方法：回顾性分析。选取在抚顺市将军社区医院就诊的2型糖尿病患者378例400眼，男184例193眼，女194例207眼，年龄43～76(平均59.0±9.7)岁。根据DR分期标准，将伴有眼底改变的DR患者278例300眼分为DR1、DR2和DR3 三组，无眼底改变的糖尿病患者100例100眼做对照组，共4组。应用频域OCT快速扫描模式扫描4组患者视盘周围3.4mm直径范围，按照不同区域记录视神经纤维层(retinal nerve fiber layer thickness， RNFL)厚度。采用应用独立样本t检验和单因素方差分析比较各组RNFL厚度是否存在差异。

结果：对照组、DR1、DR2及DR3组的平均RNFL厚度分别为109.52±7.13、108.51±7.09、99.37±8.92、98.48±8.57μm； 与对照组比较，DR各分期组的RNFL厚度差异有统计学意义(P<0. 05)。不同区域RNFL厚度的比较发现：对照组和DR组(1～3期)的RNFL厚度分布具有相似性，即鼻侧和颞侧RNFL最薄，颞上和颞下象限RNFL最厚。最薄与最厚处比较，差异有统计学意义(P<0.05)。与对照组相比，DR1期患者视盘鼻侧、颞上、鼻下象限的RNFL厚度差异有统计学意义(P<0.05)； DR2期的鼻侧、颞上、鼻下象限的RNFL厚度差异有统计学意义(P<0.05)； DR3期各个象限RNFL厚度差异均有统计学意义(P<0.05)。DR1期与DR2期相比，各个象限差异均无统计学意义(P>0.05)； DR1期与DR3期相比，除颞侧象限外均有统计学意义(P<0.05)； DR2期与DR3期相比，除颞侧象限外均有统计学意义(P<0.05)。

结论：视盘旁RNFL厚度是早期诊断DR的敏感指标之一，将OCT应用于社区DR的筛查有助于疾病的早期预测及病情进展评估。

METHODS: Retrospective analysis. A total of 378 cases with type 2 diabetes mellitus in Fushun, 184 males(193 eyes)and 194 females(207 eyes), aged from 43 to 76(averaged 59.0±9.7), were chosen in JiangJun community hospital. According to DR staging standard, 278 patients(300 eyes)with fundus changing were divided into 3 groups: DR1, DR2 and DR3. A total of 100 patients(100 eyes)with no fundus changing were as a control group. Spectralis OCT(Heidelberg, German)was used to scan retina of 3.4mm range around the optic disc with fast scanning mode and the thickness of retinal nerve fiber layer(RNFL)with different areas were recorded. Independent sample t-test and one-way ANOVA were used to compare the difference of RNFL thickness in each group.

RESULTS: The averaged thickness of RNFL in control, DR1, DR2, and DR3 group were 109.52±7.13μm, 108.51±7.09μm, 99.37±8.92μm and 98.48±8.57μm, respectively. Significant differences were found in the RNFL thickness between control group and DR 1-3 group(P<0.05). Comparison of the RNFL thickness in different areas: the distributions of RNFL thickness in control and DR groups were similar, where the RNFL in nasal and temporal optic disc was thinnest and superior and inferior temporal RNFL was thickest. There was statistic difference between the thinnest and thickest RNFL(P<0.05). The differences of the nasal, superior temporal and inferior nasal RNFL were found between DR1 group and control group(P<0.05); the differences of the nasal, superior temporal and inferior nasal RNFL were found between DR2 group and control group(P<0.05); the differences of RNFL in each area were found between DR3 group and control group(P<0.05). No difference of RNFL in each area was found between DR1 and DR2 group(P>0.05); the differences of RNFL in each area were found between DR1 and DR3 group(P<0.05)except temporal RNFL; the differences of RNFL in each area were found between DR2 and DR3 group(P<0.05)except temporal RNFL.

CONCLUSION: The RNFL thickness is one of the sensitive indexes for early diagnosis of DR. The application of OCT in community hospitals for DR screening is helpful to the early prediction and the assessment of DR progression.