Guo Hanli, Wu Wenjie, Huang Yue, Huang Yulong, Jin Ningxuan, Ma Huazhi, Li Qiong
Shengli Clinical Medical College of Fujian Medical University, Fujian Medical University, Fuzhou, China.
Ophthalmology Department, Fujian Provincial Hospital, Fuzhou, China.
Ophthalmic Res. 2025;68(1):263-274. doi: 10.1159/000545097. Epub 2025 Mar 17.
The aim of the study was to investigate the correlation between systemic inflammation biomarkers and morphological changes of retinal neurovascular unit (RNVU) under optical coherence tomography (OCT) and OCT angiography (OCTA) in type 2 diabetic patients with early signs of diabetic retinopathy (DR).
This cross-sectional study was carried out among 93 type 2 diabetic patients with early signs of DR (170 eyes), ranging from level 10 to level 35 based on ETDRS DR severity scale score. Age-, sex-, and axial length-matched normal subjects were enrolled as controls. Systemic inflammation biomarkers including neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and systemic immune-inflammatory index (SII) were calculated based on peripheral blood results. Retinal neuronal changes of RNVU were identified by accessing the thickness of macular retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) using OCT. Retinal microvascular alterations of RNVU were evaluated by measuring macular vessel density (VD) and size of foveal avascular zone (FAZ) using OCTA.
GCL thickness was significantly correlated with NLR (r = -0.183, p = 0.017) and MLR (r = -0.235, p = 0.002), RNFL thickness was significantly associated with MLR (r = -0.210, p = 0.008), FAZp was positively correlated with NLR (r = 0.153, p = 0.046) and MLR (r = 0.187, p = 0.014), FAZa was positively correlated with MLR (r = 0.189, p = 0.014), and VD was significantly correlated with NLR (r = -0.188, p = 0.014) on spearman correlation analysis. Additionally, VD was independently associated with SII in both univariable and multivariable GLM analysis (p < 0.05). This difference still remained statistically significant during subgroup analysis after controlling DM duration.
Systemic inflammation biomarkers including NLR, MLR, and SII are significantly associated with not only retinal microvascular alterations but also retinal neuronal changes, providing evidence that systemic inflammation may play a crucial role on the early morphological changes of RNVU and early DR pathogenesis. SII is independently associated with VD, which supports SII may serve as a potential biomarker for monitoring early microvascular changes of DR.
本研究旨在探讨2型糖尿病视网膜病变（DR）早期迹象患者全身炎症生物标志物与光学相干断层扫描（OCT）及OCT血管造影（OCTA）下视网膜神经血管单元（RNVU）形态学改变之间的相关性。
本横断面研究纳入了93例有DR早期迹象的2型糖尿病患者（170只眼），根据ETDRS DR严重程度量表评分，病变程度为10级至35级。年龄、性别和眼轴长度匹配的正常受试者作为对照。根据外周血结果计算全身炎症生物标志物，包括中性粒细胞与淋巴细胞比值（NLR）、单核细胞与淋巴细胞比值（MLR）和全身免疫炎症指数（SII）。通过使用OCT测量黄斑视网膜神经纤维层（RNFL）和神经节细胞层（GCL）的厚度来确定RNVU的视网膜神经元变化。通过使用OCTA测量黄斑血管密度（VD）和中心凹无血管区（FAZ）的大小来评估RNVU的视网膜微血管改变。
在Spearman相关性分析中，GCL厚度与NLR（r = -0.183，p = 0.017）和MLR（r = -0.235，p = 0.002）显著相关，RNFL厚度与MLR（r = -0.210，p = 0.008）显著相关，FAZp与NLR（r = 0.153，p = 0.046）和MLR（r = 0.187，p = 0.014）呈正相关，FAZa与MLR（r = 0.189，p = 0.014）呈正相关，VD与NLR（r = -0.188，p = 0.014）显著相关。此外，在单变量和多变量广义线性模型分析中，VD均与SII独立相关（p < 0.05）。在控制糖尿病病程后的亚组分析中，这种差异仍然具有统计学意义。
包括NLR、MLR和SII在内的全身炎症生物标志物不仅与视网膜微血管改变显著相关，而且与视网膜神经元变化也显著相关，这为全身炎症可能在RNVU早期形态学改变和早期DR发病机制中起关键作用提供了证据。SII与VD独立相关，这支持SII可能作为监测DR早期微血管变化的潜在生物标志物。
