中华实验眼科杂志
中華實驗眼科雜誌
중화실험안과잡지
CHINESE JOURNAL OF EXPERIMENTAL OPHTHALMOLOGY
2013年
1期
60-64
,共5页
耿爽%叶俊杰%陈辛元%艾凤荣
耿爽%葉俊傑%陳辛元%艾鳳榮
경상%협준걸%진신원%애봉영
糖尿病视网膜病变%视网膜神经纤维层%偏振激光扫描
糖尿病視網膜病變%視網膜神經纖維層%偏振激光掃描
당뇨병시망막병변%시망막신경섬유층%편진격광소묘
Diabetic retinopathy%Retinal nerve fiber layer%Scanning laser polarimetry
背景 糖尿病视网膜病变(DR)是不可逆盲的主要原因之一.近来研究发现,视网膜神经细胞的病变是DR病理改变的一部分,发生在DR发病之前,因此了解2型糖尿病患者视网膜神经细胞的病理变化对DR的防治有重要意义. 目的 应用GDxVCC系统测量2型糖尿病患者不同DR分期视网膜神经纤维层(RNFL)厚度的改变.方法 纳入北京协和医院眼科确诊的2型糖尿病患者48例96眼,依据检眼镜检查结果和荧光素眼底血管造影(FFA)结果分为DR临床前期组(NDR组)、非增生期糖尿病视网膜病变组(背景期)(BDR组)、增生型糖尿病视网膜病变组(PDR组)和全视网膜激光光凝组(PRP组),年龄和性别匹配的24名正常受试者作为正常对照组.应用GDxVCC系统测量受试者视网膜颞上、颞下、鼻上、鼻下(TSNIT)4个象限RNFL厚度,参数包括TSNIT平均值、上方平均值、下方平均值、TSNIT标准差及神经纤维指数,各组间的测量值进行比较. 结果 NDR组、BDR组、PDR组及PRP组患者RNFL的TSNIT平均值分别为(56.54±5.28)、(56.92±6.49)、(53.04±6.14)、(53.17±9.30) μm,正常对照组为(59.04±4.37) μm；与正常对照组相比,PDR组及PRP组患者RNFL的TSNIT平均值、上方平均值、下方平均值、TSNIT标准差明显降低,神经纤维指数增高,差异均有统计学意义(PDR组:P=0.002、0.000、0.002、0.000、0.001；PRP组:P=0.002、0.000、0.001、0.000、0.000),而NDR组、BDR组RNFL的TSNIT平均值、上方平均值、下方平均值、TSNIT标准差均降低,神经纤维指数增高,但RNFL参数差异均无统计学意义(P=0.187、0.235、0.333、0.106、0.202；P=0.262、0.063、0.072、0.098、0.062).结论2型糖尿病患者在眼底及FFA检查尚未发现DR时即可出现RNFL变薄,PDR及接受PRP治疗后的患者RNFL变薄,提示糖尿病患者视网膜神经细胞及其轴突出现变性和丢失.
揹景 糖尿病視網膜病變(DR)是不可逆盲的主要原因之一.近來研究髮現,視網膜神經細胞的病變是DR病理改變的一部分,髮生在DR髮病之前,因此瞭解2型糖尿病患者視網膜神經細胞的病理變化對DR的防治有重要意義. 目的 應用GDxVCC繫統測量2型糖尿病患者不同DR分期視網膜神經纖維層(RNFL)厚度的改變.方法 納入北京協和醫院眼科確診的2型糖尿病患者48例96眼,依據檢眼鏡檢查結果和熒光素眼底血管造影(FFA)結果分為DR臨床前期組(NDR組)、非增生期糖尿病視網膜病變組(揹景期)(BDR組)、增生型糖尿病視網膜病變組(PDR組)和全視網膜激光光凝組(PRP組),年齡和性彆匹配的24名正常受試者作為正常對照組.應用GDxVCC繫統測量受試者視網膜顳上、顳下、鼻上、鼻下(TSNIT)4箇象限RNFL厚度,參數包括TSNIT平均值、上方平均值、下方平均值、TSNIT標準差及神經纖維指數,各組間的測量值進行比較. 結果 NDR組、BDR組、PDR組及PRP組患者RNFL的TSNIT平均值分彆為(56.54±5.28)、(56.92±6.49)、(53.04±6.14)、(53.17±9.30) μm,正常對照組為(59.04±4.37) μm；與正常對照組相比,PDR組及PRP組患者RNFL的TSNIT平均值、上方平均值、下方平均值、TSNIT標準差明顯降低,神經纖維指數增高,差異均有統計學意義(PDR組:P=0.002、0.000、0.002、0.000、0.001；PRP組:P=0.002、0.000、0.001、0.000、0.000),而NDR組、BDR組RNFL的TSNIT平均值、上方平均值、下方平均值、TSNIT標準差均降低,神經纖維指數增高,但RNFL參數差異均無統計學意義(P=0.187、0.235、0.333、0.106、0.202；P=0.262、0.063、0.072、0.098、0.062).結論2型糖尿病患者在眼底及FFA檢查尚未髮現DR時即可齣現RNFL變薄,PDR及接受PRP治療後的患者RNFL變薄,提示糖尿病患者視網膜神經細胞及其軸突齣現變性和丟失.
배경 당뇨병시망막병변(DR)시불가역맹적주요원인지일.근래연구발현,시망막신경세포적병변시DR병리개변적일부분,발생재DR발병지전,인차료해2형당뇨병환자시망막신경세포적병리변화대DR적방치유중요의의. 목적 응용GDxVCC계통측량2형당뇨병환자불동DR분기시망막신경섬유층(RNFL)후도적개변.방법 납입북경협화의원안과학진적2형당뇨병환자48례96안,의거검안경검사결과화형광소안저혈관조영(FFA)결과분위DR림상전기조(NDR조)、비증생기당뇨병시망막병변조(배경기)(BDR조)、증생형당뇨병시망막병변조(PDR조)화전시망막격광광응조(PRP조),년령화성별필배적24명정상수시자작위정상대조조.응용GDxVCC계통측량수시자시망막섭상、섭하、비상、비하(TSNIT)4개상한RNFL후도,삼수포괄TSNIT평균치、상방평균치、하방평균치、TSNIT표준차급신경섬유지수,각조간적측량치진행비교. 결과 NDR조、BDR조、PDR조급PRP조환자RNFL적TSNIT평균치분별위(56.54±5.28)、(56.92±6.49)、(53.04±6.14)、(53.17±9.30) μm,정상대조조위(59.04±4.37) μm；여정상대조조상비,PDR조급PRP조환자RNFL적TSNIT평균치、상방평균치、하방평균치、TSNIT표준차명현강저,신경섬유지수증고,차이균유통계학의의(PDR조:P=0.002、0.000、0.002、0.000、0.001；PRP조:P=0.002、0.000、0.001、0.000、0.000),이NDR조、BDR조RNFL적TSNIT평균치、상방평균치、하방평균치、TSNIT표준차균강저,신경섬유지수증고,단RNFL삼수차이균무통계학의의(P=0.187、0.235、0.333、0.106、0.202；P=0.262、0.063、0.072、0.098、0.062).결론2형당뇨병환자재안저급FFA검사상미발현DR시즉가출현RNFL변박,PDR급접수PRP치료후적환자RNFL변박,제시당뇨병환자시망막신경세포급기축돌출현변성화주실.
Background Diabetic retinopathy (DR) is one of the leading causes that result in adult irreversible blindness in many countries.Recent researches suggest that neurodegeneration is an important component of DR.To realize the disease process of retinal neutron is very important for prevention and treatment on DR.Objective This study was to investigate the change of retinal nerve fiber layer thickness in patients with type 2 diabetes mellitus.Methods Ninety-six eyes of 48 patients with type 2 diabetes mellitus were enrolled in Peking Union Medical College Hospital.The patients were assigned into non-diabetic retinopathy (NDR) group,background diabetic retinopathy(BDR) group,proliferative diabetic retinopathy (PDR) group and panretinal photocoagulation (PRP) group based on the fundus finding and fundus fluorescein angiography(FFA),and 24 normal subjects with matched age were included as control group.RNFL thickness was measured by GDxVCC system,including temporal,superior,nasal,inferior,total,(TSNIT) average,superior average,inferior average,TSNIT standard deviation and nerve fiber indication.The datas of the RNFL thickness were analyzed and comparison among different groups by one-way analysis of variance and Student Newman Keuls test.Results The TSNIT averages of the NDR group,BDR group,PDR group and PRP group were(56.54±5.28),(56.92±6.49),(53.04±6.14) and(53.17±9.30) μm,respectively,while that of the control group was (59.04±4.37) μm.The TSNIT average,superior average,inferior average,TSNIT standard deviation of the PDR group and PRP group compared with control group were significantly decreased,and the nerve fiber indication of the PDR group and PRP group was significantly increased (P =0.002,0.000,0.002,0.000,0.001 ;P =0.002,0.000,0.001,0.000,0.000).Compared with the control group,the TSNIT average,superior average,inferior average,TSNIT standard deviation were insignificantly decreased,and the nerve fiber indication was insignificantly increased in the NDR group and BDR group (P =0.187,0.235,0.333,0.106,0.202 ;P=0.262,0.063,0.072,0.098,0.062).Conclusions The decline of the RNFL thickness appears prior to DR findings.The RNFL thinning of PDR and PRP patients suggests the degeneration of neurons and atrophy of axonal.The neurodegeneration is an important component of DR.
