Systemic inflammatory markers and neurovascular changes in the retina and choroid of diabetic patients without retinopathy: insights from wide-field SS-OCTA.
Qinxing Wu, Bin Zhao, Shengliang Dongye, Lu Sun, Bo An, Qian Xu
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Abstract
Purpose: The purpose of this study was to investigate the association between systemic inflammation markers and early neuronal and microvascular changes in the retinal and choroidal regions of patients with type 2 diabetes mellitus (T2DM) without clinical signs of diabetic retinopathy (DR), utilizing wide-field swept-source optical coherence tomography angiography (SS-OCTA).
Methods: This retrospective, observational cohort study included 61 patients (119 eyes) with T2DM without clinical DR (NDR group) and 44 healthy individuals (82 eyes) as controls. All participants underwent a comprehensive ophthalmic evaluation and blood sampling for hematologic indices. Inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI), were calculated. The mean thickness of the retina, choroid, and individual inner retinal layers, as well as the vessel density measurements of the superficial and deep retinal layers, and the choriocapillaris perfusion area, were recorded and analyzed from the OCTA images. Additionally, the choroidal vascularity index (CVI) was determined.
Results: The NDR group demonstrated significantly higher levels of NLR, SII, and SIRI compared to the control group (p < 0.05). The diabetic cohort showed reduced vessel density in the deep capillary plexus (DCP) across all measured regions (p < 0.05). Significant but weak negative correlations were observed between inflammation markers, particularly NLR, and OCTA parameters, with a marked impact on the DCP (r = -0.21 to -0.32, p < 0.05) and CVI (r = -0.23 to -0.28, p < 0.05).
Conclusion: The study provides new insights into the role of systemic inflammation in early structural and blood flow changes in the retina and choroid, occurring prior to the onset of DR. The findings highlight the importance of inflammation in the pathogenesis of DR, even in the absence of clinical signs, suggesting that systemic inflammatory markers may serve not only as early biomarkers of ocular changes in T2DM but also as potential early therapeutic targets to prevent or delay diabetic retinopathy.
目的：本研究的目的是利用宽视场扫描源光学相干断层扫描血管造影（SS-OCTA）研究无糖尿病视网膜病变（DR）临床体征的2型糖尿病（T2DM）患者视网膜和脉络膜区早期神经元和微血管变化与全身性炎症标志物的关系。方法：采用回顾性、观察性队列研究，纳入61例（119眼）无临床DR的T2DM患者（NDR组）和44例健康人（82眼）作为对照。所有参与者都接受了全面的眼科评估和血液指标的采血。计算炎症标志物，包括中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、单核细胞与淋巴细胞比值（MLR）、全身免疫炎症指数（SII）和全身炎症反应指数（SIRI）。记录并分析OCTA图像中视网膜、脉络膜和单个视网膜内层的平均厚度，以及视网膜浅层和深层血管密度测量，以及绒毛膜毛细血管灌注区。同时测定脉络膜血管指数（CVI）。结果：NDR组NLR、SII和SIRI水平显著高于对照组（p p r = -0.21 ~ -0.32,p r = -0.23 ~ -0.28,p ）。该研究为全身性炎症在DR发病前视网膜和脉络膜早期结构和血流变化中的作用提供了新的见解。研究结果强调了炎症在DR发病机制中的重要性，即使在没有临床体征的情况下，也表明全身性炎症标志物不仅可以作为T2DM患者眼部变化的早期生物标志物，还可以作为预防或延缓糖尿病视网膜病变的潜在早期治疗靶点。
期刊介绍：
Frontiers in Medicine publishes rigorously peer-reviewed research linking basic research to clinical practice and patient care, as well as translating scientific advances into new therapies and diagnostic tools. Led by an outstanding Editorial Board of international experts, this multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide.
In addition to papers that provide a link between basic research and clinical practice, a particular emphasis is given to studies that are directly relevant to patient care. In this spirit, the journal publishes the latest research results and medical knowledge that facilitate the translation of scientific advances into new therapies or diagnostic tools. The full listing of the Specialty Sections represented by Frontiers in Medicine is as listed below. As well as the established medical disciplines, Frontiers in Medicine is launching new sections that together will facilitate
- the use of patient-reported outcomes under real world conditions
- the exploitation of big data and the use of novel information and communication tools in the assessment of new medicines
- the scientific bases for guidelines and decisions from regulatory authorities
- access to medicinal products and medical devices worldwide
- addressing the grand health challenges around the world
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