Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan.
Department of Ophthalmology, Aichi Medical University School of Medicine, Nagakute, Japan.
J Diabetes Investig. 2021 Aug;12(8):1430-1441. doi: 10.1111/jdi.13476. Epub 2020 Dec 30.
AIMS/INTRODUCTION: Diabetic polyneuropathy (DPN) and diabetic retinopathy (DR) are traditionally regarded as microvascular complications. However, these complications may share similar neurodegenerative pathologies. Here we evaluate the correlations in the severity of DPN and changes in the thickness of neuroretinal layers to elucidate whether these complications exist at similar stages of progression.
A total of 43 patients with type 2 diabetes underwent a nerve conduction study (NCS), a macular optical coherence tomography, and a carotid artery ultrasound scan. Diabetic polyneuropathy was classified according to Baba's classification using NCS. The retina was automatically segmented into four layers; ganglion cell complex (GCC), inner nuclear layer/outer plexiform layer (INL/OPL), outer nuclear layer/photoreceptor inner and outer segments, and retinal pigment epithelium (RPE). The thickness of each retinal layer was separately analyzed for the fovea and the parafovea.
Fourteen patients were classified as having moderate to severe diabetic polyneuropathy. The thicknesses of the foveal and parafoveal INL/OPL increased in patients with diabetic polyneuropathy compared with patients without. The thickness of the parafoveal retinal pigment epithelium decreased in patients with diabetic polyneuropathy. The thinning of parafoveal ganglion cell complex and foveal and parafoveal retinal pigment epithelium were positively correlated with deterioration of nerve functions in the nerve conduction study, but the thickening of INL/OPL was positively correlated with the nerve function deterioration. The thinning of parafoveal ganglion cell complex and foveal retinal pigment epithelium were positively correlated with the thickening of the carotid intima-media.
Depending on the progression of diabetic polyneuropathy, the ganglion cell complex and retinal pigment epithelium became thinner and the INL/OPL became thicker. These retinal changes might be noteworthy for pathological investigations and for the assessment of diabetic polyneuropathy and diabetic retinopathy.
目的/引言：糖尿病性多发性神经病（DPN）和糖尿病性视网膜病变（DR）传统上被认为是微血管并发症。然而，这些并发症可能具有相似的神经退行性病变。在这里，我们评估 DPN 严重程度的相关性以及神经视网膜层厚度的变化，以阐明这些并发症是否处于相似的进展阶段。
共有 43 例 2 型糖尿病患者接受了神经传导研究（NCS）、黄斑光学相干断层扫描和颈动脉超声扫描。根据 NCS 对糖尿病性多发性神经病进行了 Baba 分类。视网膜被自动分为四层；神经节细胞复合体（GCC）、内核层/外丛状层（INL/OPL）、外核层/光感受器内节和外节以及视网膜色素上皮（RPE）。分别分析了每个视网膜层在黄斑和旁黄斑的厚度。
14 例患者被归类为中度至重度糖尿病性多发性神经病。与无糖尿病性多发性神经病的患者相比，患有糖尿病性多发性神经病的患者的黄斑和旁黄斑 INL/OPL 厚度增加。糖尿病性多发性神经病患者的旁黄斑视网膜色素上皮厚度减少。旁黄斑神经节细胞复合体和黄斑和旁黄斑视网膜色素上皮变薄与神经传导研究中神经功能恶化呈正相关，但 INL/OPL 增厚与神经功能恶化呈正相关。旁黄斑神经节细胞复合体和黄斑视网膜色素上皮变薄与颈动脉内中膜增厚呈正相关。
随着糖尿病性多发性神经病的进展，神经节细胞复合体和视网膜色素上皮变薄，INL/OPL 变厚。这些视网膜变化可能对病理性研究以及对糖尿病性多发性神经病和糖尿病性视网膜病变的评估具有重要意义。
