糖尿病患者血清中同型半胱氨酸水平与视网膜神经节细胞层厚度的相关性研究

目的　探讨2型糖尿病患者血清中同型半胱氨酸（homocysteine，Hcy）水平与视网膜神经节细胞层（ganglion cell layer，GCL）厚度之间的相关性。方法　收集2016年10月至2017年10月就诊于中国医科大学附属盛京医院的60例糖尿病患者和30人健康对照者（对照组），根据ETDRS分类将糖尿病患者分为两组:不伴眼底病变的糖尿病患者组（NDR组，n=30）和非增殖期糖尿病视网膜病变患者组（NPDR组，n=30），检测所有病例血清中Hcy水平，并使用光学相干断层扫描测量其视网膜GCL厚度。分析血清中Hcy水平和GCL厚度变化及两者之间的相关性。结果　对照组、NDR组和NPDR组血清中Hcy水平分别为（11.87±2.19）nmol·L^-1、（14.87±0.42）nmol·L^-1、（20.77±2.40）nmol·L^-1，呈明显升高趋势，差异有统计学意义（P=0.000），而GCL厚度分别为（88.33±6.36）μm、（81.73±1.41）μm、（64.00±12.73）μm，呈明显下降趋势，差异也有统计学意义（P=0.000）。随着眼底病变进展，血清中Hcy水平增加，视网膜GCL厚度变薄；Pearson相关性分析发现，血清中Hcy水平与视网膜GCL厚度呈负相关（r=-0.908，P=0.000）。结论　糖尿病患者血清中Hcy水平增加与视网膜GCL厚度变薄相关，Hcy参与了糖尿病视网膜病变的神经退行性病变。

Correlation between serum homocysteine level and retinal ganglion cell layer thickness in diabetic patients

Objective　To explore the correlation between the level of serum homocysteine （Hcy） and the thickness of retinal ganglion cell layer （GCL） on optical coherence tomography （OCT） in patients with type 2 diabetes.Methods　Totally 60 diabetic patients were collected from October 2016 to October 2017 in the Shengjing Hospital of China Medical University，and they were divided into two groups:diabetic patients without retinopathy （NDR group，n=30） and non-proliferative diabetic retinopathy group （NPDR group，n=30） according to the ETDRS classification，and meanwhile additional 30 healthy subjects were enrolled as control group.The level of serum Hcy was detected，and the retinal GCL thickness was measure using OCT in all patients for the analysis of the correlation of serum Hcy level with the thickness of GCL.Results　The serum Hcy level was （11.87±2.19）nmol·L^-1 in the control group，（14.87±0.42）nmol·L^-1 in the NDR group and （20.77±2.40）nmol·L^-1 in the NPDR group，which was significantly increased gradually，and the difference was statistically significant （P=0.000），but the thickness of GCL was （88.33±6.36）μm，（81.73±1.41）μm and （64.00±12.73）μm in the three groups，accordingly，which was decreased significantly gradually，with statistically significant difference （P=0.000）.Along with the progress of fundus lesions，the level of serum Hcy increased，but the thickness of GCL decreased，and there was a significant negative correlation of the serum Hcy level with the thickness of GCL in the retina by Pearson （r=-0.908，P=0.000）.Conclusion　The increase of serum Hcy level in diabetic patients is associated with the decrease of retinal GCL thickness，and Hcy is involved in neurodegenerative changes in patients with diabetic retinopathy.