Choi Jin A, Kim Hyo Won, Kwon Jin-Woo, Shim Yun-Sub, Jee Dong Hyun, Yun Jae-Seung, Ahn Yu-Bae, Park Chan Kee, Ko Seung-Hyun
Department of Ophthalmology and Visual Science St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
PLoS One. 2017 Mar 23;12(3):e0174377. doi: 10.1371/journal.pone.0174377. eCollection 2017.
To investigate changes in the neural retina according to the presence of retinal nerve fiber layer (RNFL) defects in type 2 diabetes, and to determine the association between inner retina thickness and the severity of diabetic complications.
We studied non-glaucomatous patients with type 2 diabetes and control subjects Circumpapillary RNFL and macula ganglion cell-inner plexiform layer (GCIPL) thicknesses were measured by spectral-domain optical coherence tomography. In patients with type 2 diabetes, a cardiovascular autonomic function test (AFT) was performed, which included the heart rate parameter of beat-beat variation-with deep breathing, in response to the Valsalva maneuver, and on postural change from lying to standing. The results of each test were scored as 0 for normal and 1 for abnormal. A total AFT score of 1 was defined as early cardiovascular autonomic neuropathy (CAN), and an AFT score≥ 2 as definite CAN.
We compared control eyes (n = 70), diabetic eyes with RNFL defects (n = 47), and eyes without RNFL defects (n = 30). The average RNFL and GCIPL thicknesses were significantly different among groups (all, P<0.05). On post-hoc testing, diabetic eyes with RNFL defects had a significantly thinner average GCIPL thickness than those without RNFL defects. On multivariate analyses, significantly thinner average GCIPL was seen in early CAN staging (B = -4.32, P = 0.016) and in definite CAN staging (B = -10.33, P<0.001), compared with no CAN involvement, after adjusting for confounding parameters.
Cardiovascular autonomic dysfunction was associated with early neurodegenerative changes in type 2 diabetes.
研究2型糖尿病患者视网膜神经纤维层（RNFL）缺损情况下神经视网膜的变化，并确定视网膜内层厚度与糖尿病并发症严重程度之间的关联。
我们研究了非青光眼的2型糖尿病患者和对照受试者。通过光谱域光学相干断层扫描测量视乳头周围RNFL和黄斑神经节细胞-内丛状层（GCIPL）的厚度。对2型糖尿病患者进行心血管自主神经功能测试（AFT），包括深呼吸时逐搏心率变异性、瓦尔萨尔瓦动作以及从卧位到站立位姿势改变时的心率参数。每项测试结果正常记为0分，异常记为1分。AFT总分1分定义为早期心血管自主神经病变（CAN），AFT评分≥2分定义为确诊CAN。
我们比较了对照眼（n = 70）、有RNFL缺损的糖尿病眼（n = 47）和无RNFL缺损的眼（n = 30）。各组间RNFL和GCIPL的平均厚度有显著差异（均P<0.05）。事后检验显示，有RNFL缺损的糖尿病眼GCIPL平均厚度显著低于无RNFL缺损的糖尿病眼。多变量分析显示，在调整混杂参数后，与无CAN累及相比，早期CAN分期（B = -4.32，P = 0.016）和确诊CAN分期（B = -10.33，P<0.001）的GCIPL平均厚度明显更薄。
心血管自主神经功能障碍与2型糖尿病早期神经退行性改变有关。
