2 型糖尿病无糖尿病视网膜病变患者的血糖控制对视网膜光感受器层和视网膜色素上皮的影响：一项随访研究。
The Impact of Glycemic Control on Retinal Photoreceptor Layers and Retinal Pigment Epithelium in Patients With Type 2 Diabetes Without Diabetic Retinopathy: A Follow-Up Study.
机构信息
Internal Medicine, Ishibashi Clinic, Hiroshima, Japan.
Diabetes and Vascular Research Centre (DVRC), NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom.
出版信息
Front Endocrinol (Lausanne). 2021 Apr 23;12:614161. doi: 10.3389/fendo.2021.614161. eCollection 2021.
AIMS
To establish the sequential changes by glycemic control in the mean thickness, volume and reflectance of the macular photoreceptor layers (MPRLs) and retinal pigment epithelium in patients with type 2 diabetes without diabetic retinopathy.
METHODS
Thirty-one poorly controlled (HbA1c > 8.0%) patients with type 2 diabetes without diabetic retinopathy undergoing glycemic control and 39 control subjects with normal HbA1c levels (< 5.9%) underwent periodical full medical, neurological and ophthalmological examinations over 2 years. Glycemic variability was evaluated by standard deviation and coefficient of variation of monthly measured HbA1c levels and casual plasma glucose. 3D swept source-optical coherence tomography (OCT) and OCT-Explorer-generated enface thickness, volume and reflectance images for 9 subfields defined by Early Treatment Diabetic Retinopathy Study of 4 MPRLs {outer nuclear layer, ellipsoid zone, photoreceptor outer segment (PROS) and interdigitation zone} and retinal pigment epithelium were acquired every 3 months.
RESULTS
Glycemic control sequentially restored the thickness and volume at 6, 4 and 5 subfields of outer nuclear layer, ellipsoid zone and PROS, respectively. The thickness and volume of outer nuclear layer were restored related to the decrease in HbA1c and casual plasma glucose levels, but not related to glycemic variability and neurological tests. The reflectance of MPRLs and retinal pigment epithelium in patients was marginally weaker than controls, and further decreased at 6 or 15 months during glycemic control. The reduction at 6 months coincided with high HbA1c levels.
CONCLUSION
Glycemic control sequentially restored the some MPRL thickness, especially of outer nuclear layer. In contrast, high glucose during glycemic control decreased reflectance and may lead to the development of diabetic retinopathy induced by glycemic control. The repeated OCT examinations can clarify the benefit and hazard of glycemic control to the diabetic retinopathy.
目的
观察未经糖尿病视网膜病变（DR）的 2 型糖尿病（T2DM）患者血糖控制后，其黄斑光感受器层（MPRL）的平均厚度、体积和反射率的顺序变化，并分析其与血糖变异性的关系。
方法
对 31 例血糖控制不佳（HbA1c＞8.0%）的 T2DM 患者（未发生 DR）和 39 例血糖控制正常（HbA1c＜5.9%）的对照组患者进行 2 年的定期全面医学、神经学和眼科检查。通过每月 HbA1c 水平和随机血糖的标准差和变异系数评估血糖变异性。每 3 个月用 3D 扫频源光相干断层扫描（OCT）和 OCT-Explorer 生成的 9 个亚区（外核层、椭圆体带、光感受器外节（PROS）和外突带）的 MPRL 及视网膜色素上皮的 Enface 厚度、体积和反射率图像。
结果
血糖控制依次恢复了外核层、椭圆体带和 PROS 的 6、4 和 5 个亚区的厚度和体积。外核层的厚度和体积恢复与 HbA1c 和随机血糖水平的降低有关，而与血糖变异性和神经学检查无关。MPRL 和视网膜色素上皮的反射率低于对照组，在血糖控制的 6 或 15 个月时进一步降低。6 个月时的降低与 HbA1c 水平较高有关。
结论
血糖控制依次恢复了部分 MPRL 厚度，尤其是外核层的厚度。相反，血糖控制期间的高血糖会降低反射率，并可能导致血糖控制引起的 DR 进展。重复的 OCT 检查可以阐明血糖控制对 DR 的益处和危害。
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