CAJ | 학술논문

目的测量不同程度糖尿病周围神经病变(DPN)的非增生期糖尿病视网膜病变(NPDR)患者视网膜神经纤维层(RNFL)厚度,探讨RNFL厚度与DPN程度的相关性.方法临床病例对照研究.对2011年4月至2012年8月在天津市眼科医院经荧光素眼底血管造影(FFA)检查确诊为非增生期糖尿病视网膜病变(NPDR)的78例患者为研究组,同时选取50名正常人作为对照组.用多伦多临床评分系统(TCSS)评估研究组78例受试者DPN程度,分为4组:无、轻度、中度、重度DPN组.采用光相干断层扫描(OCT)以视盘为中心作直径为3.4 mm的环形扫描,测量视网膜全周平均及上方、下方、鼻侧、和颞侧象限平均RNFL厚度.分析不同程度DPN各组间RNFL厚度差异以及糖尿病视网膜病变(DR)对RNFL厚度的影响.结果按DPN程度分析,与正常对照组相比,轻、中、重度DPN组全周平均、上方和下方RNFL厚度差异均有统计学意义(P＜0.05)；无DPN组与正常对照组下方象限RNFL厚度存在差异有统计学意义(P＜0.05).按视网膜病变程度分析,与正常对照组相比,中度与重度NPDR组全周平均、上方、下方RNFL厚度差异有统计学意义(均为P＜0.05)；轻度NPDR组与正常对照组比较,下方象限RNFL厚度差异有统计学意义(P＜0.05).结论 RNFL厚度的变化与DPN程度存在一定相关性,随着DPN症状的出现和加重,RNFL厚度亦明显变化,提示可通过对DPN的简单评估推测RNFL厚度变化,进而有效指导临床诊疗.
목적 측량불동정도당뇨병주위신경병변(DPN)적비증생기당뇨병시망막병변(NPDR)환자시망막신경섬유층(RNFL)후도,탐토RNFL후도여DPN정도적상관성.방법 림상병례대조연구.대2011년4월지2012년8월재천진시안과의원경형광소안저혈관조영(FFA)검사학진위비증생기당뇨병시망막병변(NPDR)적78례환자위연구조,동시선취50명정상인작위대조조.용다륜다림상평분계통(TCSS)평고연구조78례수시자DPN정도,분위4조:무、경도、중도、중도DPN조.채용광상간단층소묘(OCT)이시반위중심작직경위3.4 mm적배형소묘,측량시망막전주평균급상방、하방、비측、화섭측상한평균RNFL후도.분석불동정도DPN각조간RNFL후도차이이급당뇨병시망막병변(DR)대RNFL후도적영향.결과 안DPN정도분석,여정상대조조상비,경、중、중도DPN조전주평균、상방화하방RNFL후도차이균유통계학의의(P＜0.05)；무DPN조여정상대조조하방상한RNFL후도존재차이유통계학의의(P＜0.05).안시망막병변정도분석,여정상대조조상비,중도여중도NPDR조전주평균、상방、하방RNFL후도차이유통계학의의(균위P＜0.05)；경도NPDR조여정상대조조비교,하방상한RNFL후도차이유통계학의의(P＜0.05).결론 RNFL후도적변화여DPN정도존재일정상관성,수착DPN증상적출현화가중,RNFL후도역명현변화,제시가통과대DPN적간단평고추측RNFL후도변화,진이유효지도림상진료.
Objective To measure the retinal nerve fiber layer (RNF) thickness in patients with non-proliferative diabetic retinopathy (NPDR) of different severity peripheral neuropathy,and explore the correlation between RNFL thickness and severity of diabetic peripheral neuropathy.Methods Seventy-eight patients with NPDR diagnosed by fundus fluorescein angiography (FFA) were included in this study.Normal control group containing 50 cases,The level of neuropathy was assessed in 78 participants using Toronto clinical scoring system (TCSS).Participants were stratified into four neuropathy groups:none,mild,moderate,and severe.The mean RNFL thickness and the superior,inferior,nasal and temporal retinal nerve fiber layer thicknesses were measured at 3.45 mm diameter around,the optic nerve head using optical coherence tomography (OCT).RNFL thickness difference was estimate according to the analysis of DPN degree between the teams,and analysis evaluation retinopathy to the influence of RNFL thickness.Results Compared normal control group with mild,moderate,and severe DPN group,there were statistical differences in the mean and superior,inferior of quadrant of RNFL (P ＜0.05 for all); No DPN group and normal control group comparison,only inferior quadrant RNFL thickness had statistical difference (P ＜0.05).According to the degree of retinopathy,compared with normal control group,moderate and severe NPDR group mean,superior,inferior of quadrant RNFL thickness difference had statistical significance (P ＜0.05 for all); Mild NPDR group and normal control group comparison,inferior quadrant RNFL thickness had statistical difference(P ＜0.05).Conclusions RNFL thinning is associated with peripheral neuropathy in NPDR patients.With DPN symptoms appear and aggravating,RNFL thickness obviously thin.This is a simple method to speculation RNFL thickness change based on simple assessment of DPN,bring convenience for clinical work.