无视网膜病变的糖尿病患者视网膜神经与血管损害及其相关性分析  

Early retinal neurovascular impairment in diabetic patients without clinically detectable retinopathy and the correlation analysis

作　　者：胡云燕[1] 曾运考 曹丹[1] 余洪华 庄雪楠 李娟[1] 杨静 吴乔伟 刘宝怡 张良[1] HU Yunyan;ZENG Yunkao;CAO Dan;YU Honghua;ZHUANG Xuenan;LI Juan;YANG Jing;WU Qiaowei;LIU Baoyi;ZHANG Liang(Department of Ophthalmology,Guangdong Provincial People’s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,Guangdong Province,China;Shantou University Medical College,Shantou 515000,Guangdong Province,China;Southern Medical University,Guangzhou 510080,Guangdong Province,China)

机构地区：[1]广东省人民医院眼科,广东省医学科学院,广东省广州市510080 [2]汕头大学医学院,广东省汕头市515000 [3]南方医科大学,广东省广州市510080

出　　处：《眼科新进展》2020年第10期957-962,共6页Recent Advances in Ophthalmology

基　　金：广东省医学科学技术研究基金(编号:B2018096);广州科技计划项目(编号:201607010343)。

摘　　要：目的探究无糖尿病视网膜病变(NDR)的糖尿病患者视网膜神经与血管损害,并分析其相关性。方法纳入无视网膜病变的2型糖尿病患者66眼为NDR组,健康者62眼为对照组。使用免散瞳、全视野闪光ERG记录仪(RETeval)记录16 Td·s(6.0 mm瞳孔直径时,1 cd·s·m-2=28.3 Td·s)和32 Td·s光刺激时两组的潜伏期及振幅。采用光学相干断层扫描血管成像(OCTA)检测黄斑区浅层毛细血管丛(SCP)、深层毛细血管丛(DCP)的血管密度及黄斑中心凹无血管区周围300μm的毛细血管密度(FD300)、神经节细胞复合体(GCC)层厚度、视网膜神经纤维层(RNFL)厚度。分析NDR组患眼视网膜结构与功能的改变,并分析其与糖尿病病程和糖化血红蛋白(HbAlc)水平的相关性。结果NDR组在旁中心凹区和中心凹周围区的SCP的血管密度分别为(49.97±4.45)%、(48.12±4.01)%,均低于对照组的(52.47±4.31)%(P=0.002)、(50.42±3.73)%(P=0.001);NDR组在旁中心凹区和中心凹周围区的DCP的血管密度分别为(52.70±4.51)%、(48.62±6.39)%,均低于对照组的(55.99±4.09)%(P<0.001)、(52.71±6.56)%(P=0.001)。但两组间GCC层厚度无明显差异(P=0.661)。NDR组RNFL厚度为(109.85±11.50)μm,较对照组(115.06±10.61)μm显著降低(P=0.009);NDR组视盘周围血管密度为(50.27±4.10)%,较对照组(52.48±2.73)%显著降低(P<0.001)。ERG检测结果显示,在16 Td·s和32 Td·s光刺激时与对照组相比,NDR组潜伏期均延长和振幅均下降(均为P<0.01)。多元线性回归分析结果显示,16 Td·s和32 Td·s光刺激ERG的潜伏期延长均与HbAlc升高显著相关(β=0.350,P<0.001;β=0.328,P<0.001),与旁中心凹区SCP血管密度下降也显著相关(β=-0.266,P=0.013;β=-0.253,P=0.005),而与GCC层厚度均不相关(均为P>0.05)。结论在出现临床可见的视网膜病变之前,糖尿病患者的视网膜就已经开始出现结构和功能的损伤。NDR患者早期视功能改变可能与微血管异常有关,ERG潜伏期延长与血糖控制�Objective To investigate the retinal neurovascular impairment in diabetic patients without clinically detectable retinopathy and the correlation analysis.Methods Sixty-six eyes with type 2 diabetes without retinopathy(NDR)and 62 healthy controls(62 eyes)were recruited.The incubation period and amplitude of the two groups were recorded using a non-mydriatic,full-field flash ERG recorder(RETEval)during 16 Td·s(At 6.0 mm pupil diameter,1 cd·s·m-2=28.3 Td·s)and 32 Td·s light stimulation.Optical coherence tomography angiography(OCTA)was used to detect the vascular volume of the superficial capillary plexus(SCP)and deep capillary plexus(DCP)in the macular area,and the vessel density of 300μm around the avascular area of the fovea(FD300),ganglion cell complex(GCC)thickness,retinal nerve fiber layer(RNFL)thickness.The changes in the structure and function of the retina in the NDR group,and its correlation with the course of diabetes and the level of glycosylated hemoglobin(HbAlc)were analyzed.Results The parafoveal and perifoveal vessel density in SCP in NDR group were(49.97±4.45)%,(48.12±4.01)%,respectively,which were both lower than those of the control group[(52.47±4.31)%,P=0.002 and(50.42±3.73)%,P=0.001].The parafoveal and perifoveal vessel density of DCP in the NDR group were(52.70±4.51)%and(48.62±6.39)%,respectively,which were lower than those of the control group[(55.99±4.09)%,P<0.001;(52.71±6.56)%,P=0.001)].However,there was no significant difference in the thickness of the GCC layer between the two groups(P=0.661).The thickness of RNFL in the NDR group was(109.85±11.50)μm,which was significantly lower than that of the control group[(115.06±10.61)μm,P=0.009].The density of blood vessels around the optic disc in the NDR group was(50.27±4.10)%,which was significantly lower than that of the control group[(52.48±2.73)%,P<0.001].With regard to ERG parameters,delayed implicit time and decreased amplitude for both 16 Td·s and 32 Td·s stimuli were found in NDR group in comparison to the control grou

关 键 词：糖尿病视网膜病变临床前期 光学相干断层扫描血管成像 ERG 糖化血红蛋白 血管密度 神经节细胞复合体 视网膜神经纤维层 

分 类 号：R774[医药卫生—眼科]