Dehghani Cirous, Srinivasan Sangeetha, Edwards Katie, Pritchard Nicola, Russell Anthony W, Malik Rayaz A, Efron Nathan
Institute of Health & Biomedical Innovation, and School of Optometry and Vision Science, Queensland University of Technology, Australia.
Commonwealth Scientific and Industrial Research Organisation (CSIRO), Parkville, Victoria, Australia.
Invest Ophthalmol Vis Sci. 2017 May 1;58(6):BIO234-BIO239. doi: 10.1167/iovs.17-21801.
Reduced retinal nerve fiber layer (RNFL) thickness has been demonstrated in patients with diabetic peripheral neuropathy (DPN) in cross-sectional studies. This prospective study defines longitudinal alterations to the RNFL thickness in individuals with type 1 diabetes without (DPN-ve) and with (DPN+ve) DPN and in relation to risk factors for nerve damage.
A cohort of 105 individuals with type 1 diabetes (20% DPN+ve) with predominantly mild or no retinopathy and no previous retinal photocoagulation underwent spectral-domain optical coherence tomography (SD-OCT) at baseline, 2 years, and 4 years. SD-OCT scans were acquired at 3.45-mm diameter around the optic nerve head and the overall RNFL and RNFL in the nasal, superior, temporal, and inferior quadrants were quantified. By including serial quantified RNFL parameters, linear mixed models were applied to assess the change in RNFL thickness over time and to explore the associations with other clinical variables.
There was a significant decline in the overall RNFL thickness (-0.7 μm/y, P = 0.02) and RNFL in the superior quadrant (-1.9 μm/y, P < 0.01) in the DPN+ve group compared with DPN-ve group. The overall RNFL thickness and RNFL in the superior and nasal quadrants were inversely associated with age (β = -0.29, -0.41, and -0.29, respectively; P ≤ 0.02). Sex, retinopathy, diabetes duration, hemoglobin A1c, lipid profile, blood pressure, cigarette use, alcohol consumption, and body mass index did not show any significant effects (P > 0.05).
Individuals with DPN showed a progressive RNFL thinning overall and in the superior quadrant, which was more pronounced in older individuals. There may be common pathways for retinal and peripheral neurodegeneration that are independent of conventional DPN risk factors.
在横断面研究中已证实糖尿病周围神经病变（DPN）患者的视网膜神经纤维层（RNFL）厚度降低。这项前瞻性研究确定了1型糖尿病无DPN（DPN阴性）和有DPN（DPN阳性）个体的RNFL厚度的纵向变化及其与神经损伤危险因素的关系。
105名1型糖尿病患者（20%为DPN阳性）组成的队列，主要为轻度或无视网膜病变且既往未接受过视网膜光凝治疗，在基线、2年和4年时接受了光谱域光学相干断层扫描（SD-OCT）。在视神经乳头周围直径3.45毫米处进行SD-OCT扫描，并对视神经乳头周围整体RNFL以及鼻侧、上方、颞侧和下方象限的RNFL进行量化。通过纳入连续量化的RNFL参数，应用线性混合模型评估RNFL厚度随时间的变化，并探讨其与其他临床变量的关联。
与DPN阴性组相比，DPN阳性组的整体RNFL厚度（-0.7μm/年，P = 0.02）和上方象限的RNFL（-1.9μm/年，P < 0.01）显著下降。整体RNFL厚度以及上方和鼻侧象限的RNFL与年龄呈负相关（β分别为-0.29、-0.41和-0.29；P≤0.02）。性别、视网膜病变、糖尿病病程、糖化血红蛋白、血脂谱、血压、吸烟、饮酒和体重指数均未显示出任何显著影响（P > 0.05）。
DPN患者的RNFL整体和上方象限呈现进行性变薄，在老年人中更为明显。视网膜和周围神经退变可能存在独立于传统DPN危险因素的共同途径。
