中华眼科医学杂志(电子版)
中華眼科醫學雜誌(電子版)
중화안과의학잡지(전자판)
CHINESE JOURNAL OF OPHTHALMOLOGIC MEDICINE(ELECTRONIC EDITION)
2014年
3期
144-148
,共5页
糖尿病性视网膜病变%餐后血糖%糖化血红蛋白
糖尿病性視網膜病變%餐後血糖%糖化血紅蛋白
당뇨병성시망막병변%찬후혈당%당화혈홍단백
Diabetic retinopathy%Postprandial blood glucose%Glycosylated hemoglobin
目的:探讨糖尿病性视网膜病变( DR)患者在空腹血糖有效控制下,而餐后血糖失控时对视网膜病变进程的影响。方法收集2012年12月至2013年12月河南省人民医院眼科收治的141例(282只眼)确诊为2型DR患者的临床资料。统计患者日间血糖波动值,并分析不同血糖水平状况与DR荧光素眼底血管造影和光学相干断层扫描变化的相关性。将其中77例(154只眼)依从性好的患者作为调控组接受调控方案,严格调控饮食起居,适当变更胰岛素和其他治疗药物;将另外64例(128只眼)依从性较差的患者作为非调控组,未实施调控方案。比较两组患者末次随访时的视力变化情况、眼底病变情况、血糖波动情况及治疗效果,随诊时间均为12个月以上。两组患者血糖波动情况和治疗效果的比较采用卡方检验。结果141例(282只眼)患者中,非增殖性DR患者54例(108只眼),占38.30%,增殖性 DR 患者87例(174只眼),占61.70%;玻璃体积血患者16例(32只眼),占11.35%,视网膜大面积出血患者21例(42只眼),占14.89%,眼底可视者105例(105只眼),占27.23%,并发黄斑囊样水肿者59例(118只眼),占41.84%。患者总体晨起空腹血糖4.8~7.7 mmol/L,其中>7 mmol/L 者56例(39.72%);餐后2 h 血糖8~21.2 mmol/L,其中>11 mmol/L者128例(90.78%),以午餐后高血糖最为明显。患者日间血糖波动范围<4 mmol/L者21例(14.89%),日间血糖波动范围4~7 mmol/L 者54例(38.30%),日间血糖波动范围7~10 mmol/L者37例(26.24%),日间血糖波动范围>10 mmol/L者29例(20.57%),日间血糖波动范围控制在4 mmol/L以下的患者仅占14.89%,大多数患者血糖波动幅度超出正常范围。非增殖性DR患者血糖波动<7 mmol/L者39例(72.22%),血糖波动7~10 mmol/L者10例(18.52%),血糖波动>10 mmol/L者5例(9.26%);增殖性DR患者血糖波动<7 mmol/L者21例(24.14%),血糖波动7~10 mmol/L者27例(31.03%),血糖波动>10 mmol/L者39例(44.83%),增殖性DR患者日间血糖波动度较非增殖性DR患者明显增大,差异有统计学意义(χ2=13.5,P<0.05)。调控组患者视力提升者46例(92只眼),占59.74%,玻璃体积血吸收者2例(4只眼),占2.60%,黄斑水肿减轻者6例(12只眼),占7.79%;非调控组患者视力提升者12例(24只眼),占18.75%,玻璃体积血吸收者8例(16只眼),占12.50%,黄斑水肿减轻者23例(46只眼),占35.94%,两组患者治疗效果比较,差异有统计学意义(χ2=24.52,36.03,18.22;P <0.05)。结论忽视餐后血糖水平的监测与普遍存在的昼夜持续性高血糖状态是导致DR恶化的重要因素。
目的:探討糖尿病性視網膜病變( DR)患者在空腹血糖有效控製下,而餐後血糖失控時對視網膜病變進程的影響。方法收集2012年12月至2013年12月河南省人民醫院眼科收治的141例(282隻眼)確診為2型DR患者的臨床資料。統計患者日間血糖波動值,併分析不同血糖水平狀況與DR熒光素眼底血管造影和光學相榦斷層掃描變化的相關性。將其中77例(154隻眼)依從性好的患者作為調控組接受調控方案,嚴格調控飲食起居,適噹變更胰島素和其他治療藥物;將另外64例(128隻眼)依從性較差的患者作為非調控組,未實施調控方案。比較兩組患者末次隨訪時的視力變化情況、眼底病變情況、血糖波動情況及治療效果,隨診時間均為12箇月以上。兩組患者血糖波動情況和治療效果的比較採用卡方檢驗。結果141例(282隻眼)患者中,非增殖性DR患者54例(108隻眼),佔38.30%,增殖性 DR 患者87例(174隻眼),佔61.70%;玻璃體積血患者16例(32隻眼),佔11.35%,視網膜大麵積齣血患者21例(42隻眼),佔14.89%,眼底可視者105例(105隻眼),佔27.23%,併髮黃斑囊樣水腫者59例(118隻眼),佔41.84%。患者總體晨起空腹血糖4.8~7.7 mmol/L,其中>7 mmol/L 者56例(39.72%);餐後2 h 血糖8~21.2 mmol/L,其中>11 mmol/L者128例(90.78%),以午餐後高血糖最為明顯。患者日間血糖波動範圍<4 mmol/L者21例(14.89%),日間血糖波動範圍4~7 mmol/L 者54例(38.30%),日間血糖波動範圍7~10 mmol/L者37例(26.24%),日間血糖波動範圍>10 mmol/L者29例(20.57%),日間血糖波動範圍控製在4 mmol/L以下的患者僅佔14.89%,大多數患者血糖波動幅度超齣正常範圍。非增殖性DR患者血糖波動<7 mmol/L者39例(72.22%),血糖波動7~10 mmol/L者10例(18.52%),血糖波動>10 mmol/L者5例(9.26%);增殖性DR患者血糖波動<7 mmol/L者21例(24.14%),血糖波動7~10 mmol/L者27例(31.03%),血糖波動>10 mmol/L者39例(44.83%),增殖性DR患者日間血糖波動度較非增殖性DR患者明顯增大,差異有統計學意義(χ2=13.5,P<0.05)。調控組患者視力提升者46例(92隻眼),佔59.74%,玻璃體積血吸收者2例(4隻眼),佔2.60%,黃斑水腫減輕者6例(12隻眼),佔7.79%;非調控組患者視力提升者12例(24隻眼),佔18.75%,玻璃體積血吸收者8例(16隻眼),佔12.50%,黃斑水腫減輕者23例(46隻眼),佔35.94%,兩組患者治療效果比較,差異有統計學意義(χ2=24.52,36.03,18.22;P <0.05)。結論忽視餐後血糖水平的鑑測與普遍存在的晝夜持續性高血糖狀態是導緻DR噁化的重要因素。
목적:탐토당뇨병성시망막병변( DR)환자재공복혈당유효공제하,이찬후혈당실공시대시망막병변진정적영향。방법수집2012년12월지2013년12월하남성인민의원안과수치적141례(282지안)학진위2형DR환자적림상자료。통계환자일간혈당파동치,병분석불동혈당수평상황여DR형광소안저혈관조영화광학상간단층소묘변화적상관성。장기중77례(154지안)의종성호적환자작위조공조접수조공방안,엄격조공음식기거,괄당변경이도소화기타치료약물;장령외64례(128지안)의종성교차적환자작위비조공조,미실시조공방안。비교량조환자말차수방시적시력변화정황、안저병변정황、혈당파동정황급치료효과,수진시간균위12개월이상。량조환자혈당파동정황화치료효과적비교채용잡방검험。결과141례(282지안)환자중,비증식성DR환자54례(108지안),점38.30%,증식성 DR 환자87례(174지안),점61.70%;파리체적혈환자16례(32지안),점11.35%,시망막대면적출혈환자21례(42지안),점14.89%,안저가시자105례(105지안),점27.23%,병발황반낭양수종자59례(118지안),점41.84%。환자총체신기공복혈당4.8~7.7 mmol/L,기중>7 mmol/L 자56례(39.72%);찬후2 h 혈당8~21.2 mmol/L,기중>11 mmol/L자128례(90.78%),이오찬후고혈당최위명현。환자일간혈당파동범위<4 mmol/L자21례(14.89%),일간혈당파동범위4~7 mmol/L 자54례(38.30%),일간혈당파동범위7~10 mmol/L자37례(26.24%),일간혈당파동범위>10 mmol/L자29례(20.57%),일간혈당파동범위공제재4 mmol/L이하적환자부점14.89%,대다수환자혈당파동폭도초출정상범위。비증식성DR환자혈당파동<7 mmol/L자39례(72.22%),혈당파동7~10 mmol/L자10례(18.52%),혈당파동>10 mmol/L자5례(9.26%);증식성DR환자혈당파동<7 mmol/L자21례(24.14%),혈당파동7~10 mmol/L자27례(31.03%),혈당파동>10 mmol/L자39례(44.83%),증식성DR환자일간혈당파동도교비증식성DR환자명현증대,차이유통계학의의(χ2=13.5,P<0.05)。조공조환자시력제승자46례(92지안),점59.74%,파리체적혈흡수자2례(4지안),점2.60%,황반수종감경자6례(12지안),점7.79%;비조공조환자시력제승자12례(24지안),점18.75%,파리체적혈흡수자8례(16지안),점12.50%,황반수종감경자23례(46지안),점35.94%,량조환자치료효과비교,차이유통계학의의(χ2=24.52,36.03,18.22;P <0.05)。결론홀시찬후혈당수평적감측여보편존재적주야지속성고혈당상태시도치DR악화적중요인소。
Objective To assess the association of postprandial blood glucose levels with the progression of diabetic retinopathy ( DR ) in subjects with a good control of the fasting blood glucose. Methods Clinical records of 141 patients ( 282 eyes ) who were diagnosed with type II DR in the Department of Ophthalmology,Henan Provincial People′s Hospital between December,2012 and December, 2013 obtained.Of these patients,77 had good compliance and underwent dietary intervention together with insulin therapy at adjustable doses while the remaining 64 served as control subjects and received no dietary intervention.Data on levels of daytime blood glucose in association with fundus fluorescein angiographic and optical coherence tomographic findings,visual acuity,and retinopathy at the end of 12 month were analyzed byχ2 test.Results Out of the 141 DR cases,54 (38.30%) were non-proliferative and 87 (61.70%) were proliferative;16 ( 11.35%) presented with vitreous hemorrhage, 21 ( 14.89%) with large-area retinal hemorrhage,105 (105 eyes,27.23%) with fundus visualization,and 59 (41.84%) with concurrent cystoid macular edema.The morning fasting blood glucose concentration was averaged at 4.8-7.7 mmol/L in the 141 patients and was >7 mmol/L in 56 (39.72%) cases.The blood glucose concentration 2 h after a meal was averaged at 8-21.2 mmol/L in the 141 patients and was >11 mmol/L in 128 ( 90.78%) cases;postprandial hyperglycemia was most pronounced after lunch as compared to breakfast and dinner.The daytime blood glucose fluctuation was <4 mmol/L in 21 (14.89%) cases,4-7 mmol/L in 54 (38.30%) cases,7-10 mmol/L in 37 (26.24%) cases,and >10 mmol/L in 29 (20.57%) cases;the fluctuation was out of the normal range in most cases.In patients with non-proliferative DR, the blood glucose fluctuation was <7 mmol/L in 39 (72.22%) cases,7-10 mmol/L in 10 (18.52%) cases,and >10 mmol/L in 5 (9.26%) cases.In patients with proliferative DR, the blood glucose fluctuation was <7 mmol/L in 21 (24.14%) cases,7-10 mmol/L in 27 (31.03%) cases,and >10 mmol/L in 39 (44.83%) cased.The daytime blood glucose fluctuation range was significantly larger in proliferative DR patients than in non-proliferative DR patients (χ2=13.5,P <0.05).Visual acuity improvement was observed in 46 (59.74%) cases in the dietary intervention group but only in 12 (18.75%) cases in the control group (P <0.05). Vitreous hemorrhage absorption occurred in 2 (2.60%) in the intervention group but in 8 (12.5%) cases in the control group (P <0.05).Macular edema was alleviated in 6 (7.79%) cases in the intervention group but in 23 (35.94%) cases in the control group (P <0.05).Conclusion Ignorance of postprandial blood glucose monitoring and the persistent diurnal hyperglycemia may be important causes of DR deterioration.