Early retinal neurodegeneration in preclinical diabetic retinopathy: a multifactorial investigation
Early retinal neurodegeneration in preclinical diabetic retinopathy: a multifactorial investigation
复制标题
DOI：
10.1038/s41433-019-0646-1
复制
发表时间：
2020-06-01
期刊：
影响因子：
3.9
通讯作者：
Yaylali, Volkan
中科院分区：
文献类型：
--
作者：
Toprak, Ibrahim;Fenkci, Semin Melahat;Yaylali, Volkan
背景/目的利用光谱域光学相干断层扫描（SD-OCT）研究无糖尿病视网膜病变（DR）的糖尿病患者，微量白蛋白尿（MA）、糖尿病病程、糖化血红蛋白（HbA1c）水平、高血压（HT）和/或高脂血症（HL）共存对视网膜层的影响。本横断面研究纳入95例（45例有MA， 50例无MA）无DR的2型糖尿病（DM）患者和91例年龄和性别匹配的非糖尿病对照。黄斑和乳头周围SD-OCT测量（Heidelberg Engineering GmbH, Heidelberg, Germany）、糖尿病持续时间、HbA1c水平以及HT和/或HL的存在用于统计分析。结果MA（+）组、MA（-）组与对照组年龄、性别分布相似（p < 0.05）。MA（+）组、MA（-）组与对照组SD-OCT测量值差异无统计学意义（p < 0.05）。然而，糖尿病患者（n = 95）的颞下乳头状周围视网膜神经纤维层（RNFL）明显比对照组（n = 91）薄（p = 0.042）。在HbA1c水平为bb0.7%的患者中，上乳头周围RNFL明显变薄（p = 0.049）。然而，DM病程超过10年的患者3 mm鼻、颞、上凹周厚度显著降低（p < 0.05）。HT和/或HL共存不导致组间SD-OCT参数的显著差异。结论在无DR的糖尿病患者中，乳头周围颞下RNFL变薄可能是神经视网膜变性的早期征兆，它似乎与血管内皮损伤（MA）无关。代谢控制不佳可能导致上乳头状周围RNFL变薄，而随着糖尿病持续时间的延长，裂孔周围厚度趋于减少。
Background/Objectives To investigate effects of microalbuminuria (MA), diabetes duration, glycosylated haemoglobin (HbA1c) level, hypertension (HT) and/or hyperlipidaemia (HL) coexistence on retinal layers in diabetic patients without diabetic retinopathy (DR) using spectral-domain optical coherence tomography (SD-OCT). Subjects/Methods This cross-sectional study involved 95 (45 had MA and 50 had no MA) patients with type 2 diabetes mellitus (DM) without DR and 91 age- and gender-matched non-diabetic controls. Macular and peripapillary SD-OCT measurements (Heidelberg Engineering GmbH, Heidelberg, Germany), DM duration, HbA1c levels and presence of HT and/or HL were used for statistical analyses. Results The MA (+), MA (-) and control groups had similar age and gender distribution (p > 0.05). The differences in SD-OCT measurements among the MA (+), MA (-) and control groups were insignificant (p > 0.05). However, diabetic patients (n = 95) had significantly thinner inferior-temporal peripapillary retinal nerve fibre layer (RNFL) (p = 0.042) than in the controls (n = 91). Superior peripapillary RNFL was significantly thinner in patients with an HbA1c level > 7% (p = 0.049). However, 3 mm-nasal, temporal and superior perifoveal thicknesses were significantly lower in patients with DM duration over 10 years (p < 0.05). HT and/or HL coexistence did not lead a significant difference in SD-OCT parameters among the groups. Conclusions In diabetic patients without DR, peripapillary inferior-temporal RNFL thinning might be an early sign of neuroretinal degeneration and it seems to be independent from vascular endothelial damage (MA). Poor metabolic control appears to lead superior peripapillary RNFL thinning, while perifoveal thicknesses tend to decrease with longer DM duration.