目的：通过光学相干断层扫描(OCT)检测2型糖尿病患者黄斑区各层厚度预测糖尿病视网膜病变(DR)进展。

方法：回顾性研究。收集2023年1月至2024年9月我院收治的2型糖尿病患者100例200眼临床资料，并根据国际临床DR分级分为无糖尿病视网膜病变(NDR)组32例64眼、非增殖性糖尿病视网膜病变(NPDR)组38例76眼和增殖性糖尿病视网膜病变(PDR)组30例60眼。收集同期与糖尿病患者年龄与性别分布相匹配的体检健康者49例98眼作为正常组。所有参与者均行OCT检查，比较各组参与者黄斑各分区神经纤维层(RNFL)、神经节细胞层(GCL)、内丛状层(IPL)、外核层(ONL)、光感受器细胞层和总视网膜厚度(RT)变化，Eta系数分析其与DR严重程度的相关性。

结果： PDR组患者黄斑区各分区及平均RNFL、GCL、IPL、ONL和光感受器细胞层厚度明显低于NDR组和正常组，而黄斑区平均RT厚度明显高于NPDR组、NDR组和正常组(均P<0.05)； PDR组患者黄斑区RNFL(中央区、上方内外环和下方内外环以及平均)、GCL(上方内外环和下方内外环以及平均)、IPL(上方内环)、ONL(中央、上方内环和下方内环)和光感受器细胞层(上方内外环和下方内外环以及平均)厚度明显高于NPDR组(均P<0.05)。NPDR组患者黄斑区各分区及平均RNFL、GCL、IPL、ONL和光感受器细胞层明显低于NDR组和正常组，而黄斑区平均RT厚度明显高于NDR组和正常组(均P<0.05)； NDR组以上指标与正常组比较差异无统计学意义(均P>0.05)。DR严重程度与黄斑区平均RNFL、GCL、IPL、ONL、光感受器细胞层和RT厚度有一定的相关性(均P<0.001)。

结论：OCT检测2型糖尿病患者黄斑区RNFL、GCL、IPL、ONL、光感受器细胞层和RT厚度能评估DR病情进展。

METHODS: Retrospective study. The clinical data of 100 cases(200 eyes)of diabetic patients admitted to our hospital from January 2023 to September 2024 were collected. According to the international clinical DR classification, they were divided into the non-diabetic retinopathy(NDR)group with 32 cases(64 eyes), the non-proliferative diabetic retinopathy(NPDR)group with 38 cases(76 eyes), and the proliferative diabetic retinopathy(PDR)group with 30 cases(60 eyes). At the same time, 49 cases(98 eyes)of healthy controls whose age and gender were matched with those of the diabetic patients were collected as the normal group. All patients underwent OCT examination. The thickness changes of the retinal nerve fiber layer(RNFL), ganglion cell layer(GCL), inner plexiform layer(IPL), outer nuclear layer(ONL), photoreceptor cell layer and total retinal thickness(RT)in the subregions of the macular area were compared among the groups. The Eta coefficient was used to analyze the correlation between them and the severity of DR.

RESULTS: The thickness of RNFL, GCL, IPL, ONL and photoreceptor cell layer in each sub-region and the average of macular area in the PDR group was significantly lower than that in the NDR and normal groups, while the average RT thickness was significantly higher than that in the NPDR, NDR and normal groups(all P<0.05). The thickness of RNFL(central area, upper inner and outer rings and lower inner and outer rings and average), GCL(upper inner and outer rings and lower inner and outer rings and average), IPL(upper inner ring), ONL(central, upper inner ring and lower inner ring)and photoreceptor cell layer(upper inner and outer rings and lower inner and outer rings and average)in macular area of the PDR group was significantly thicker than that in the NPDR group(all P<0.05). The thickness of RNFL, GCL, IPL, ONL and photoreceptor cell layer in each sub-region and the average of macular area in the NPDR group was significantly lower than that in the NDR and normal groups, while the average RT thickness was significantly thicker than that in the NDR and normal groups(all P<0.05). There was no statistically significant difference in the above indicators between the NDR group and the normal group(all P>0.05). The severity of DR was significantly correlated with the average thickness of RNFL, GCL, IPL, ONL, photoreceptor cell layer and RT in macular area(all P<0.001).

CONCLUSION: OCT measurement of the thickness of RNFL, GCL, IPL, ONL, photoreceptor cell layer and RT in the macular area in the diabetic patients can evaluate the progression of DR.