Liu Kaiqun, Li Ting, Zhong Pingting, Zhu Ziyu, Guo Xiao, Liu Riqian, Xiong Ruilin, Huang Wenyong, Wang Wei
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Study Center for Ocular Diseases, Guangzhou, China.
Department of Rheumatology and Immunology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Study Center for Obstetrics and Gynecology, The Third Affiliated Hospital (T.L.), Guangzhou Medical University, Guangzhou, China.
Am J Ophthalmol. 2025 Jan;269:205-215. doi: 10.1016/j.ajo.2024.08.039. Epub 2024 Sep 3.
To investigate longitudinal changes in choroidal thickness (CT) and ganglion cell-inner plexiform layer thickness (GC-IPLT) across distinct phenotypes of type 2 diabetes mellitus (T2DM) patients.
Prospective cohort study.
T2DM patients were categorized into 5 groups (SAID, SIDD, SIRD, MOD, and MARD) using K-means clustering based on β-cell function and insulin resistance. Swept-source optical coherence tomography measured baseline and 4-year follow-up CT and GC-IPLT. Linear mixed-effects models assessed absolute and relative changes in CT and GC-IPLT across subtypes.
Over a median 4.11-year follow-up, CT and GC-IPLT decreased significantly across all groups. Choroidal thinning rates were most pronounced in SIDD (-6.5 ± 0.53 µm/year and -3.5 ± 0.24%/year) and SAID (-6.27 ± 0.8 µm/year and -3.19 ± 0.37%/year), while MARD showed the slowest thinning rates (-3.63 ± 0.34 µm/year and -1.98 ± 0.25%/year). SIRD exhibited the greatest GC-IPLT loss (-0.66 ± 0.05 µm/year and -0.91 ± 0.07%/year), with the least in SIDD (-0.36 ± 0.05 µm/year and -0.49 ± 0.07%/year), all statistically significant (all P < 0.001). Adjusted for confounding variables, SIDD and SAID groups showed faster CT thinning than MARD [-2.57 µm/year (95% CI: -4.16 to -0.97; P = 0.002) and -2.89 µm/year (95% CI: -4.12 to -1.66; P < 0.001), respectively]. GC-IPLT thinning was notably accelerated in SIRD versus MARD, but slowed in SIDD relative to MARD [differences of -0.16 µm/year (95% CI: -0.3 to -0.03; P = 0.015) and 0.15 µm/year (95% CI: 0.03 to 0.27; P = 0.015), respectively].
Microvascular damage in the choroid is associated with SIDD patients, whereas early signs of retinal neurodegeneration are evident in SIRD patients. All these changes may precede the onset of DR.
研究2型糖尿病（T2DM）患者不同表型的脉络膜厚度（CT）和神经节细胞-内丛状层厚度（GC-IPLT）的纵向变化。
前瞻性队列研究。
根据β细胞功能和胰岛素抵抗，采用K均值聚类将T2DM患者分为5组（SAID、SIDD、SIRD、MOD和MARD）。扫频光学相干断层扫描测量基线和4年随访时的CT和GC-IPLT。线性混合效应模型评估各亚型CT和GC-IPLT的绝对和相对变化。
在中位4.11年的随访中，所有组的CT和GC-IPLT均显著降低。脉络膜变薄率在SIDD组（-6.5±0.53µm/年和-3.5±0.24%/年）和SAID组（-6.27±0.8µm/年和-3.19±0.37%/年）最为明显，而MARD组的变薄率最慢（-3.63±0.34µm/年和-1.98±0.25%/年）。SIRD组的GC-IPLT损失最大（-0.66±0.05µm/年和-0.91±0.07%/年），SIDD组最小（-0.36±0.05µm/年和-0.49±0.07%/年），差异均有统计学意义（均P<0.001）。校正混杂变量后，SIDD组和SAID组的CT变薄速度比MARD组快[-2.57µm/年（95%CI：-4.16至-0.97；P=0.002）和-2.89µm/年（95%CI：-4.12至-1.66；P<0.001）]。与MARD组相比，SIRD组的GC-IPLT变薄明显加速，但SIDD组相对于MARD组减慢[差异分别为-0.16µm/年（95%CI：-0.3至-0.03；P=0.015）和0.15µm/年（95%CI：0.03至0.27；P=0.015）]。
脉络膜微血管损伤与SIDD患者相关，而视网膜神经变性的早期迹象在SIRD患者中明显。所有这些变化可能在糖尿病视网膜病变发病之前出现。
