早期2型糖尿病及糖耐量受损患者黄斑视网膜厚度的初步分析

Liang-wen Yan, Li Wei, Li Jia, Wen Li, J. Mu, Shiwei Li
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摘要

目的分析早期2型糖尿病伴糖耐量异常患者视网膜黄斑厚度的变化。方法采用观察性横断面研究。将62例45 ~ 70岁社区居民流行病学调查对象排除一系列系统和眼部异常后,按WHO DM诊断标准分为2型糖尿病(T2DM)组、糖耐量异常(IGT)组和正常对照(CTR)组。采用光谱域眼相干断层扫描(SD-OCT),以6mm ETDRS模式扫描所有受试者的黄斑。采用SAS统计软件对各组黄斑视网膜厚度数据进行分析。结果与CTR比较,T2DM组黄斑视网膜厚度有衰减的趋势;IGT组呈增厚。inT2DM组的内核层(INL)、视网膜内层(IRL)和视网膜外层(ORL)较CTR组明显减弱。与T2DM比较,IGT组IPL、RPEL、INL、IRL均明显增高。结论在未发生糖尿病视网膜病变的情况下,早期T2DM患者的INL可能出现衰减和萎缩;IGT可能增加内视网膜的厚度,引起视网膜水肿。结构改变可能发生在糖尿病早期和IGT期间,这可能不同于微血管病变,也可能发生在微血管病变之前,提示早期T2DM和IGT可能导致视网膜神经变性。关键词:糖尿病;葡萄糖耐量受损;视网膜内;内网状层;内核层;神经退化
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Preliminary analysis of the macular retinal thickness in early stage of type 2 diabetes mellitus and impaired glucose tolerance patients
Objective To analyze the alteration of the macula retinal thickness in early stage of type 2 diabetes mellitus and impaired glucose tolerance patients. Methods An observational crosssectional study. After excluding a series of systematic and ocular abnormalities, 62 cases of epidemiology investigative subjects of community residents aged from 45 to 70 were divided into type2 diabetic mellitus (T2DM), impaired glucose tolerance (IGT), and normal control (CTR) group, followed by the WHO DM diagnostic criteria. All the subjects’macula were scanned by spectral-domain ocular coherence tomography (SD-OCT) with the mode of 6mm ETDRS. Data of macular retinal thickness were analyzed using SAS statistic software among the groups. Results With comparison of CTR, macular retinal thickness in T2DM group has the tendency of attenuation; IGT group show thickening. Inner nuclear layer (INL), inner retinal layer (IRL) and outer retinal layer (ORL) inT2DM group were significantly attenuated than those of CTR group. With comparison of T2DM, IGT group has significant thicker in IPL, RPEL, INL and IRL. Conclusions INL might be attenuated and atrophied during early stage of T2DM patients when no diabetic retinopathy occur; IGT might increase the thickness of the inner retina and cause retinal edema. Structural alteration might be occurred during diabetic early stage and IGT, which might differ from and prior to the microangiopathy as well, suggesting that early stage of T2DM and IGT might lead to retinal neurodegeneration. Key words: Diabetic mellitus; Impaired glucose tolerance; Inner retina; Inner plexiform layer; Inner nuclear layer; Neurodegeneration
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