糖尿病视网膜病变早期危险因素与视网膜神经纤维层丢失之间的关联
Association between risk factors and retinal nerve fiber layer loss in early stages of diabetic retinopathy.
作者信息
Wan Zhong-Qi, Gao Yan, Cui Min, Zhang Yong-Jie
机构信息
School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu Province, China.
Department of Vitreoretinology, Shanxi Eye Hospital, Taiyuan 030005, Shanxi Province, China.
出版信息
Int J Ophthalmol. 2021 Feb 18;14(2):255-262. doi: 10.18240/ijo.2021.02.12. eCollection 2021.
AIM
To investigate the changes of retinal nerve fiber layer (RNFL) among normal individuals, diabetic patients without diabetic retinopathy (NDR) and non-proliferative diabetic retinopathy (NPDR), and explore the possible risk factors of early diabetic retinopathy (DR).
METHODS
In this cross-sectional study, 107 participants were divided in three groups. Totally 31 normal individuals (control group), 40 diabetic patients without DR (NDR group) and 36 patients with NPDR (NPDR group) were included. Optical coherence tomography (OCT) was used to detect RNFL thickness and other optic disc parameters among different groups. The potential association between RNFL loss and systemic risk factors were assessed for DR, including diabetes duration, body mass index (BMI), hemoglobin A1c (HbA1c), serum lipids, and blood pressure.
RESULTS
The average and each quadrant RNFL thickness were thinner in NPDR group compared to control group of the right (=0.00, =0.01, =0.01, =0.02, =0.04) and left eyes (=0.00, =0.00, =0.00, =0.03, =0.04). The average, superior and inferior RNFL thickness were thinner in NDR group compared to the NPDR group of the right (=0.00, =0.02, =0.03) and left eyes (=0.00, =0.00, =0.01). Diabetic duration was negatively correlated with the superior, inferior, and average RNFL thickness of the right (=-0.385, =0.001; =-0.366, =0.001; =-0.503, =0.000) and left eyes (=-0.271, =0.018; =0.278, =0.015; =-0.260, =0.023). HbA1c was negatively correlated with the superior, inferior, and average RNFL thickness of the right (=-0.316 =0.005; =-0.414, =0.000; =-0.418, =0.000) and left eyes (=-0.367, =0.001; =-0.250, =0.030; =-0.393, =0.000). Systolic pressure was negatively correlated with the inferior and average RNFL thickness of the right eye (=-0.402, =0.000; =-0.371, =0.001) and was negatively correlated with the superior and average RNFL thickness of the left eye (=-0.264, =0.021; =-0.233, =0.043).
CONCLUSION
RNFL loss, especially in the superior and inferior quadrants, may be the earliest structural change of the retina in diabetic patients, and is also associated with diabetic duration, HbA1c, and systolic pressure.
目的
研究正常个体、无糖尿病视网膜病变（NDR）的糖尿病患者及非增殖性糖尿病视网膜病变（NPDR）患者视网膜神经纤维层（RNFL）的变化，并探讨早期糖尿病视网膜病变（DR）的可能危险因素。
方法
在这项横断面研究中，107名参与者被分为三组。共纳入31名正常个体（对照组）、40名无DR的糖尿病患者（NDR组）和36名NPDR患者（NPDR组）。采用光学相干断层扫描（OCT）检测不同组间的RNFL厚度及其他视盘参数。评估RNFL厚度降低与DR的全身危险因素之间的潜在关联，包括糖尿病病程、体重指数（BMI）、糖化血红蛋白（HbA1c）、血脂和血压。
结果
与对照组相比，NPDR组右眼（=0.00，=0.01，=0.01，=0.02，=0.04）和左眼（=0.00，=0.00，=0.00，=0.03，=0.04）的平均RNFL厚度及各象限RNFL厚度均变薄。与NPDR组相比，NDR组右眼（=0.00，=0.02，=0.03）和左眼（=0.00，=0.00，=0.01）的平均、上方和下方RNFL厚度变薄。糖尿病病程与右眼（=-0.385，=0.001；=-0.366，=0.001；=-0.503，=0.000）和左眼（=-0.271，=0.018；=0.278，=0.015；=-0.260，=0.023）的上方、下方及平均RNFL厚度呈负相关。HbA1c与右眼（=-0.316 =0.005；=-0.414，=0.000；=- .418，=0.000）和左眼（=-0.367，=0.001；=-0.250，=0.030；=-0.393，=0.000）的上方、下方及平均RNFL厚度呈负相关。收缩压与右眼下方和平均RNFL厚度呈负相关（=-0.402，=0.000；=-0.371，=0.001），与左眼上方和平均RNFL厚度呈负相关（=-0.264，=0.021；=-0.233，=0.043）。
结论
RNFL厚度降低，尤其是上方和下方象限，可能是糖尿病患者视网膜最早的结构变化，且与糖尿病病程、HbA1c和收缩压有关。
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