Wu Qinxing, Zhao Bin, Dongye Shengliang, Sun Lu, An Bo, Xu Qian
Department of Ophthalmology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China.
Shandong Healthcare Industry Development Group, Tai'an, China.
Front Med (Lausanne). 2025 Jun 4;12:1566047. doi: 10.3389/fmed.2025.1566047. eCollection 2025.
The purpose of this study was to investigate the association between systemic inflammation markers and early neuronal and microvascular changes in the retinal and choroidal regions of patients with type 2 diabetes mellitus (T2DM) without clinical signs of diabetic retinopathy (DR), utilizing wide-field swept-source optical coherence tomography angiography (SS-OCTA).
This retrospective, observational cohort study included 61 patients (119 eyes) with T2DM without clinical DR (NDR group) and 44 healthy individuals (82 eyes) as controls. All participants underwent a comprehensive ophthalmic evaluation and blood sampling for hematologic indices. Inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI), were calculated. The mean thickness of the retina, choroid, and individual inner retinal layers, as well as the vessel density measurements of the superficial and deep retinal layers, and the choriocapillaris perfusion area, were recorded and analyzed from the OCTA images. Additionally, the choroidal vascularity index (CVI) was determined.
The NDR group demonstrated significantly higher levels of NLR, SII, and SIRI compared to the control group ( < 0.05). The diabetic cohort showed reduced vessel density in the deep capillary plexus (DCP) across all measured regions ( < 0.05). Significant but weak negative correlations were observed between inflammation markers, particularly NLR, and OCTA parameters, with a marked impact on the DCP ( = -0.21 to -0.32, < 0.05) and CVI ( = -0.23 to -0.28, < 0.05).
The study provides new insights into the role of systemic inflammation in early structural and blood flow changes in the retina and choroid, occurring prior to the onset of DR. The findings highlight the importance of inflammation in the pathogenesis of DR, even in the absence of clinical signs, suggesting that systemic inflammatory markers may serve not only as early biomarkers of ocular changes in T2DM but also as potential early therapeutic targets to prevent or delay diabetic retinopathy.
本研究旨在利用广角扫频源光学相干断层扫描血管造影（SS-OCTA），调查2型糖尿病（T2DM）且无糖尿病视网膜病变（DR）临床体征患者视网膜和脉络膜区域全身炎症标志物与早期神经元及微血管变化之间的关联。
这项回顾性观察队列研究纳入了61例无临床DR的T2DM患者（119只眼）（无DR组）和44名健康个体（82只眼）作为对照组。所有参与者均接受了全面的眼科评估并采集血液样本以检测血液学指标。计算炎症标志物，包括中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、单核细胞与淋巴细胞比值（MLR）、全身免疫炎症指数（SII）和全身炎症反应指数（SIRI）。从OCTA图像中记录并分析视网膜、脉络膜及各个视网膜内层的平均厚度，以及视网膜浅层和深层的血管密度测量值和脉络膜毛细血管灌注面积。此外，还测定了脉络膜血管指数（CVI）。
与对照组相比，无DR组的NLR、SII和SIRI水平显著更高（<0.05）。糖尿病队列在所有测量区域的深层毛细血管丛（DCP）中血管密度均降低（<0.05）。炎症标志物，尤其是NLR，与OCTA参数之间存在显著但微弱的负相关，对DCP（=-0.21至-0.32，<0.05）和CVI（=-0.23至-0.28，<0.05）有显著影响。
该研究为全身炎症在DR发病前视网膜和脉络膜早期结构及血流变化中的作用提供了新见解。研究结果突出了炎症在DR发病机制中的重要性，即使在无临床体征时也是如此，表明全身炎症标志物不仅可作为T2DM眼部变化的早期生物标志物，还可作为预防或延缓糖尿病视网膜病变的潜在早期治疗靶点。
