·AIM:To find the sensitive targets by observing the changes of early fundus detection in function and structure and correlation of systemic monitoring indicators on non-proliferative diabetic retinopathy. ·METHODS: Totally 20 normal peoples ( 40 eyes ) in normal control group and 105 in-patients ( 210 eyes ) in diabetic group, which was divided into two groups, 24 cases (48 eyes) in no diabetic retinopathy (NDR) group, 81 cases ( 162 eyes ) in non - proliferative diabetic retinopathy ( NPDR ) group. The NPDR group was divided into three groups:mild NPDR group 30 cases (60 eyes) , moderate NPDR group 26 cases ( 52 eyes ) and severe NPDR group 25 cases (50 eyes). The retinal blood flow (RBF) of Heidelberg retinal flowmeter (HRF), the OS2 amplitude of oscillatory potentials ( OPs ) and the subfoveal choroidal thickness ( SFCT ) of OCT were measured in normal control group and diabetic group. The duration of diabetes, blood pressure, fasting blood glucose, hemoglobin, blood lipids and coagulation were also examined in each group. All test results in each group were compared and analyzed statistically. ·RESULTS: HRF: the value of RBF in NDR and NPDR group was significantly lower than that in the normal control group (P<0. 05); the value of RBF in moderate NPDR group was obviously higher than that in the other groups (P<0. 05); the value of RBF in the temporal side of the optic disc was higher than that in the nasal side of the optic disc in NPDR group ( P< 0. 05 ). OPs: the amplitude of OS2 in NDR and NPDR group was significantly lower than that in the normal control group (P<0. 05); the amplitude of OS2 of the severe NPDR group and moderate NPDR group were significantly lower than that in mild NPDR group and NDR group ( P<0. 05). OCT: with the progression of DR, the value of SFCT were thinner and thinner (P<0. 05). The duration of diabetes without therapy, diastolic blood pressure, fasting blood glucose, hemoglobin, cholesterol, low density lipoprotein, fibrinogen, D - dimer positively positive correlated with degree of DR ( rs=0. 722, 0. 791, 0. 864, 0. 473, 0. 611, 0. 735, 0. 591, 0. 554, P<0. 05). The occurrence of DR was consistent with other microvascular complications. ·CONCLUSION:The detection of HRF, OPs and OCT can be used as sensitive indicators for the early diagnosis of DR. They can earlier and more accurately reflect the changes of microcirculation function and structure of the fundus. The duration of diabetes, blood pressure, fasting blood glucose, hemoglobin, blood lipids, coagulation status are positive correlated in DR progression. The monitoring of these indicators and disseminating timely healthy information own important clinical value in primary medical care.%目的:观察早期糖尿病视网膜病变(diabetic retinopathy,DR)眼底结构和功能改变的特点及全身监测指标的相关性,明确DR早期监控的敏感临床指标.方法:观察正常对照组20例40眼;糖尿病患者105例210眼,将其分为无视网膜病变的糖尿病组(no diabetic retinopathy,NDR)24例48眼,非增殖性糖尿病视网膜病变组(non-proliferative diabetic retinopathy,NPDR)81例162眼,其中NPDR组又分为三组,轻度30例60眼、中度26例52眼和重度25例50眼.正常对照组和糖尿病患者组检查空腹血糖、糖化血红蛋白、血压、血脂四项和凝血六项;观察糖尿病未正规治疗时间,DR是否合并糖尿病肾病;检测共焦扫描激光多普勒视网膜血流仪(Heidelberg retinal flowmeter,HRF)鼻、颞侧视乳头旁视网膜的血流量(retinal blood flow,RBF),视网膜电图震荡电位(oscillatory potentials,OPs)OS2幅值,OCT扫描黄斑中心凹下脉络膜厚度(subfoveal choroidal thickness,SFCT).对各组检查数据进行比较和统计学分析.结果:HRF:NDR组,轻、中、重度NPDR三组RBF均低于正常对照组,差异有统计学意义(P<0.05).轻、中、重度NPDR三组中,颞侧RBF均高于鼻侧,差异有统计学意义(P<0.05).中度NPDR组RBF均高于NDR组和轻、重度NPDR组,差异有统计学意义(P<0.05).OPs:NDR组和NPDR组OS2幅值均降低,与正常对照组比较,差异均有统计学意义(P<0.05);重度NPDR组和中度NPDR组与轻度NPDR组、NDR组OS2幅值比较,差异具有统计学意义(P<0.05).OCT:SFCT随着DR程度的进展逐渐变薄,各组间比较差异均有统计学意义(P<0.05).糖尿病患者未经过正规降糖治疗的时间、舒张压、空腹血糖、糖化血红蛋白、胆固醇、低密度脂蛋白、纤维蛋白原、D-二聚体均与DR的进展呈正相关关系(rs=0.722、0.791、0.864、0.473、0.611、0.735、0.591、0.554,P<0.05).糖尿病其他微血管并发症与DR具有高度一致性.结论:HRF、OPs和OCT的检测可以作为DR早期诊断较为敏感的指标,能客观、较早、准确地反映眼底微循环机能的变化.糖尿病病程、血压、空腹血糖、糖化血红蛋白、血脂、凝血状态和是否存在其他糖尿病微血管并发症与DR的进展有正相关性.这些指标的监控,适时的健康教育,对DR在基层的早期防控具有重要的临床应用价值.
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