而INL、IRL增厚的差异有显著统计学意义（P〈0．01）。结论2型糖尿病早期患者在眼底照相未发现微血管病变时，已有INL层变薄；糖耐量受损可能导致视网膜内层增厚；由2型糖尿病和糖耐量受损所产生的糖代谢紊乱可导致视网膜内层结构改变，这一改变可能先于且不同于微血管病变，提示2型糖尿病早期和糖耐量受损可能导致眼部神经视网膜变性。Objective To analyze the alteration of the macula retinal thickness in early stage of type 2 diabetes mellitus and impaired glucose tolerance patients. Methods An observational cross-sectional study. After excluding a series of systematic and ocular abnormalities, 62 cases of epi- demiology investigative subjects of community residents aged from 45 to 70 were divided into type2 diabetic mellitus （T2DM）, impaired glucose tolerance （IGT）, and normal control （CTR） group, fol- lowed by the WHO DM diagnostic criteria. All the subjects＇ macula were scanned by spectral-do- main ocular coherence tomography （SD-OCT） with the mode of 6mm ETDRS. Data of macular reti- nal thickness were analyzed using SAS statistic software among the groups. Results With compari- son of CTR, macular retinal thickness in T2DM group has the tendency of attenuation; IGT group show thickening. Inner nuclear layer （INL）, inner retinal layer （IRL） and outer retinal layer （ORL） in T2DM group were significantly attenuated than those of CTR group. With comparison of T2DM,IGT group has significant thicker in IPL, RPEL, INL and IRL. Conclusions INL might be attenuat- ed and atrophied during early stage of T2DM patients when no diabetic retinopathy occur; IGT might increase the thickness of the inner retina and cause retinal edema. Structural alteration might be occurred during diabetic early stage and IGT, which might differ from and prior to the microangi- opathy as well, suggesting that early stage of T2DM and IGT might lead to retinal neurodegeneration.

关 键 词：2型糖尿病 糖耐量受损 视网膜内层 内丛状层 内核层 神经变性 

分 类 号：R775.3[医药卫生—眼科]