无糖尿病视网膜病变的2型糖尿病患者黄斑区视网膜厚度变化:基于SD-OCT的观察
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摘要
目的观察无糖尿病视网膜病变(diabetic retinopathy,DR)的2型糖尿病患者黄斑区视网膜厚度变化。方法选择2017年8月至10月在我院检查确诊无DR的2型糖尿病患者40例(40眼,无DR组)和健康志愿者70名(70眼,正常对照组)纳入研究。采用频域光学相干断层扫描成像(spectral domain optical coherence tomography,SD-OCT)以及自动化分层技术分别测量黄斑区视网膜全层(retina,R)、视网膜内层(inner retinal layer,IRL)和视网膜外层即感光细胞层(photoreceptor layer,PL)厚度,将黄斑区以中心凹为中心点,分别以直径为1 mm、3 mm和6 mm的3个同心圆进行分区(R总、R-1、R-3、R-6、IRL-1、IRL-3、IRL-6、PL-1、PL-3及PL-6),对比两组间视网膜厚度差异。结果无DR组患者PL-1、PL-3厚度分别为(71±4)μm、(66±2)μm,较正常对照组(73±3)μm、(67±2)μm明显变薄(均为P<0.05)。正常对照组中除IRL-6和PL-1外,其余测量区域不同性别间视网膜结构厚度差异显著(均为P<0.05)。无DR组男性患者PL-3、PL-6厚度分别为(67±2)μm、(65±2)μm,较正常对照组的(68±2)μm、(66±2)μm明显变薄(均为P<0.05)。无DR组女性患者PL-3、PL-6厚度分别为(65±2)μm、(63±2)μm,较正常对照组的(67±2)μm、(64±2)μm明显变薄(均为P<0.05)。其余测量区域组间差异均无统计学意义(均为P>0.05)。结论无DR组黄斑旁中心凹及中心凹周围视网膜PL厚度较正常对照组明显变薄,SD-OCT测量视网膜PL厚度有助于DR早期病变研究,并成为早期监测DR的重要生物学标志。
Objective To observe the retinal thickness of macular in type 2 diabetic mellitus( T2 DM) patients without clinical features of diabetic retinopathy( DR). Methods Totally 40 patients( 40 eyes) with T2 DM without DR and 70 healthy volunteers( 70 eyes) from August2017 to October 2017 were enrolled in this study. Usage of spectral domain optical coherence tomography( SD-OCT) and the software of automatic segmentation to measure the average thickness of total retinal( R),inner retinal layer( IRL) and outer retinal layer namely photoreceptor layer( PL) in macular. The foveal center was divided according to three concentric circle with the diameter of 1 mm,3 mm and 6 mm( including the partition of R total,R-1,R-3,R-6,IRL-1,IRL-3,IRL-6,PL-1,PL-3 and PL-6),and the average retinal thicknesses of these partitions between these two group were compared and analyzed. Results The thickness of PL-1 and PL-3 in no DR group was significantly thinner than that in the normal control group [( 71 ± 4) μm vs.( 73 ± 3)μm and( 66 ± 2) μm vs.( 67 ± 2) μm,respectively]( both P < 0. 05). In the normal control group,except the IRL-6 and PL-1,the difference of the thickness was significant in the other macular regions between various genders( all P < 0. 05). In the male subjects,the thickness of PL-3 and PL-6 in no DR group was significantly thinner than that in the normal control group [( 67 ± 2) μm vs.( 68 ± 2) μm and( 65 ± 2) μm vs.( 66 ± 2) μm,respectively]( both P < 0. 05). In the female subjects,the mean thicknesses of PL-3 and PL-6 in no DR group was significant thinner than those in normal control group [( 65 ± 2) μm vs.( 67 ± 2) μm and( 63 ± 2) μm vs.( 64 ± 2) μm,respectively]( both P < 0. 05). There was no obviously difference in the other parts between these two groups. Conclusion The mean retinal thicknesses of the parafovea and perifovea are significantly thinner in no DR group than that of the normal control group. The measurement of the PL thickness of macular by SD-OCT may promote the study of early stage of DR,and become an important biological marker for early monitoring of DR.
Objective To observe the retinal thickness of macular in type 2 diabetic mellitus( T2 DM) patients without clinical features of diabetic retinopathy( DR). Methods Totally 40 patients( 40 eyes) with T2 DM without DR and 70 healthy volunteers( 70 eyes) from August2017 to October 2017 were enrolled in this study. Usage of spectral domain optical coherence tomography( SD-OCT) and the software of automatic segmentation to measure the average thickness of total retinal( R),inner retinal layer( IRL) and outer retinal layer namely photoreceptor layer( PL) in macular. The foveal center was divided according to three concentric circle with the diameter of 1 mm,3 mm and 6 mm( including the partition of R total,R-1,R-3,R-6,IRL-1,IRL-3,IRL-6,PL-1,PL-3 and PL-6),and the average retinal thicknesses of these partitions between these two group were compared and analyzed. Results The thickness of PL-1 and PL-3 in no DR group was significantly thinner than that in the normal control group [( 71 ± 4) μm vs.( 73 ± 3)μm and( 66 ± 2) μm vs.( 67 ± 2) μm,respectively]( both P < 0. 05). In the normal control group,except the IRL-6 and PL-1,the difference of the thickness was significant in the other macular regions between various genders( all P < 0. 05). In the male subjects,the thickness of PL-3 and PL-6 in no DR group was significantly thinner than that in the normal control group [( 67 ± 2) μm vs.( 68 ± 2) μm and( 65 ± 2) μm vs.( 66 ± 2) μm,respectively]( both P < 0. 05). In the female subjects,the mean thicknesses of PL-3 and PL-6 in no DR group was significant thinner than those in normal control group [( 65 ± 2) μm vs.( 67 ± 2) μm and( 63 ± 2) μm vs.( 64 ± 2) μm,respectively]( both P < 0. 05). There was no obviously difference in the other parts between these two groups. Conclusion The mean retinal thicknesses of the parafovea and perifovea are significantly thinner in no DR group than that of the normal control group. The measurement of the PL thickness of macular by SD-OCT may promote the study of early stage of DR,and become an important biological marker for early monitoring of DR.
引文
[1]Chinese Ocular Fundus Diseases Society,Chinese Ophthalmological Society,Chinese Medical Association.Guidelines for clinical diagnosis and treatment of diabetic retinopathy in China[J].Chin J Ophthalmol,2014,50(11):851-865.中华医学会眼科学会眼底病学组.我国糖尿病视网膜病变临床诊疗指南(2014年)[J].中华眼科杂志,2014,50(11):851-865.
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[5]SAFI S,RAHIMI A,RAEESI A,SAFI H,AMIRI MA,MALEK M,et al.Contrast sensitivity to spatial gratings in moderate and dim light conditions in patients with diabetes in the absence of diabetic retinopathy[J].BMJ Open Diabetes Res Care,2017,5(1):e000408.
[6]SUN TS,ZHANG MN.Characters of contrast sensitivity in diabetic patients without diabetic retinopathy[J].Chin J Ophthalmol,2012,48(1):41-46.孙堂胜,张卯年.无视网膜病变的糖尿病患者对比敏感度检测分析[J].中华眼科杂志,2012,48(1):41-46.
[7]ALEXANDRU DO,CORCI AC,CORCI OM,SAS TN,STEFAˇNESCU-DIMA A,IANCAˇU M.Temporal aspects of full-field erg in patients with diabetes without diabetic retinopathy[J].Fiziol Physiol,2015,1(25):12.
[8]MARCO L,MARIACRISTINA P,SEBASTIANO S,LUCIA Z,DANIELA G,GIUSEPPE L.Investigation of adaptive optics imaging biomarkers for detecting pathological changes of the cone mosaic in patients with type 1 diabetes mellitus[J].PLo S One,2016,11(3):e0151380.
[9]OMRI S,BEHARCOHEN F,ROTHSCHILD P R,GLIZE,JONET L,JEANNY JC,et al.PKCζmediates breakdown of outer blood-retinal barriers in diabetic retinopathy[J].PLo S One,2013,8(11):e81600.
[10]LIU XZ,XIAO H,WEI GS,QU WS,LI RX,LI CL.Ultrastructural changes of photoreceptors of early diabetic rats[J].Chin J Exp Ophthalmol,2000,18(4):322-324.刘学政,萧鸿,魏广生,曲维新,李瑞祥,李春丽.早期糖尿病大鼠光感受器超微结构变化[J].中华实验眼科杂志,2000,18(4):322-324.
[11]ALVAREZ Y,CHEN K,REYNOLDS AL,WAGHORNE N,O’CONNOR JJ,KENNEDY BN.Predominant cone photoreceptor dysfunction in a hyperglycaemic model of non-proliferative diabetic retinopathy[J].Dis Model Mech,2010,3(3-4):236-245.
[2]ANTCLIFF R J,MARSHALL J.The pathogenesis of edema in diabetic maculopathy[J].Semin Ophthalmol,1999,14(4):223-232.
[3]SOHN EH,van DIJK HW,JIAO C,KOK PH,JEONG W,DEMIRKAYA N,et al.Retinal neurodegeneration may precede microvascular changes characteristic of diabetic retinopathy in diabetes mellitus[J].Proc Natl Acad Sci USA,2016,113(19):E2655.
[4]OZKAYA A,ALKIN Z,KARAKUCUK Y,KARATAS G,FAZIL K,GURKAN EM,et al.Thickness of the retinal photoreceptor outer segment layer in healthy volunteers and in patients with diabetes mellitus without retinopathy,diabetic retinopathy,or diabetic macular edema[J].Saudi J Ophthalmol,2017,31(2):69-75.
[5]SAFI S,RAHIMI A,RAEESI A,SAFI H,AMIRI MA,MALEK M,et al.Contrast sensitivity to spatial gratings in moderate and dim light conditions in patients with diabetes in the absence of diabetic retinopathy[J].BMJ Open Diabetes Res Care,2017,5(1):e000408.
[6]SUN TS,ZHANG MN.Characters of contrast sensitivity in diabetic patients without diabetic retinopathy[J].Chin J Ophthalmol,2012,48(1):41-46.孙堂胜,张卯年.无视网膜病变的糖尿病患者对比敏感度检测分析[J].中华眼科杂志,2012,48(1):41-46.
[7]ALEXANDRU DO,CORCI AC,CORCI OM,SAS TN,STEFAˇNESCU-DIMA A,IANCAˇU M.Temporal aspects of full-field erg in patients with diabetes without diabetic retinopathy[J].Fiziol Physiol,2015,1(25):12.
[8]MARCO L,MARIACRISTINA P,SEBASTIANO S,LUCIA Z,DANIELA G,GIUSEPPE L.Investigation of adaptive optics imaging biomarkers for detecting pathological changes of the cone mosaic in patients with type 1 diabetes mellitus[J].PLo S One,2016,11(3):e0151380.
[9]OMRI S,BEHARCOHEN F,ROTHSCHILD P R,GLIZE,JONET L,JEANNY JC,et al.PKCζmediates breakdown of outer blood-retinal barriers in diabetic retinopathy[J].PLo S One,2013,8(11):e81600.
[10]LIU XZ,XIAO H,WEI GS,QU WS,LI RX,LI CL.Ultrastructural changes of photoreceptors of early diabetic rats[J].Chin J Exp Ophthalmol,2000,18(4):322-324.刘学政,萧鸿,魏广生,曲维新,李瑞祥,李春丽.早期糖尿病大鼠光感受器超微结构变化[J].中华实验眼科杂志,2000,18(4):322-324.
[11]ALVAREZ Y,CHEN K,REYNOLDS AL,WAGHORNE N,O’CONNOR JJ,KENNEDY BN.Predominant cone photoreceptor dysfunction in a hyperglycaemic model of non-proliferative diabetic retinopathy[J].Dis Model Mech,2010,3(3-4):236-245.