NPDR患者黄斑区视网膜厚度、视网膜神经纤维层厚度与全视野闪光ERG的变化

目的探讨非增生性糖尿病视网膜病变(non-proliferative diabetic retinopathy,NPDR)患者黄斑区视网膜厚度(retinal thickness,RT)、视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度与全视野闪光视网膜电图(electroretinogram,ERG)的变化及相互关系。方法选择2010年2月至12月于我院就诊的2型糖尿病患者91例(168眼),依据糖尿病视网膜病变(diabetic retinopathy,DR)国际分期标准分为3组:无糖尿病视网膜病变(NDR)组39例(78眼),轻度NPDR组28例(52眼),中重度NPDR组24例(38眼)。另选择同龄正常人30例(60眼)作为正常对照组。通过光学相干断层扫描检测黄斑区中心RT及RN-FL厚度,全视野闪光ERG检测视网膜功能。结果 NDR组、轻度NPDR组、中重度NPDR组患者黄斑区RT分别为(198.01±22.51)μm、(218.00±28.15)μm、(239.90±65.04)μm,均较正常对照组(184.45±18.50)μm增厚,差异均有统计学意义(t=2.312、5.235、7.947,均为P<0.05);随着DR加重,糖尿病各组间黄斑区RT比较,差异均有显著统计学意义(t=3.305、6.300、3.069,均为P<0.01)。正常对照组与NDR组黄斑区RNFL厚度比较,差异无统计学意义(P>0.05);轻度NDPR组及中重度NPDR组与正常对照组相比,黄斑区RNFL厚度变薄,差异均有统计学意义(均为P<0.05)。与正常对照组比较,中重度NPDR组全视野闪光ERG暗适应0.01反应及明适应3.0反应b波潜伏期明显延长(均为P<0.05),暗适应0.01反应b波振幅和暗适应3.0反应a波振幅均下降(均为P<0.05)。结论随着NPDR病情加重,2型糖尿病患者黄斑区中心RT增加,RNFL厚度减小,视网膜功能受损。

Changes of macular retinal thickness,retinal nerve fiber layer thickness and full-field flare ERG in NPDR patients

Objective To research the changes of macular retinal thickness (RT),retinal nerve fiber thickness layer (RNFL) thickness and full-filed flare electroretinogram (ERG) in patents with non-proliferative diabetic retinopathy (NPDR) and their relationship. Methods Ninety-one patients (168 eyes) with type 2 diabetes mellitus in our hospital from February 2010 to December 2010 were chosen and divided into three groups based on international stage standard of diabetic retinopathy (DR):no diabetic retinopathy (NDR) group (39 cases,78 eyes),mild non-proliferative NPDR group (28 cases,52 eyes),moderate and severe NPDR group (24 cases,38 eyes).Another 30 age-matched participants (60 eyes) were enrolled as normal control group.The macular RT and RNFL thickness in patients of three groups were detected by optical coherence tomography,and the retinal function was examined with full-filed flare ERG. Results The macular RT in NDR,mild NPDR,moderate and severe NPDR groups were (198.01±22.51)μm,(218.00±28.15)μm and (239.90±65.04)μm,respectively,which all thicker than that in normal control group (184.45±18.50)μm,there were statistical differences(t=2.312,5.235,7.947,all P<0.05).With the progression of DR,there were significant differences in RT among NDR,mild NPDR,moderate and severe NPDR groups(t=3.305,6.300,3.069,all P<0.01).There was no statistical difference in RNFL thickness between normal control group and NDR group(P>0.05).The macular RNFL thickness in mild,moderate and severe NPDR groups were thinner than that in normal control group,there were statistical differences(both P<0.05).Compared with the control group,b-wave latency of scotopic 0.01 response and photopic 3.0 response in moderate and severe NPDR group were obviously prolonged,there were statistical differences(both P<0.05);The amplitude of b-wave in scotopic 0.01 response and a-wave in scotopic 3.0 response in moderate and severe NPDR group were decreased,there were statistical differences(both P<0.05). Conclusion With progress of NPDR,the macular RT in type 2 diabetes patients increases,RNFL thickness decreases and the retinal function is impaired.