2型糖尿病患者黄斑区结构改变与视力的相关性分析

目的观察不同眼底病变程度的2型糖尿病患者浅层黄斑中心凹无血管区(FAZ)面积、黄斑中心凹视网膜厚度(CFT)、黄斑神经节细胞-内丛状层(GCIPL)厚度等黄斑区结构改变与BCVA的相关性。方法前瞻性临床研究。2018年1月至2019年1月在中国医科大学附属盛京医院确诊为2型糖尿病的51例患者83只眼纳入研究。其中,男性31例,女性20例;平均年龄(53.4±7.8)岁。依据糖尿病视网膜病变(DR)国际临床分期标准将患者分为无DR(NDR)组17例31只眼,非增生型DR(NPDR)组34例52只眼。选取同期年龄、性别相匹配的健康体检者8例13只眼作为正常对照组。所有受检者均采用国际标准视力表行BCVA检查,并将结果转换为logMAR视力记录;采用OCT检查测量CFT、GCIPL厚度平均值与最小值;应用OCT血管成像(OCTA)对黄斑区视网膜行3 mm×3 mm范围模式扫描,通过Photoshop软件测量浅层FAZ面积。对比分析各组患者浅层FAZ面积、BCVA、CFT、GCIPL平均及最小厚度差异性。三组计量资料比较采用方差分析;三组计数资料比较采用χ2检验;对各因素间相关分析采用Pearson相关性分析。结果正常对照组、NDR组、NPDR组患者平均浅层FAZ面积分别为(0.314±0.103)、(0.349±0.102)、(0.416±0.148)mm2;平均logMAR BCVA分别为0.015±0.038、0.029±0.059、0.129±0.133;平均CFT分别为(247.46±13.35)、(244.13±25.09)、(263.12±24.96)μm;平均GCIPL平均厚度分别为(89.00±4.98)、(86.06±4.43)、(82.61±14.32)μm;平均GCIPL最小厚度分别为(84.85±3.18)、(80.68±5.39)、(71.19±19.94)μm。三组间浅层FAZ面积、logMAR BCVA、CFT、GCIPL最小厚度比较,差异均有统计学意义(F=4.660、11.708、6.891、6.333,P=0.012、0.000、0.002、0.003)。Pearson相关性分析结果显示,BCVA与浅层FAZ面积呈正相关(r=0.335,P=0.001),与GCIPL平均厚度、GCIPL最小厚度呈负相关(r=-0.348、-0.416,P=0.001、0.000),与CFT无明显相关性(r=0.171,P=0.095);浅层FAZ面积与CFT、GCIPL最小厚度呈负相关(r=-0.262、-0.213,P=0.010、0.037),与GCIPL平均厚度无明显相关性(r=-0.179,P=0.081)。结论随着2型糖尿病患者眼底病变程度加重,浅层FAZ面积逐渐扩大,GCIPL最小厚度逐渐变薄,BCVA逐渐下降。BCVA与浅层FAZ面积及GCIPL厚度明显相关,浅层FAZ面积与CFT及GCIPL最小厚度明显相关。

Correlation between the changes of macular structure and visual acuity in patients with type 2 diabetes mellitus

Objective To observe the correlation between the changes of area foveal avascular zone(FAZ),central foveal thickness(CFT),the thickness of the macular ganglion cell-inner plexiform layer(GCIPL)and the BCVA in type 2 diabetic mellitus patients with different fundus lesions.Methods A prospective clinical study.Eighty-three eyes of 51 patients with type 2 diabetic mellitus were collected in Shengjing Hospital of China Medical University from January 2018 to January 2019,including 31 males and 20 females.The average age was 53.4±7.8 years.According to the diabetic retinopathy international clinical staging criteria,the patients were divided into the non-diabetic retinopathy(NDR)group with 17 patients(31 eyes),and the non-proliferative diabetic retinopathy(NPDR)group with 34 patients(52 eyes).And 13 control eyes of 8 age-and sex-matched healthy physical examination subjects(control group)were selected in this study.The BCVA examination was performed using the international standard visual acuity chart,which was converted intoIogMAR visual acuity.OCT was used to measure the CFT,the mean and the minimum thickness of GCIPL.OCT angiography(OCTA)examination was applied to obtain blood flow density scan images in macular area of 3 mm×3 mm size.The superficial FAZ area was measured by Photoshop software.The differences of the superficial FAZ area,BCVA,CFT,the mean and the minimum thickness of GCIPL in each group were statistically analyzed,and to explore the correlation between the parameters.Analysis of variance was used to compare measurement data among three groups,and chi-square test was used for the comparison of counting data among three groups.The statistical correlation was evaluated using Pearson’s correlation coefficient.Results The average area of superficial FAZ area in the control group,NDR group and NPDR group were 0.314±0.103,0.349±0.102,0.416±0.148 mm2;the mean logMAR BCVA were 0.015±0.038,0.029±0.059,0.129±0.133;the mean CFT were 247.46±13.35,244.13±25.09,263.12±24.96μm;the mean GCIPL thickness were 89.00±4.98,86.06±4.43,82.61±14.32μm;the mean minimum GCIPL thickness were 84.85±3.18,80.68±5.39,71.19±19.94μm,respectively.The superficial FAZ area,logMAR BCVA,CFT and the minimum thickness of GCIPL showed significant differences(F=4.660,11.708,6.891,6.333;P=0.012,0.000,0.002,0.003)among these three groups.Correlation analysis showed that the logMAR BCVA was positively correlated with the superficial FAZ area(r=0.335,P=0.001),negatively correlated with the mean GCIPL thickness(r=-0.348,P=0.001)and the minimum GCIPL thickness(r=-0.416,P=0.000),no significant correlated with the CFT(r=0.171,P=0.095).The superficial FAZ area was negatively correlated with the CFT(r=-0.262,P=0.010)and the minimum GCIPL thickness(r=-0.213,P=0.037),no significant correlated with the mean GCIPL thickness(r=-0.179,P=0.081).Conclusions With the aggravation of fundus lesions in patients with type 2 diabetic mellitus,the superficial FAZ area gradually expands,the minimum GCIPL thickness gradually becomes thinner and the BCVA gradually decreases.Both the superficial FAZ area and the GCIPL thickness are correlated with BCVA.The superficial FAZ area is correlated with CFT and the minimum GCIPL thickness.