目的 观察糖尿病视网膜病变(DR)视盘新生血管(DNVD)的临床特点.方法 回顾分析内科确诊为糖尿病,服科经间接检眼镜,荧光素眼底血管造影(FFA)检查确诊的DR患者526例1052只眼的临床资料.所有患者均进行最佳矫正视力(BCVA)、裂隙灯显微镜、散瞳后双目间接检眼镜和FFA检查,对其中间接检眼镜及FFA检查发现视盘有新生血管者纳入研究.分析患者不同DR分期,糖尿病病程、血糖控制水平和全视网膜激光光凝术(PRP)与DNVD发生、发展的相互关系.结果 1052只眼中,DNVD167只眼,占15.87%.BCVA<0.1者91只眼,占54.49%,0.1≤BCVA<0.4者58只眼,占34.73%,BCVA≥0.4者18只眼,占19.78%.眼底检查见视网膜新生血管位于视盘表面或距离视盘1个视盘直径范围以内;FFA检查显示视盘早期新生血管显影,荧光充盈迅速,中、晚期新生血管处大量荧光渗漏,形成局部强荧光.167只眼均为增生期DR(PDR),其中Ⅳ期43只眼,占25.75%;Ⅴ期52只眼,占31.14%;Ⅵ期72只眼,占43.11%.糖尿病病程<3年者5只眼,占2.99%;3年≤病程<5年者12只眼,占7.19%;5年≤病程<10年者21只眼,占12.57%;10年≤病程<15年者56只眼,占33.53%;病程≥15年者73只眼,占43.71%;空腹血糖(FBG)<7.0 mmol/L者15只眼,占8.98%;7.0≤FBG<9.0 mmol/L者26只眼,占15.57%;9.0≤FBG<12.0 mmol/L者50只眼,占29.94%.FBG≥12.0 mmol/L者76只服,占45.51%.餐后2 h血糖(2 h PBG)<10.0 mmol/L者28只眼,占16.77%;10.0≤2 h PBG<12.0mmol/L者35只眼,占20.96%;12.0≤2 h PBO<16.0 mmol/L者42只眼.占25.15%;2 h PBG≥16.0mmol/L者62只眼,占50.30%,经Person相关分析,DNVD的发生与糖尿病病程、FBG和餐后2 h PBG均成正相关(r=0.991、0.984、0.960,P=0.001、0.016、0.040).重度非增生期(NPDR)曾行PRP治疗的257只眼,发生DNVD15只眼,占行RPR治疗眼的5.84%;未行PRP治疗的795只眼,发生DNVD152只眼,占未行RPR治疗眼的19.12%,两者发生率比较,差异有统计学意义(χ~2=25.659,P<0.01).结论 DNVD不少见,其发生与DR分期、糖尿病病程、FBG和餐后血糖控制水平均密集相关.
目的 觀察糖尿病視網膜病變(DR)視盤新生血管(DNVD)的臨床特點.方法 迴顧分析內科確診為糖尿病,服科經間接檢眼鏡,熒光素眼底血管造影(FFA)檢查確診的DR患者526例1052隻眼的臨床資料.所有患者均進行最佳矯正視力(BCVA)、裂隙燈顯微鏡、散瞳後雙目間接檢眼鏡和FFA檢查,對其中間接檢眼鏡及FFA檢查髮現視盤有新生血管者納入研究.分析患者不同DR分期,糖尿病病程、血糖控製水平和全視網膜激光光凝術(PRP)與DNVD髮生、髮展的相互關繫.結果 1052隻眼中,DNVD167隻眼,佔15.87%.BCVA<0.1者91隻眼,佔54.49%,0.1≤BCVA<0.4者58隻眼,佔34.73%,BCVA≥0.4者18隻眼,佔19.78%.眼底檢查見視網膜新生血管位于視盤錶麵或距離視盤1箇視盤直徑範圍以內;FFA檢查顯示視盤早期新生血管顯影,熒光充盈迅速,中、晚期新生血管處大量熒光滲漏,形成跼部彊熒光.167隻眼均為增生期DR(PDR),其中Ⅳ期43隻眼,佔25.75%;Ⅴ期52隻眼,佔31.14%;Ⅵ期72隻眼,佔43.11%.糖尿病病程<3年者5隻眼,佔2.99%;3年≤病程<5年者12隻眼,佔7.19%;5年≤病程<10年者21隻眼,佔12.57%;10年≤病程<15年者56隻眼,佔33.53%;病程≥15年者73隻眼,佔43.71%;空腹血糖(FBG)<7.0 mmol/L者15隻眼,佔8.98%;7.0≤FBG<9.0 mmol/L者26隻眼,佔15.57%;9.0≤FBG<12.0 mmol/L者50隻眼,佔29.94%.FBG≥12.0 mmol/L者76隻服,佔45.51%.餐後2 h血糖(2 h PBG)<10.0 mmol/L者28隻眼,佔16.77%;10.0≤2 h PBG<12.0mmol/L者35隻眼,佔20.96%;12.0≤2 h PBO<16.0 mmol/L者42隻眼.佔25.15%;2 h PBG≥16.0mmol/L者62隻眼,佔50.30%,經Person相關分析,DNVD的髮生與糖尿病病程、FBG和餐後2 h PBG均成正相關(r=0.991、0.984、0.960,P=0.001、0.016、0.040).重度非增生期(NPDR)曾行PRP治療的257隻眼,髮生DNVD15隻眼,佔行RPR治療眼的5.84%;未行PRP治療的795隻眼,髮生DNVD152隻眼,佔未行RPR治療眼的19.12%,兩者髮生率比較,差異有統計學意義(χ~2=25.659,P<0.01).結論 DNVD不少見,其髮生與DR分期、糖尿病病程、FBG和餐後血糖控製水平均密集相關.
목적 관찰당뇨병시망막병변(DR)시반신생혈관(DNVD)적림상특점.방법 회고분석내과학진위당뇨병,복과경간접검안경,형광소안저혈관조영(FFA)검사학진적DR환자526례1052지안적림상자료.소유환자균진행최가교정시력(BCVA)、렬극등현미경、산동후쌍목간접검안경화FFA검사,대기중간접검안경급FFA검사발현시반유신생혈관자납입연구.분석환자불동DR분기,당뇨병병정、혈당공제수평화전시망막격광광응술(PRP)여DNVD발생、발전적상호관계.결과 1052지안중,DNVD167지안,점15.87%.BCVA<0.1자91지안,점54.49%,0.1≤BCVA<0.4자58지안,점34.73%,BCVA≥0.4자18지안,점19.78%.안저검사견시망막신생혈관위우시반표면혹거리시반1개시반직경범위이내;FFA검사현시시반조기신생혈관현영,형광충영신속,중、만기신생혈관처대량형광삼루,형성국부강형광.167지안균위증생기DR(PDR),기중Ⅳ기43지안,점25.75%;Ⅴ기52지안,점31.14%;Ⅵ기72지안,점43.11%.당뇨병병정<3년자5지안,점2.99%;3년≤병정<5년자12지안,점7.19%;5년≤병정<10년자21지안,점12.57%;10년≤병정<15년자56지안,점33.53%;병정≥15년자73지안,점43.71%;공복혈당(FBG)<7.0 mmol/L자15지안,점8.98%;7.0≤FBG<9.0 mmol/L자26지안,점15.57%;9.0≤FBG<12.0 mmol/L자50지안,점29.94%.FBG≥12.0 mmol/L자76지복,점45.51%.찬후2 h혈당(2 h PBG)<10.0 mmol/L자28지안,점16.77%;10.0≤2 h PBG<12.0mmol/L자35지안,점20.96%;12.0≤2 h PBO<16.0 mmol/L자42지안.점25.15%;2 h PBG≥16.0mmol/L자62지안,점50.30%,경Person상관분석,DNVD적발생여당뇨병병정、FBG화찬후2 h PBG균성정상관(r=0.991、0.984、0.960,P=0.001、0.016、0.040).중도비증생기(NPDR)증행PRP치료적257지안,발생DNVD15지안,점행RPR치료안적5.84%;미행PRP치료적795지안,발생DNVD152지안,점미행RPR치료안적19.12%,량자발생솔비교,차이유통계학의의(χ~2=25.659,P<0.01).결론 DNVD불소견,기발생여DR분기、당뇨병병정、FBG화찬후혈당공제수평균밀집상관.
Objective To observe the clinical characteristics of diabetic neovascularization on the disc (DNVD). Methods The clinical data of 526 patients (1052 eyes) who were diagnosed as diabetes in Department of intern medicine, as diabetic retinopathy by ophthalmoscope and fundus fluorescein angiograph (FFA) was retrospectively reviewed. All patients were carried out with best corrected visual acuity (BCVA), slit-lamp microscope, ophthalmoscope and FFA after mydriasis. In which, who has neovascularization on the optic disc with ophthalmoscopy and FFA examination were included in this study. The relationship between the occurrence and development of DNVD and phase of DR, disease duration, the level of blood glucose and panretinal photocoagulation were analyzed. Results DNVD was found in 167/1052 eyes (15.87%). There were 91 eyes (54.49%) with BCVA<0. 1, 58 eyes (34. 73%) with BCVA<0. 4 but ≥0. 1,and 18 eyes(19.78%) with BCVA≥0. 4. Retinal neovascularization was located in the surface of disc surface or within 1PD from the optic disc;Those vessels filled early and rapidly, and with local strong fluorescence due to fluorescence leakage at middle and late stage of FFA examination. All 167 DNVD eyes are proliferative diabetic retinopathy (PDR) with 43 eyes (25.75%) in stage Ⅳ, 52 eyes (31.14%) in stage Ⅴ and 72 eyes (43. 11%) in stage Ⅵ. Of those DNVD eyes, there were 5 eyes (2. 99%) with course of diabetes <3 years, 12 eyes (7.19%) s<5 years but ≥3 years, 21 eyes (12. 57%)<10 but ≥5 years, 56 eyes (33. 53%)<15 but ≥10 years and 73 eyes (43. 71%)≥15 years. There were 15 eyes (8. 98%) with fasting blood glucose (FBG)<7. 0 mmol/L, 26 eyes (15.57%) with FBG< 9.0 but ≥7.0 mmol/L, 50 eyes (29. 94%) with FBG<12. 0 but ≥9. 0 mmol/L and 76 eyes (45.51%) with FBG ≥12.0 mmol/L; there were 28 eyes (16. 77%) with 2 hour postprandial blood glucose(2hPBG)<10. 0 mmol/L, 35 eyes (20. 96%) with 2hPBG<12. 0 but ≥10. 0 mmol/L, 42 eyes (25.15%) with 2hPBG <16.0 but ≥12.0 mmol/L and 62 eyes (50. 30%) with 2hPBG ≥16.0 mmol/L. The occurrence of DNVD and duration of diabetes, FBG and 2hPBG were all positively correlated (r= 0. 991, 0. 984, 0. 960, P= 0. 001, 0. 016, 0. 040) by the Person correlation analysis. 15 eyes (5.84%) of DNVD happened in 257 eyes who treated with PRP in severe nonproliferative diabetic retinopathy (NPDR), 152 eyes (19.12%) DNVD happened in 795 eyes who untreated with PRP in severe NPDR,the differences were statistically significant (χ~2 =25. 659,P<0. 01) between them. Conclusion DNVD happened commonly in DR, the occurrence of DNVD is intensive related with diabetic retinopathy stage, duration of diabetes, FBG and PBG.
