糖尿病患者黄斑中心凹的亚临床增厚及其与血糖控制的关系：应用扫频源光学相干断层扫描的研究。
Sub-clinical thickening of the fovea in diabetes and its relationship to glycaemic control: a study using swept-source optical coherence tomography.
机构信息
School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
Department of Ophthalmology, Inverclyde Royal Hospital, Greenock, UK.
出版信息
Graefes Arch Clin Exp Ophthalmol. 2021 Mar;259(3):633-641. doi: 10.1007/s00417-020-04914-2. Epub 2020 Sep 8.
BACKGROUND
Accumulation of multiple pockets of fluid at the fovea, as a complication of poor blood glucose control in diabetes, causes impairment of central vision. A new ability to demonstrate a pre-clinical phase of this maculopathy could be valuable, enabling diabetic individuals to be alerted to the need to improve their glycaemic control. This study aimed to use swept-source optical coherence tomography (SS-OCT) to measure foveal thickness and macular volume in diabetic individuals without cystoid macular oedema, and in non-diabetic individuals, and relate these measures to participants' glycaemic control.
METHODS
Centre point thickness (CPT) and total macular volume (TMV) were measured using SS-OCT (DRI OCT Triton™, Topcon, Tokyo, Japan). Participants' glycosylated haemoglobin (HbA) level was also assessed (ANow®+ System, PTS Diagnostics, Indianapolis, IN, USA). The diabetic (n = 27) and non-diabetic (n = 27) groups were matched for age (p = 0.100) and sex (p = 0.414), and HbA level differed between diabetic and non-diabetic groups (p < 0.0005). The diabetic group comprised type 1 (n = 7) and type 2 (n = 20) diabetic individuals who were matched for duration of diabetes (p = 0.617) and whose glycaemic control was similar (p = 0.814).
RESULTS
Diabetic individuals had significantly higher CPT (t(37) = 3.859, p < 0.0005) than non-diabetic individuals. In the diabetic group, multiple linear regression analysis revealed a conspicuous relationship between CPT and HbA level (β = 0.501, t(21) = 3.139, p = 0.005): there was a 19-μm increase in CPT for each 1% increase in HbA level. This relationship was not present in the non-diabetic group (β = - 0.068, t(23) = - 0.373, p = 0.712).
CONCLUSIONS
SS-OCT is the only way to measure macular thickness in vivo. Diabetic individuals en bloc had higher CPT compared with non-diabetic individuals. Moreover, in the diabetic group, HbA level significantly predicted CPT. Our results suggest that, in diabetes, sub-clinical thickening may occur at the fovea before cystoid macular oedema becomes clinically evident. This could provide diabetic individuals with an early warning of disease progression and motivate them to improve control of their diabetes, with a view to avoiding the need of intra-vitreal injections with their attendant risks.
背景
糖尿病患者由于血糖控制不佳，在黄斑区出现多个液体积聚的囊腔，导致中心视力受损。如果能够及早发现这种黄斑病变的临床前期，对于患者来说将具有重要意义，有助于提醒他们改善血糖控制。本研究旨在使用扫频源光学相干断层扫描（SS-OCT）测量无囊样黄斑水肿的糖尿病患者和非糖尿病患者的黄斑中心凹厚度（foveal thickness，FT）和黄斑体积（macular volume，MV），并将这些指标与患者的血糖控制情况相关联。
方法
使用 SS-OCT（DRI OCT Triton™，Topcon，东京，日本）测量中心凹点厚度（centre point thickness，CPT）和总黄斑体积（total macular volume，TMV）。同时评估参与者的糖化血红蛋白（glycosylated haemoglobin，HbA）水平（ANow®+ System，PTS Diagnostics，印第安纳波利斯，IN，美国）。将糖尿病组（n=27）和非糖尿病组（n=27）按年龄（p=0.100）和性别（p=0.414）进行匹配，并且糖尿病组和非糖尿病组的 HbA 水平存在显著差异（p<0.0005）。糖尿病组包括 7 例 1 型糖尿病和 20 例 2 型糖尿病患者，他们的糖尿病病程相匹配（p=0.617），血糖控制情况相似（p=0.814）。
结果
糖尿病患者的 CPT（t（37）=3.859，p<0.0005）显著高于非糖尿病患者。在糖尿病组中，多元线性回归分析显示 CPT 与 HbA 水平之间存在显著关系（β=0.501，t（21）=3.139，p=0.005）：HbA 水平每升高 1%，CPT 增加 19μm。这种关系在非糖尿病组中并不存在（β=-0.068，t（23）=-0.373，p=0.712）。
结论
SS-OCT 是活体测量黄斑厚度的唯一方法。与非糖尿病患者相比，糖尿病患者的 CPT 整体较高。此外，在糖尿病组中，HbA 水平显著预测 CPT。我们的研究结果表明，在糖尿病中，在囊样黄斑水肿出现临床症状之前，黄斑中心凹可能已经出现亚临床增厚。这可能为糖尿病患者提供疾病进展的早期预警，并促使他们改善糖尿病的控制，以避免需要玻璃体腔内注射及其相关风险。
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