角膜神经纤维形态参数变化在早期T2DM视网膜病变的应用价值

目的探讨角膜神经纤维形态参数变化在早期发现Ⅱ型糖尿病(T2DM)视网膜病变的应用价值.方法选取T2DM患者236例,其中合并糖尿病视网膜病变114例(Ⅰ期36例,Ⅱ期50例,Ⅲ期28例),无糖尿病视网膜病变122例;另收集同期健康志愿者120例为对照组.使用共焦激光角膜显微镜检测角膜神经纤维形态变化,分析与T2DM视网膜病变临床指标的关系.结果视网膜病变组神经长度、神经纤维密度、神经分支密度明显低于无视网膜病变组和对照组,神经纤维弯曲度明显高于无视网膜病变组和对照组,差异均具有统计学意义(P0.05).无视网膜病变组神经纤维弯曲度、神经分支密度明显高于对照组,差异具有统计学意义(P0.05);无视网膜病变组与对照组神经长度、神经纤维密度之间差异均无统计学意义(P0.05).Ⅲ期视网膜病变患者神经长度、神经纤维密度、神经分支密度均明显低于Ⅰ期和Ⅱ期患者,神经纤维弯曲度明显高于Ⅰ期和Ⅱ期患者,差异均具有统计学意义(P0.05).视网膜病变组患者病程明显长于无视网膜病变组,空腹C肽、GLU明显低于无视网膜病变组,差异均具有统计学意义(P0.05).T2DM患者病程与角膜神经纤维长度和分支密度均呈负相关;T2DM患者空腹C肽水平与角膜神经纤维弯曲度呈负相关,与神经纤维密度呈正相关.结论 T2DM视网膜病变患者角膜神经纤维形态参数发生异常变化,有助于早期发现视网膜病变;对病程较长和空腹C肽水平较低的T2DM患者应用价值更高.

Application Value of Morphological Parameters Changes of Corneal Nerve Fibers in the Early Detection of T2DM Retinopathy

Objective To investigate the application value of morphological parameters changes of corneal nerve fibers in the early detection of type 2 diabetic retinopathy (T2DM). Method 236 patients with T2DM including 114 patients with diabetic retinopathy (36 cases of stageⅠ,50 cases of stageⅡ,and 28 cases of stageⅢ) ,122 cases without diabetic retinopathy,and another 120 healthy volunteers as the control were collected in this study. The confocal laser corneal microscope was used to detect the morphological changes of the corneal nerve fibers, and the relationship between the results and clinical indexes of T2DM retinopathy was analyzed. Results Compared with the group without retinopathy and the control group,the nerve length,fiber density nerve and nerve branches density in the retinopathy group were significantly lower,and the curvature of nerve fiber was significantly higher ( P<0. 05) . The degree of nerve fiber curvature and nerve branch density in the group without retinopathy were significantly higher than those in the control group ( P<0. 05 ) . There were no statistically significant differences in nerve length and nerve fiber density between the group without retinopathy and the control group (P>0. 05). Compared with the patients with retinopathy in stageⅠandⅡ,the patients in stageⅢhad shorter nerve length,lower nerve fiber density and nerve branch,and higher nerve curvature,the differences were statistically significant (P<0. 05). In the retinopathy group,the course of disease was significantly longer and the levels of fasting C-peptide and GLU were significantly lower than those in the group without visual omentum lesion ( P<0. 05) . The course of T2DM was negatively correlated with the length of corneal nerve fiber and branch density. The level of fasting C-peptide in T2DM patients was negatively correlated with corneal nerve fiber curvature,and positively correlated with the nerve fiber density. Conclusion Abnormal changes of corneal nerve fiber morphology parameters in patients with T2DM retinopathy are helpful for the early detection of retinopathy. It is more valuable for T2DM patients with longer course and low fasting C-peptide level.