轻度非增殖期糖尿病视网膜病变患者对比敏感度与其黄体生成素的相关性研究

Correlation between Contrast Sensitivity and Its Luteinizing Hormone in Patients with Mild Non-Proliferative Diabetic Retinopathy

摘要: 目的：研究轻度非增殖期糖尿病性视网膜病变(Non-proliferative diabetic retinopathy, NPDR)患者不同空间频率的对比敏感度(Contrast sensitivity, CS)和低对比度视力(Low-contrast visual acuity, LCVA)的变化与其黄体生成素水平(Luteinizing hormone, LH)的相关性。方法：本研究共选取2022年3月至2022年9月在重庆医科大学附属永川医院眼科住院的2型糖尿病患者40例(80眼)，并选取体检健康无糖尿病患者20例(40眼)作为正常对照组。所有患者均仔细询问病史，收集并检测患者外周血清LH水平及空腹血浆葡萄糖(Fasting blood glucose, FBG)等相关生化指标，并进行视力检测、裂隙灯检查、眼底检查、CS和LCVA检测。糖尿病患者(Diabetes mellitus, DM)另行荧光素眼底血管造影检查(Fundus fluorescein angiography, FFA)、眼底照相及光学相干断层扫描(Optical coherence tomography, OCT)，根据结果分为无糖尿病性视网膜病变组(Non-diabetic retinopathy, NDR)和轻度非增殖期糖尿病视网膜病变组(Non-proliferative diabetic retinopathy, NPDR)，分析轻度NPDR患者CS及LCVA的变化及其与LH水平的相关性。结果：三组之间年龄差异有统计学意义(P < 0.05)，NDR组及轻度NPDR组在空间频率为0.75 c/d、1.5 c/d、3 c/d、6 c/d、12 c/d下的CS均低于正常对照组(P < 0.05)，年龄校正后，轻度NPDR组和NDR组与正常对照组相比，在各空间频率的CS均低于正常对照组(P < 0.01)；轻度NPDR组在对比度为6%、4.3%和3.2%时的视力低于NDR组，差异有统计学意义(P < 0.001)，年龄校正后在对比度6%时轻度NPDR组的视力低于NDR组，在对比度为6%、4.3%和3.2%时轻度NPDR组的视力低于对照组，且NDR组视力低于对照组；三组男性患者血清LH水平存在显著差异，且DR病变程度与血清LH水平呈正相关，三组之间女性患者的血清LH水平无显著差异；LCVA与受试者血清LH水平无相关关系(P > 0.05)；另外，在空间频率为3 c/d、6 c/d时轻度NPDR组患者的血清LH水平与对比敏感度呈负相关关系。结论：轻度NPDR患者的CS和LCVA均下降，CS及LCVA检测可用于DR患者视觉功能损害的早期监测。男性糖尿病患者LH水平与DR程度及视觉功能存在一定相关性，LH水平越高，患者DR程度越严重，这可能为临床糖尿病视网膜病变治疗靶点的选择提供理论依据。

Abstract: Objection: To study the changes in contrast sensitivity (CS) and low-contrast visual acuity (LCVA) at different spatial frequencies and their correlation with luteinizing hormone (LH) levels in patients with mild non-proliferative diabetic retinopathy. Method: We selected 40 patients (80 eyes) with type 2 diabetes mellitus hospitalized in the Ophthalmology Department of Yongchuan Hospital, Chongqing Medical University between March 2022 and September 2022, and selected 20 patients (40 eyes) without diabetes as the control group. All patients were collected their medical history, peripheral blood was taken for examination of biochemical indexes such as serum LH level and fasting plasma glucose (FBG). Visual acuity test, slit-lamp test, fundus test, CS and LCVA tests were measured. Fluorescence angiography, fundus photography and optical coherence tomography (OCT) were measured in diabetic patients. According to the results, the group without diabetic retinopa-thy (non-diabetic retinopathy, NDR) and the group with mild non-proliferative diabetic retinopathy (non-proliferative diabetic retinopathy, NPDR) were divided. The changes in CS and LCVA in pa-tients with mild NPDR and their correlation with LH levels were analyzed. Result: There was a sig-nificant difference in age among the three groups (P < 0.05). The contrast sensitivity of the NDR group and the mild NPDR group at spatial frequencies of 0.75 c/d, 1.5 c/d, 3 c/d, 6 c/d, and 12 c/d was lower than that of the normal control group (P < 0.05). After age correction, there was a signifi-cant difference in contrast sensitivity between the NDR group and the mild NPDR group and the normal control group at each spatial frequency (P < 0.01). The visual acuity of the mild NPDR group at 6%, 4.3%, and 3.2% contrast was lower than that of the NDR group, showing a significant differ-ence (P < 0.001). The mild NPDR group had lower visual acuity than the NDR group at 6% of con-trast after age correction, and the NDR group had lower visual acuity than the normal control group at 6%, 4.3%, and 3.2% contrast, the NDR group had lower visual acuity than the normal control group. LH serum level was positively correlated with diabetic retinopathy in male patients, but there was no significant difference in LH serum level in female patients. There was no correlation between LCVA and serum LH level (P > 0.05). LH serum levels in the NPDR group were negatively correlated with contrast sensitivity at spatial frequencies of 3 c/d, 6 c/d. Conclusion: CS and LCVA were decreased in mild NPDR group, they can be used for early monitoring of visual function im-pairment in DR patients. There is a correlation between LH level and the degree of DR and visual function in male diabetic patients, the higher the LH level, the more severe the degree of DR in pa-tients, which may provide a theoretical basis for the selection of therapeutic targets for clinical dia-betic retinopathy.