摘要
目的 观察2型糖尿病患者脉络膜厚度与糖尿病视网膜病变（DR）严重程度的关系.方法 2012年10月至2014年6月于首都医科大学附属北京同仁医院内分泌科门诊就诊的161例2型糖尿病患者纳入本研究,根据早期糖尿病视网膜病变治疗研究（ETDRS）标准分为5组：无DR无糖尿病黄斑水肿（DR-/DME-）组45例（45只眼）;非增殖型糖尿病视网膜病变（NPDR）无糖尿病黄斑水肿（NPDR ＋/DME-）组58例（58只眼）;增殖型糖尿病视网膜病变（PDR）无糖尿病黄斑水肿（PDR ＋/DME-）组12例（12只眼）;NPDR伴糖尿病黄斑水肿（NPDR ＋/DME＋）组41例（41只眼）;PDR伴糖尿病黄斑水肿（PDR ＋/DME＋）组5例（5只眼）.选取同期招募的健康受试者60例作为对照组.全部研究对象行增强深部成像光学相干断层扫描（EDI-OCT）.比较不同阶段DR中心凹下脉络膜厚度（SFCT）的差异,分析DR的严重程度与SFCT的关系.本研究通过首都医科大学附属北京同仁医院伦理委员会批准.结果 对照组、DR-/DME-组、NPDR ＋/DME-组、PDR ＋/DME-组、NPDR ＋/DME＋组的平均SFCT分别为（271±36）、（270±35）、（262±38）、（244±36）、（229±35）μm;PDR ＋/DME-组、NPDR ＋/DME＋组SFCT均小于对照组（P=0.004、0.001）;PDR ＋/DME-组SFCT小于DR-/DME-组（P=0.003）;NPDR ＋/DME＋组SFCT小于NPDR ＋/DME-组（P=0.001）.SFCT与糖尿病病程、空腹血糖、糖化血红蛋白（HbA1c）、眼轴长度、收缩压及舒张压均无显著相关性（r=-0.024、0.159、0.089、0.036、0.143、0.057,均P＞0.05）,而与最佳矫正视力有相关性（r =0.397,P＜0.01）.不同类型黄斑水肿（弥浸水肿型、囊样水肿型、浆液性神经上皮脱离型、硬性渗出型）患者平均SFCT比较,差异无统计学意义（F=0.071,P＞0.05）.结论 2型糖尿病患者随着视网膜病变严重程度增加,SFCT呈降低的趋势.2型糖尿病患者脉络膜厚度监测将有助于综合分析病情.
Objective To explore the association of choroidal thickness variations in type 2 diabetes mellitus （T2DM） patients with diabetic retinopathy （DR） at different stages.Methods A total of 161 patients with T2DM were included in this study,from October 2012 to June 2014.According to Early Treatment Diabetic Retinopathy Study （ETDRS） criteria,the patients were divided into 5 groups：non-DR without diabetic macular edema （DME） group （DR-/DME-group,45 eyes）,nonproliferative diabetic retinopathy （NPDR） without DME group （NPDR ＋/DME-group,58 eyes）,proliferative diabetic retinopathy （PDR） without DME group （PDR ＋/DME-group,12 eyes）,NPDR with DME group （NPDR ＋/DME ＋ group,41 eyes）,PDR with DME group （PDR ＋/DME ＋ group,5 eyes）.Meanwhile,60 normal subjects were enrolled as the control group.All study subjects received optical coherence tomography enhanced depth imaging （EDI-OCT） examination to detect and compare subfoveal choroidal thickness at different stages of DR.Results Mean SFCT was （271 ± 36）,（270 ± 35）,（262 ± 38）,（244 ±36）,（229 ±35） μm respectively in control,DR-/DME-,NPDR ＋/DME-,PDR ＋/DME-,NPDR ＋/DME ＋ groups.The SFCTs of PDR ＋/DME-and NPDR ＋/DME ＋ group were statistically lower than that of control group（P =0.004,P =0.001）.The SFCT of PDR ＋/DME-group was lower than that of DR-/DME-group（P =0.003）,and there was also a significant difference of SFCT between NPDR ＋/DME ＋ and NPDR ＋/DME-group（P =0.001）.There was linear correlation between SFCT and the logMAR best-corrected visual acuity （r =0.397,P 〈0.01）,but the SFCT was independent of diabetic duration,fasting blood glucose,HbA1c,axial length,diastolic blood pressure （DBP） and systolic blood pressure SBP （r =-0.024,0.159,0.089,0.036,0.143,0.057,all P 〉 0.05）.There was no significant difference of SFCT among different DME types （F =0.071,P 〉 0.05）.Conclusion The SFCT decreased with increasing severity of DR.To monitor the SFCT in T2DM patients may be helpful to evaluate the severity of DR and provide a new treatment conception.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2015年第32期2584-2588,共5页
National Medical Journal of China
基金
北京市重大科技计划项目（D12110000412001）
天津市应用基础及前沿技术研究计划项目（11JCYBJC14000）
