非增生型糖尿病视网膜病变患者黄斑中心凹下脉络膜厚度变化

摘要

目的 观察非增生型糖尿病视网膜病变(NPDR)患者黄斑中心凹下脉络膜厚度(SFCT)变化及其与视网膜病变严重程度的关系.方法 内分泌科检查确诊的2型糖尿病(DM)患者93例164只眼(DM组)纳入研究.其中,男性34例,女性59例;平均年龄(59.3±5.6)岁.平均糖尿病病程(5.11±4.64)年.所有患者均行视力、眼压、裂隙灯显微镜、间接检眼镜、A/B型超声、光相干断层扫描(OCT)检查,以及空腹血糖、平均动脉压检查.患者平均眼轴长度(23.04±0.78) mm;平均空腹血糖(8.88±2.59) mmol/L;平均动脉压(100.44±9.63) mmHg.按糖尿病视网膜病变(DR)国际分期标准将DM组分为无DR (NDR)组、轻度NPDR组、中度NPDR组、重度NPDR组,分别为64、33、37、30只眼.选取同期正常受试者25例42只眼作为对照组.应用Topcom 3D-OCT仪测量受检者黄斑SFCT.采用完全随机设计资料的方差分析法分析SFCT变化及其与DR严重程度的关系以及糖尿病病程、空腹血糖、平均动脉压、眼轴长度与SFCT的相关性.结果 DM组SFCT为130.5～340.0 μm,平均SFCT为(224.24±42.10)μm.正常对照组SFCT为141.5～415.0μtm,平均SFCT为(276.77±48.07) μm.DM组SFCT与正常对照组SFCT比较,差异有统计学意义(F=23.86,P＜0.05).NDR组、轻度NPDR组、中度NPDR组、重度NPDR组间SFCT比较,差异有统计学意义(P＜0.05).NDR组SFCT较轻度NPDR组SFCT厚,但差异无统计学意义(P＜0.05);中度NPDR组SFCT与重度NPDR组SFCT比较,中度NPDR组SFCT较厚,但差异也无统计学意义(P＞0.05).SFCT与DR严重程度呈负直线相关关系(r=-0.555,P=0.000);糖尿病病程与SFCT呈负相关(r=-0.332,P=0.001);而空腹血糖(r=-0.123)、平均动脉压(r=-0.116)、眼轴长度(r=-0.018)与SFCT无相关性(P＞0.05).结论 DM患者较正常对照者SFCT变薄;不同分期DR患者间SFCT也存在差异,随DR严重程度增加SFCT逐渐变薄.%Objective To investigate the change of subfoveal choroidal thickness (SFCT) and the relationship between SFCT and the severity of the diabetic retinopathy using enhanced depth imaging optical coherence tomography (EDI-OCT).Methods A total of 164 eyes (93 patients) of type 2 diabetes mellitus (DM) were included in this study.The patients included 34 males and 59 females,with an average age of (59.3±5.6) years,with an average diabetes duration of (5.11 ±4.64) years.The patients were divided into 4 groups according to international classification standards of DR,including non-diabetic retinopathy (NDR) group (64 eyes),mild non-proliferative diabetic retinopathy (NPDR) group (33 eyes),moderate NPDR group (37 eyes),and severe NPDR group (30 eyes).The control group included 25 normal subjects (42 eyes).All patients underwent visual acuity,intraocular pressure,slit lamp microscope,indirect ophthalmoscope,A/B-type ultrasound scan,frequency domain optical coherence tomography (SD-OCT) examination,as well as fasting blood glucose and mean arterial blood pressure measurement.The mean axial length was (23.04 ± 0.78) mm,mean fasting blood glucose was (8.88 ± 2.59) mmol/L,mean arterial pressure was (100.44±9.63) mmHg.SFCT of all eyes were measured by EDI-OCT.The relationship between SFCT and the severity of the diabetic retinopathy,DM duration,fasting blood glucose,the mean arterial pressure,axial length was analyzed by one-way ANOVA.Results The mean SFCT was (224.24± 42.10) μm in DM group and (276.77±48.07) μm in normal control group,the difference was statistically significant (F=23.86,P＜0.05).The mean SFCT was also statistically significant between all DM groups (P＜0.05).There were negative linear correlation between SFCT of all patients and the severity of retinal lesions (r=-0.555,P=0.000),and between SFCT and DM duration (r=-0.332,P＜0.05).But SFCT was independent of fasting plasma glucose (r=-0.123,P＞0.05),mean arterial pressure (r=-0.116,P＞ 0.05),and axial length (r=-0.018,P＞0.05).Conclusions SFCT in DM eyes is thinner than that in normal controls.SFCT is different in the NDR,mild NPDR,moderate NPDR,severe NPDR patient.Severe DR patients have much thinner SFCT.