Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Sci Rep. 2018 Jul 12;8(1):10510. doi: 10.1038/s41598-018-28985-8.
Retinal nerve fiber layer (RNFL) loss in diabetic patients is especially common regardless of diabetic retinopathy (DR). The correlations between nonglaucomatous RNFL loss and systemic characteristics in diabetic patients have aroused interests in many aspects. 167 subjects with type 2 diabetes who underwent evaluation for arterial stiffness and cardiovascular autonomic function using heart rate variability (HRV) were included in this study. Arterial stiffness was measured using cardio-ankle vascular index (CAVI) and ankle-brachial index (ABI). Multivariate regression analysis was performed to determine factors influencing the presence of RNFL loss according to age. Factors determining the superior location of diabetic RNFL loss were also investigated. CAVI were worse in patients with RNFL loss, especially in those with old age (≥50 yrs) (p = 0.037). Influential factor of RNFL defect in old group was ABI (p = 0.007). However, in young group (<50 yrs), HRV parameter (low-frequency/high-frequency ratio) determined the presence of RNFL loss (p = 0.040). Significant determinants of superior RNFL defect in old subjects were CAVI and ABI (p = 0.032 and p = 0.024). For young diabetic patients, autonomic dysfunction may have relationship with RNFL loss, but as patients get older, arterial stiffness could aggravate vascular autoregulation and diabetic RNFL loss. RNFL loss in diabetes may be correlated with systemic vascular conditions.
糖尿病患者的视网膜神经纤维层（RNFL）损失尤其常见，无论是否患有糖尿病视网膜病变（DR）。非青光眼性 RNFL 损失与糖尿病患者的全身特征之间的相关性引起了许多方面的兴趣。本研究纳入了 167 例 2 型糖尿病患者，他们接受了心率变异性（HRV）评估，以评估动脉僵硬度和心血管自主神经功能。使用心血管踝血管指数（CAVI）和踝臂指数（ABI）测量动脉僵硬度。进行多变量回归分析，根据年龄确定影响 RNFL 损失存在的因素。还研究了确定糖尿病性 RNFL 损失优势部位的因素。RNFL 损失患者的 CAVI 更差，尤其是年龄较大（≥50 岁）的患者（p=0.037）。老年组（≥50 岁）RNFL 缺损的影响因素是 ABI（p=0.007）。然而，在年轻组（<50 岁）中，HRV 参数（低频/高频比）决定了 RNFL 损失的存在（p=0.040）。老年患者中 RNFL 缺陷的显著决定因素是 CAVI 和 ABI（p=0.032 和 p=0.024）。对于年轻的糖尿病患者，自主神经功能障碍可能与 RNFL 损失有关，但随着患者年龄的增长，动脉僵硬度可能会加重血管自动调节和糖尿病性 RNFL 损失。糖尿病中的 RNFL 损失可能与全身血管状况有关。
