中华眼视光学与视觉科学杂志
中華眼視光學與視覺科學雜誌
중화안시광학여시각과학잡지
CHINESE JOURNAL OF OPTOMETRY OPHTHALMOLOGY AND VISUAL SCIENCE
2015年
3期
176-180
,共5页
冀向宁%张习%韩风梅%李坤
冀嚮寧%張習%韓風梅%李坤
기향저%장습%한풍매%리곤
糖尿病视网膜病变%糖耐量异常%临床前期%视网膜神经纤维层%体层摄影术,光学相干%对比敏感度
糖尿病視網膜病變%糖耐量異常%臨床前期%視網膜神經纖維層%體層攝影術,光學相榦%對比敏感度
당뇨병시망막병변%당내량이상%림상전기%시망막신경섬유층%체층섭영술,광학상간%대비민감도
Diabetic retinopathy%Impaired glucose tolerance%Preclinical phase%Nerve fiber layer%Tomography,optical coherence%Contrast sensitivity
目的 观察糖耐量异常(IGT)人群和已确诊2型糖尿病(DM)尚未进展至糖尿病视网膜病变(DR)人群的视觉功能的异常及视网膜神经纤维层(RNFL)厚度的变化,探讨糖代谢异常造成的视网膜损伤.方法 横断面研究.随机选取2012年6月至2013年6月间于沧州市中心医院就诊的有2型DM病史10～15年但尚未进展至DR的患者76例为2型DM组,同期、同院就诊的IGT病史3年以上尚未进展至DM的患者79例为IGT组,随机选取同龄健康体检者80例为对照组.所有受检者进行OCT、视觉对比敏感度(CS)、视力、眼底镜等检测,2型DM患者进行FFA检查.以上受检者均取左眼的OCT和CS测量值计入统计结果.采用方差分析的方法,比较2型DM组和IGT组的视盘周围RNFL厚度与对照组的差异,分不同的年龄段比较2型DM组、IGT组与对照组CS检测值的差异,并采用相关分析分析RNFL厚度和CS检测值的相关性.结果 2型DM组RNFL的厚度值全周为(98.3±10.3) μm、视盘上方象限(114.8±14.7) μm、下方象限(128.5±15.4)μm和鼻侧(71.4±8.6) μm,明显低于对照组(P＜0.05),IGT组的RNFL的厚度与对照组比较无明显差异.2型DM组的CS检测值与对照组比较,40岁～年龄段在6、12、18 c/d频段有明显差异(P＜0.01),50岁～年龄段和60～70岁年龄段在3、6、12、18 c/d频段有明显差异(P＜0.05),IGT组40岁～年龄段在12、18 c/d频段有明显差异(P＜0.05),50岁～年龄段在6、12、18 c/d频段有明显差异(P＜0.05),60～70岁年龄段在6、12 c/d频段有明显差异(P＜0.05).CS在6 c/d频段的检测值与RNFL平均厚度相关性分析显示两者呈正相关(r=0.596,P＜0.01).结论 2型DM患者在视网膜尚未出现可视的微血管病变以前,已经存在RNFL变薄和CS代表的部分视功能的减低;CS等视功能的减低的出现可能早于RNFL变薄.
目的 觀察糖耐量異常(IGT)人群和已確診2型糖尿病(DM)尚未進展至糖尿病視網膜病變(DR)人群的視覺功能的異常及視網膜神經纖維層(RNFL)厚度的變化,探討糖代謝異常造成的視網膜損傷.方法 橫斷麵研究.隨機選取2012年6月至2013年6月間于滄州市中心醫院就診的有2型DM病史10～15年但尚未進展至DR的患者76例為2型DM組,同期、同院就診的IGT病史3年以上尚未進展至DM的患者79例為IGT組,隨機選取同齡健康體檢者80例為對照組.所有受檢者進行OCT、視覺對比敏感度(CS)、視力、眼底鏡等檢測,2型DM患者進行FFA檢查.以上受檢者均取左眼的OCT和CS測量值計入統計結果.採用方差分析的方法,比較2型DM組和IGT組的視盤週圍RNFL厚度與對照組的差異,分不同的年齡段比較2型DM組、IGT組與對照組CS檢測值的差異,併採用相關分析分析RNFL厚度和CS檢測值的相關性.結果 2型DM組RNFL的厚度值全週為(98.3±10.3) μm、視盤上方象限(114.8±14.7) μm、下方象限(128.5±15.4)μm和鼻側(71.4±8.6) μm,明顯低于對照組(P＜0.05),IGT組的RNFL的厚度與對照組比較無明顯差異.2型DM組的CS檢測值與對照組比較,40歲～年齡段在6、12、18 c/d頻段有明顯差異(P＜0.01),50歲～年齡段和60～70歲年齡段在3、6、12、18 c/d頻段有明顯差異(P＜0.05),IGT組40歲～年齡段在12、18 c/d頻段有明顯差異(P＜0.05),50歲～年齡段在6、12、18 c/d頻段有明顯差異(P＜0.05),60～70歲年齡段在6、12 c/d頻段有明顯差異(P＜0.05).CS在6 c/d頻段的檢測值與RNFL平均厚度相關性分析顯示兩者呈正相關(r=0.596,P＜0.01).結論 2型DM患者在視網膜尚未齣現可視的微血管病變以前,已經存在RNFL變薄和CS代錶的部分視功能的減低;CS等視功能的減低的齣現可能早于RNFL變薄.
목적 관찰당내량이상(IGT)인군화이학진2형당뇨병(DM)상미진전지당뇨병시망막병변(DR)인군적시각공능적이상급시망막신경섬유층(RNFL)후도적변화,탐토당대사이상조성적시망막손상.방법 횡단면연구.수궤선취2012년6월지2013년6월간우창주시중심의원취진적유2형DM병사10～15년단상미진전지DR적환자76례위2형DM조,동기、동원취진적IGT병사3년이상상미진전지DM적환자79례위IGT조,수궤선취동령건강체검자80례위대조조.소유수검자진행OCT、시각대비민감도(CS)、시력、안저경등검측,2형DM환자진행FFA검사.이상수검자균취좌안적OCT화CS측량치계입통계결과.채용방차분석적방법,비교2형DM조화IGT조적시반주위RNFL후도여대조조적차이,분불동적년령단비교2형DM조、IGT조여대조조CS검측치적차이,병채용상관분석분석RNFL후도화CS검측치적상관성.결과 2형DM조RNFL적후도치전주위(98.3±10.3) μm、시반상방상한(114.8±14.7) μm、하방상한(128.5±15.4)μm화비측(71.4±8.6) μm,명현저우대조조(P＜0.05),IGT조적RNFL적후도여대조조비교무명현차이.2형DM조적CS검측치여대조조비교,40세～년령단재6、12、18 c/d빈단유명현차이(P＜0.01),50세～년령단화60～70세년령단재3、6、12、18 c/d빈단유명현차이(P＜0.05),IGT조40세～년령단재12、18 c/d빈단유명현차이(P＜0.05),50세～년령단재6、12、18 c/d빈단유명현차이(P＜0.05),60～70세년령단재6、12 c/d빈단유명현차이(P＜0.05).CS재6 c/d빈단적검측치여RNFL평균후도상관성분석현시량자정정상관(r=0.596,P＜0.01).결론 2형DM환자재시망막상미출현가시적미혈관병변이전,이경존재RNFL변박화CS대표적부분시공능적감저;CS등시공능적감저적출현가능조우RNFL변박.
Objective To evaluate the effect of early damage to the retina caused by impaired glucose tolerance (IGT) by studying the changes in visual function and the retinal nerve fiber layer (RNFL).Methods This was a cross-sectional study.Patients who visited Cangzhou Center Hospital from June 2012 to 2013 were randomly selected to be assigned to 3 groups:the diabetes mellitus (DM) group (76 patients with type 2 diabetes mellitus for 10 to 20 years without diabetic retinopathy),the IGT group (79 patients with IGT for 3 or more years who have not yet progressed to DM) and a normal control group (80 healthy people).All groups underwent optical coherence tomography (OCT),contrast sensitivity (CS),visual acuity tests,and ophthalmoscope examination.In the DM group,patients were further checked by FFA.Differences in these results,including RNFL thickness of the optic disk and CS measurements,were statistically compared between the different groups (one-way ANOVA).In addition,the correlation of RNFL thickness and CS measurements were analyzed.Results The RNFL thicknesses of patients in the DM group were much lower than in the normal controls in an average 360° circumference (98.3±10.3,P＜0.01),in the quadrant above the optic disk (114.8±14.7,P＜0.01),beneath the optic disk (128.5±15.4,P＜0.01) and in the nasal quadrant (71.4±8.6,P＜0.05).No significant difference was found between the IGT group and normal control group.At the same time,there was a significant difference in CS measurements between the DM group and normal controls,including patients in their 40s at 6 c/d,12 c/d and 18 c/d (P＜0.01),in their 50s at 3 c/d,6 c/d,12 c/d and 18 c/d (P＜0.05),and in their 60s and 70s at 3 c/d,6 c/d,12 c/d,and 18 c/d (P＜0.05).Obvious differences were found in the IGT group for patients in their 40s at 12 c/d and 18 c/d (P＜0.05),in their 50s at 6 c/d,12 c/d and 18 c/d (P＜0.05) and in their 60s and 70s at 6 c/d and 12 c/d (P＜0.05).There was also a positive correlation between CS measurements at the intermediate frequency (6 c/d) and the average RNFL thickness (r=0.596,P＜0.01).Conclusion Results of the present study show that a thinner RNFL and visual dysfunction appear before significant microangiopathy in the retina of type 2 DM patients.Visual function decreases in steps in patients with IGT,and this occurs earlier than a thinning of the RNFL.
