Choi Eun Young, Park Yae Won, Lee Minyoung, Kim Min, Lee Christopher Seungkyu, Ahn Sung Soo, Kim Jinna, Lee Seung-Koo
Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea.
Department of Radiology, Center for Clinical Imaging Data Science, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea.
Front Aging Neurosci. 2021 Nov 12;13:666495. doi: 10.3389/fnagi.2021.666495. eCollection 2021.
The aim of this study was to evaluate whether perivascular space (PVS) severity and retinal ganglion cell layer (GCL) thickness differed based on the stage of diabetic retinopathy (DR) and the cognitive status in patients with DR. A total of 81 patients with DR (51 in the non-proliferative group and 30 in the proliferative group) were included in this retrospective, cross-sectional study. PVS severity was assessed in the basal ganglia (BG) and centrum semiovale using MRI. The total cerebral small vessel disease (SVD) score was determined based on the numbers of lacunes and microbleeds and the severity of white matter hyperintensity. Optical coherence tomography was used to measure foveal and perifoveal GCL thicknesses. Cerebral SVD markers and cognitive function were compared between the groups, and correlations between the BG-PVS severity and the Mini-Mental Status Examination (MMSE) scores and GCL parameters were evaluated. Patients with proliferative DR had higher BG-PVS severity ( = 0.012), higher total cerebral SVD scores ( = 0.035), reduced GCL thicknesses in the inferior ( = 0.027), superior ( = 0.046), and temporal ( = 0.038) subfields compared to patients with non-proliferative DR. In addition, the BG-PVS severity was negatively correlated with the MMSE score ( = 0.007), and the GCL thickness was negatively correlated with the BG-PVS severity (-values < 0.05 for inferior, superior, and temporal subfields). BG-PVS severity and retinal GCL thickness may represent novel imaging biomarkers reflecting the stage of DR and cognitive decline in diabetic patients. Furthermore, these results suggest a possible link between cerebral and retinal neurodegeneration at the clinical level.
本研究的目的是评估糖尿病视网膜病变（DR）患者的血管周围间隙（PVS）严重程度和视网膜神经节细胞层（GCL）厚度是否因DR阶段和认知状态而异。本项回顾性横断面研究共纳入81例DR患者（非增殖性组51例，增殖性组30例）。使用MRI评估基底节（BG）和半卵圆中心的PVS严重程度。基于腔隙和微出血的数量以及白质高信号的严重程度确定全脑小血管疾病（SVD）评分。使用光学相干断层扫描测量黄斑中心凹和黄斑旁GCL厚度。比较各组之间的脑SVD标志物和认知功能，并评估BG-PVS严重程度与简易精神状态检查表（MMSE）评分和GCL参数之间的相关性。与非增殖性DR患者相比，增殖性DR患者的BG-PVS严重程度更高（ = 0.012），全脑SVD评分更高（ = 0.035），其下方（ = 0.027）、上方（ = 0.046）和颞侧（ = 0.038）子区域的GCL厚度降低。此外，BG-PVS严重程度与MMSE评分呈负相关（ = 0.007），GCL厚度与BG-PVS严重程度呈负相关（下方、上方和颞侧子区域的 - 值<0.05）。BG-PVS严重程度和视网膜GCL厚度可能代表反映糖尿病患者DR阶段和认知衰退的新型成像生物标志物。此外，这些结果提示在临床水平上脑和视网膜神经变性之间可能存在联系。
