糖尿病患者无视网膜病变时脉络膜和神经退行性变的随时间变化率：一项 3 年的前瞻性研究。

Rates of Choroidal and Neurodegenerative Changes Over Time in Diabetic Patients Without Retinopathy: A 3-Year Prospective Study.

机构信息

From the Nanshan School, Guangzhou Medical University (Y.H.), Guangzhou, China.

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (N.Z., S.Z., W.W.), Guangzhou, China.

出版信息

Am J Ophthalmol. 2023 Feb;246:10-19. doi: 10.1016/j.ajo.2022.07.011. Epub 2022 Jul 20.

DOI:10.1016/j.ajo.2022.07.011

PMID:35870490

Abstract

PURPOSE

To evaluate the longitudinal changes of retinal neurodegeneration and choroidal thickness in diabetic patients with and without diabetic retinopathy (DR).

DESIGN

Prospective observational cohort study.

METHODS

This prospective observational cohort study recruited type 2 diabetic patients from a community registry in Guangzhou. All participants underwent annual ocular examinations via swept-source optical coherence tomography that obtained choroid thickness (CT), retinal thickness (RT), and ganglion cell-inner plexiform layer (GC-IPL) thickness. The changes in GC-IPL, CT, and RT between patients who developed incident DR (IDR) or remained non-DR (NDR) were compared during a 3-year follow-up.

RESULTS

Among 924 patients, 159 (17.2%) patients developed IDR within the 3-year follow-up. A reduction in GC-IPL, RT, and CT was observed in NDR and IDR; however, CT thinning in patients with IDR was significantly accelerated, with an average CT reduction of -6.98 (95% CI: -8.26, -5.71) μm/y in patients with IDR and -3.98 (95% CI: -4.60, -3.36) μm/y in NDR patients (P < .001). Reductions in average GC-IPL thickness over 3 years were -0.97 (95% CI: -1.24, -0.70) μm/y in patients with IDR and -0.76 (95% CI: -0.82, -0.70) μm/y in NDR patients (P = .025). After adjusting for confounding factors, the average CT and GC-IPL thinning were significantly faster in patients with IDR compared with those who remained NDR by 2.09 μm/y (95% CI: 1.01, 3.16; P = .004) and -0.29 μm/y (95% CI: -0.49, -0.09; P = .004), respectively. The RT in the IDR group increased, whereas the RT in the NDR group decreased over time, with the adjusted difference of 2.09 μm/y (95% CI: 1.01, 3.16; P < .001) for central field RT.

CONCLUSIONS

The rate of retinal neurodegeneration and CT thinning were significantly different between the eyes that developed IDR and remained NDR during the 3-year follow-up, but both groups observed thickness reduction. This indicates that GC-IPL and CTs may decrease before the clinical manifestations of DR.

摘要

目的

评估有和无糖尿病视网膜病变（DR）的糖尿病患者的视网膜神经退行性变和脉络膜厚度的纵向变化。

设计

前瞻性观察队列研究。

方法

这项前瞻性观察队列研究从广州的一个社区登记处招募了 2 型糖尿病患者。所有参与者均接受年度眼部检查，包括扫频源光学相干断层扫描（OCT），以获得脉络膜厚度（CT）、视网膜厚度（RT）和神经节细胞-内丛状层（GC-IPL）厚度。在 3 年的随访期间，比较发生新发糖尿病性视网膜病变（IDR）或保持非糖尿病性视网膜病变（NDR）的患者的 GC-IPL、CT 和 RT 的变化。

结果

在 924 名患者中，有 159 名（17.2%）患者在 3 年内发生 IDR。NDR 和 IDR 患者均出现 GC-IPL、RT 和 CT 变薄，但 IDR 患者的 CT 变薄速度明显加快，IDR 患者的平均 CT 减少为-6.98（95%CI：-8.26，-5.71）μm/y，而 NDR 患者为-3.98（95%CI：-4.60，-3.36）μm/y（P<0.001）。3 年内平均 GC-IPL 厚度减少分别为 IDR 患者为-0.97（95%CI：-1.24，-0.70）μm/y，NDR 患者为-0.76（95%CI：-0.82，-0.70）μm/y（P=0.025）。调整混杂因素后，与保持 NDR 相比，IDR 患者的平均 CT 和 GC-IPL 变薄速度分别快 2.09μm/y（95%CI：1.01，3.16；P=0.004）和-0.29μm/y（95%CI：-0.49，-0.09；P=0.004）。IDR 组的 RT 增加，而 NDR 组的 RT 随时间减少，中央视野 RT 的调整差异为 2.09μm/y（95%CI：1.01，3.16；P<0.001）。