摘要
目的 观察应用光学相干断层扫描成像(OCT)测量不同程度糖尿病视网膜病变(DR)患者视网膜神经纤维层(RNFL)及黄斑视网膜厚度.方法 回顾性病例对照研究.纳入 2021 年 5 月至 2023 年 5 月在金华市人民医院收治的糖尿病患者 117 例(234 眼),根据检眼镜和眼底荧光血管造影检查结果分为无糖尿病视网膜病变(NDR)组(32 例,64 眼)、轻度非增生型糖尿病视网膜病变(NPDR)组(46 例,92 眼)、中度 NPDR组(39 例,78 眼).所有患者均行 OCT检查,比较各组平均RNFL(鼻侧、颞侧、上方、下方和视盘周围)、黄斑视网膜厚度和中心区厚度,分析其与DR严重程度关系.结果 NDR组、轻度NPDR组、中度NPDR组鼻侧RNFL厚度为(85.92±8.12)、(81.35±6.28)、(76.41±5.20)μm,颞侧为(88.54±6.74)、(84.16±5.39)、(80.27±7.18)μm,视盘周围为(112.34±10.05)、(108.57±11.26)、(102.71±10.29)μm,上方为(126.67±13.43)、(118.31±12.72)、(111.89±10.50)μm,下方为(125.91±14.23)、(116.42±13.84)、(106.07±12.33)μm,总体差异有统计学意义(F=37.66、29.33、15.02、25.66、38.46,均P<0.001),其中轻度NPDR组、中度NPDR组均低于NDR组(均P<0.05).NDR 组、轻度 NPDR 组、中度 NPDR 组黄斑区视网膜厚度为(229.78±15.64)、(240.56±16.08)、(269.22±17.41)μm,中心区厚度为(175.82±13.05)、(184.90±14.11)、(197.43±14.75)μm,总体差异有统计学意义(F= 113.69、42.69,均 P<0.001).其中轻度 NPDR 组及中度NPDR组均高于NDR组(均P<0.05).DR病情严重程度与平均RNFL(鼻侧、颞侧、上方、下方和视盘周围)厚度呈负相关,与黄斑区视网膜厚度和中心区视网膜厚度呈正相关(r=-0.53、-0.45、-0.61、-0.63、-0.53、0.59、0.55,均P<0.001).结论 应用OCT扫描能早期评估DR患者病变严重程度,且随着疾病严重程度加重,视盘周围RNFL厚度呈下降改变,黄斑区视网膜厚度逐渐升高.
Abstract
Objective To observe the application of optical coherence tomography(OCT)in measuring retinal nerve fiber layer(RNFL)thickness and retinal thickness in patients with different severity of diabetic retinopathy(DR).Methods In this retrospective case-control study,117 patients(234 eyes)with diabetes mellitus in Jinhua People's Hospital were enrolled from May 2021 to May 2023.Based on examination results of ophthalmoscope and fluorescence fundus angiography,they were divided into a non-diabetic retinopathy(NDR)group(32 cases,64 eyes),a mild non-proliferative diabetic retinopathy(NPDR)group(46 cases,92 eyes)and a moderate NPDR group(39 cases,78 eyes).All patients underwent OCT examination.The mean RNFL(nasal side,temporal side,above,below and around optic disk),macular retinal thickness and central retinal thickness in different groups were compared,and their relationship with DR severity was analyzed.Results In the NDR group,the mild NPDR group and the moderate NPDR group,RNFL thickness at nasal side was(85.92±8.12),(81.35±6.28)and(76.41±5.20)μm;RNFL thickness at temporal side was(88.54±6.74),(84.16±5.39)and(80.27±7.18)μm;RNFL thickness around optic disk was(112.34±10.05),(108.57±11.26)and(102.71±10.29)μm;RNFL thickness above optic disk was(126.67±13.43),(118.31±12.72)and(111.89±10.50)μm;RNFL thickness below optic disk was(125.91±14.23),(116.42±13.84)and(106.07±12.33)μm.The overall differences were statistically significant(F= 37.66,29.33,15.02,25.66,38.46;all P<0.001),and the above indexes in the mild and moderate NPDR groups were lower than those in the NDR group(all P<0.05).In the NDR group,the mild NPDR group and the moderate NPDR group,macular retinal thickness was(229.78±15.64),(240.56±16.08)and(269.22±17.41)μm,central thickness was(175.82±13.05),(184.90±14.11)and(197.43±14.75)μm.The overall differences were statistically significant(F=113.69,42.69;all P<0.001),and the above indexes in the mild and moderate NPDR groups were higher than those in the NDR group(all P<0.05).The severity of DR was negatively correlated with mean RNFL(nasal side,temporal side,above,below and around optic disk)thickness,while positively correlated with mean macular retinal thickness and central retinal thickness(r=-0.53,-0.45,-0.61,-0.63,-0.53,0.59,0.55;all P<0.001).Conclusion OCT application can early evaluate the severity of lesions in patients with DR.With the aggravation of disease severity,RNFL thickness around the optic disc decreases,while macular retinal thickness gradually increases.
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