Longitudinal Relationship Between Retinal Diabetic Neurodegeneration and Progression of Diabetic Retinopathy in Patients With Type 2 Diabetes
Longitudinal Relationship Between Retinal Diabetic Neurodegeneration and Progression of Diabetic Retinopathy in Patients With Type 2 Diabetes
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DOI：
10.1016/j.ajo.2018.08.053
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发表时间：
2018-12-01
影响因子：
4.2
通讯作者：
Yu, Seung-Young
中科院分区：
文献类型：
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作者：
Kim, Kiyoung;Kim, Eung Suk;Yu, Seung-Young
目的：通过测量2型糖尿病(T2 DM)患者黄斑神经节细胞-内丛状层(MGCIPL)厚度，探讨糖尿病视网膜神经变性与糖尿病视网膜病变(DR)进展的纵向关系。设计：回顾性队列研究。方法：对无DR或轻度非增殖性DR(NPDR)的T2 DM患者进行为期4年的随访。根据视网膜照相对DR进行分级，并使用光学相干断层扫描测量平均mGCIPL厚度，从基线开始至少间隔6个月。结果：在87只T2 DM患者中，39只眼(44.8%)出现两步进展，6只眼(6.9%)进展为增殖性视网膜病变。糖尿病视网膜病变进展的患者表现为T2 DM病程较长，mGCIPL变薄，mGCIPL变薄，心脏自主神经病变(CAN)严重，周围神经传导速度减慢，糖化血红蛋白A1c水平升高。多因素回归分析显示，mGCIPL厚度(HR=0.94)、MGCIPL减薄率(HR=1.924)、CAN评分(HR=1.248)和周围神经传导速度(HR=0.894)是预测DR进展的显著因素。结论：进行性丢失mGCIPL是早期DR进展的独立危险因素。进一步评估自主神经和周围神经功能可提高预测T2 DM患者DR恶化的敏感性。((C)2018 Elsevier Inc.保留所有权利。)
PURPOSE: To investigate the longitudinal relationship between diabetic retinal neurodegeneration and the progression of diabetic retinopathy (DR) by measuring macular ganglion cell-inner plexiform layer (mGCIPL) thickness in patients with type 2 diabetes (T2DM).DESIGN: Retrospective cohort study.METHODS: T2DM patients with no DR or mild nonproliferative DR (NPDR) followed up for >= 4 years were included in this study. DR was graded according to retinal photography, and mean parafoveal mGCIPL thickness was measured using optical coherence tomography with at least a 6-month interval from baseline. Hazard ratios (HR) for predicting 2-step progression and development of proliferative DR (PDR) were calculated using Cox proportional hazard modeling using baseline clinical factors.RESULTS: Of 87 eyes of T2DM patients, 39 (44.8%) exhibited 2-step DR progression and 6 (6.9%) experienced progression to PDR. Patients with DR progression exhibited longer T2DM duration, thinner mGCIPL, greater mGCIPL thinning rate, severe cardiac autonomic neuropathy (CAN), lower peripheral nerve-conduction velocity, and higher glycated hemoglobin A1c level. Multivariate regression modeling revealed that baseline mGCIPL thickness (HR = 0.94), mGCIPL thinning rate (HR = 1.924), CAN score (HR = 1.248), and conduction velocity of peripheral nerves (HR = 0.894) were significant predictive factors for DR progression (area under the curve = 0.92).CONCLUSION: Progressive loss of mGCIPL is an independent risk factor for progression in early-stage DR. Further assessment of autonomic and peripheral nerve functions can increase sensitivity in predicting aggravation of DR in patients with T2DM. ((C) 2018 Elsevier Inc. All rights reserved.)