糖尿病视网膜神经损伤的病变规律及危险因素分析  

Analysis of pathological regularity and related risk factors of retinal nerve injury in patients with diabetes mellitus

作　　者：唐德荣 杨雨雯 石蕊[3] 刘丹丹 林蓉[4] TANG Derong;YANG Yuwen;SHI Rui;LIU Dandan;LIN Rong(Medical College of Ankang Vocational and Technical College(Ankang Central Hospital),Ankang 725000,Shaanxi Province,China;Wenzhou Medical University,Wenzhou 325025,Zhejiang Province,China;Department of Ophthalmology,Shaanxi Provincial People’s Hospital,Xi’an 710068,Shaanxi Province,China;School of Basic Medical Sciences,Xi’an Jiaotong University,Xi’an 710061,Shaanxi Province,China)

机构地区：[1]安康市职业技术学院医学院(安康市中心医院),陕西省安康市725000 [2]温州医科大学,浙江省温州市325035 [3]陕西省人民医院眼科,陕西省西安市710068 [4]西安交通大学基础医学院,陕西省西安市710061

出　　处：《眼科新进展》2023年第12期964-969,共6页Recent Advances in Ophthalmology

基　　金：陕西省自然科学基础研究计划项目(编号:2022JM-571);陕西省人民医院科技发展孵化基金资助项目(编号:2021YJY-20)。

摘　　要：目的通过观察视盘旁视网膜神经纤维层(RNFL)和黄斑区神经节细胞-内丛状层(GC-IPL)厚度变化,在糖尿病视网膜病变(DR)患者中分析糖尿病视网膜神经损伤的病变规律,并探索其相关危险因素。方法选择2017年1月1日至2018年1月1日就诊于陕西省人民医院眼科及内分泌科的2型糖尿病患者164例(164眼)为研究对象,根据伴发DR的情况,将研究对象分为3组:无DR(NDR)组[56例(56眼)]、轻度非增生型糖尿病视网膜病变(NPDR)组[53例(53眼)]和中度NPDR组[55例(55眼)],并以同期体检的健康人群作为对照组[50例(50眼)]。OCT及OCTA测量所有研究对象的视盘旁RNFL和黄斑区GC-IPL,以及黄斑区血流密度(VD),将上述视网膜神经损伤指标进行组间比较及相关性分析。结果与对照组和NDR组相比,轻度NPDR组及中度NPDR患者视盘旁平均、上方及下方RNFL均明显变薄,差异均有统计学意义(均为P<0.05)。各组平均、上方、颞上方、颞下方、下方、鼻下方、鼻上方区域的黄斑区GC-IPL厚度比较,差异均有统计学意义(均为P<0.05);组间两两比较显示,与对照组相比,NDR组、轻度NPDR组及中度NPDR组患者各象限黄斑区GC-IPL厚度均变薄,差异均有统计学意义(均为P<0.05),其中上方GC-IPL变薄最显著;与NDR组相比,轻度NPDR组患者上方、平均及颞上方黄斑区GC-IPL厚度均变薄,差异均有统计学意义(均为P<0.05);与轻度NPDR组相比,中度NPDR组患者上方黄斑区GC-IPL厚度变薄,差异有统计学意义(P<0.05)。各组间黄斑区平均及内环VD比较,差异均有统计学意义(均为P<0.05)。相关性分析结果显示,视盘旁RNFL厚度与黄斑区平均VD呈显著正相关(r=0.517,P<0.01),黄斑区平均GC-IPL厚度与黄斑区平均VD呈弱正相关(r=0.279,P<0.01)。结论视盘旁RNFL厚度可以客观反映视网膜神经元损伤的程度,是糖尿病视网膜神经损伤程度的关键评价指标。Objective To observe the thickness changes in the peripapillary retinal nerve fiber layer(RNFL)and the ganglion cell-inner plexiform layer(GC-IPL)in the macular region,so as to analyze the pathological rules of retinal nerve injury in diabetes retinopathy(DR)patients and explore the related risk factors.Methods A total of 164 patients(164 eyes)with type 2 diabetes who visited the Department of Ophthalmology and Department of Endocrinology of Shaanxi Provincial People’s Hospital from January 1,2017 to January 1,2018 were selected as the subjects.According to the condition of concomitant DR,these subjects were divided into three groups:non-DR(NDR)group(56 eyes of 56 patients),mild non-proliferative DR(NPDR)group(53 eyes of 53 patients)and moderate NPDR group(55 eyes of 55 patients).Healthy individuals who underwent physical examinations in the same period were selected as the control group(50 eyes of 50 patients).Optical coherence tomography and optical coherence tomography angiography were used to measure the peripapillary RNFL,macular GC-IPL,and macular vessel density(VD)of all subjects.Comparison among groups and correlation analysis were conducted on the above retinal nerve injury indicators.Results Compared with the control group and NDR group,the average,upper and lower peripapillary RNFL in the mild NPDR group and moderate NPDR group were significantly thinner,and the differences were statistically significant(all P<0.05).The differences in macular GC-IPL thickness at the average,upper,upper temporal,lower temporal,lower,lower nasal,and upper nasal regions in all groups were statistically significant(all P<0.05);pairwise comparisons showed that compared with the control group,the GC-IPL thickness in each quadrant of the macular area of patients in the NDR group,mild NPDR group and moderate NPDR group decreased significantly(all P<0.05),with the upper GC-IPL thinning being the most significant;compared with the NDR group,the GC-IPL thickness in the upper,average,and upper temporal macular area of patients w

关 键 词：糖尿病视网膜病变 视网膜神经损伤 视网膜神经纤维层 光学相干断层扫描 光学相干断层扫描血管成像 血流密度 

分 类 号：R774.1[医药卫生—眼科]