闪光视网膜电图揭示的神经视网膜功能障碍与糖尿病患者的周围神经功能障碍和动脉粥样硬化参数相关。
Neuroretinal dysfunction revealed by a flicker electroretinogram correlated with peripheral nerve dysfunction and parameters of atherosclerosis in patients with diabetes.
机构信息
Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan.
Department of Laboratory, The Medical Clinic of Aichi Medical University, Nagoya, Japan.
出版信息
J Diabetes Investig. 2021 Jul;12(7):1236-1243. doi: 10.1111/jdi.13465. Epub 2020 Dec 18.
AIMS/INTRODUCTION: Diabetic polyneuropathy (DPN) develops in the early stage of diabetes. However, no common diagnostic protocol has yet been established. Here, to verify that the flicker electroretinogram using a hand-held device can detect the early dysfunction of the peripheral nervous system in patients with diabetes, we investigated the correlation between the progression of DPN and neuroretinal dysfunction.
MATERIALS AND METHODS
In total, 184 participants with type 1 or 2 diabetes underwent a flicker electroretinogram (ERG) using a hand-held device RETeval™ and nerve conduction study. Participants were also evaluated for intima-media thickness, ankle-brachial index, toe brachial index and brachial-ankle pulse wave velocity. Parameters of the nerve conduction study were used to diagnose the severity according to Baba's classification. A multiple regression analysis was used to examine the associations of ERG parameters with the severity of DPN categorized by Baba's classification. Diagnostic properties of the device in DPN were evaluated using a receiver operating characteristic curve.
RESULTS
A multiple regression model to predict the severity of DPN was generated using ERG. In the model, moderate-to-severe DPN was effectively diagnosed (area under the receiver operating characteristic curve 0.692, sensitivity 56.5%, specificity 78.3%, positive predictive value 70.6%, negative predictive value 66.1%, positive likelihood ratio 2.60, negative likelihood ratio 0.56). In the patients without diabetic retinopathy, the implicit time and amplitude in ERG significantly correlated with the parameters of the nerve conduction study, brachial-ankle pulse wave velocity and intima-media thickness.
CONCLUSIONS
Electroretinogram parameters obtained by the hand-held device successfully predict the severity of DPN. The device might be useful to evaluate DPN.
目的/引言：糖尿病性多发性神经病（DPN）在糖尿病早期发展。然而，目前尚未建立通用的诊断方案。在这里，为了验证使用手持式设备的闪烁视网膜电图可以检测糖尿病患者外周神经系统的早期功能障碍，我们研究了 DPN 的进展与神经视网膜功能障碍之间的相关性。
材料和方法
共有 184 名 1 型或 2 型糖尿病患者使用手持式设备 RETeval™进行闪烁视网膜电图（ERG）和神经传导研究。还评估了参与者的内膜中层厚度、踝臂指数、趾臂指数和肱踝脉搏波速度。神经传导研究的参数用于根据 Baba 分类诊断严重程度。使用多元回归分析检查 ERG 参数与 Baba 分类的 DPN 严重程度之间的相关性。使用接收者操作特征曲线评估设备在 DPN 中的诊断特性。
结果
使用 ERG 生成了预测 DPN 严重程度的多元回归模型。在该模型中，有效地诊断了中重度 DPN（受试者工作特征曲线下面积 0.692、灵敏度 56.5%、特异性 78.3%、阳性预测值 70.6%、阴性预测值 66.1%、阳性似然比 2.60、阴性似然比 0.56）。在没有糖尿病视网膜病变的患者中，ERG 的潜伏期和振幅与神经传导研究的参数、肱踝脉搏波速度和内膜中层厚度显著相关。
结论
手持式设备获得的视网膜电图参数成功预测了 DPN 的严重程度。该设备可能有助于评估 DPN。
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