本文關(guān)鍵詞： 糖尿病視網(wǎng)膜病變 黃斑水腫 視野缺失 微脈沖激光　出處：《中國(guó)糖尿病雜志》2017年08期 　論文類型：期刊論文

【摘要】：目的探討糖尿病性黃斑水腫(DME)與視野缺失的相關(guān)性并觀察微脈沖激光治療的效果。方法選取糖尿病視網(wǎng)膜病變(DR)患者117例(149眼),根據(jù)美國(guó)糖尿病視網(wǎng)膜病變?cè)缙谥委熝芯啃〗M(ETDRS)DME診斷標(biāo)準(zhǔn),分為DME組50例(70眼)和N-DME組67例(79眼)。選取體檢健康者40名(80眼)作為正常對(duì)照(NC)組。收集各組臨床資料和生化指標(biāo)并進(jìn)行視野檢查。另將DME組分為微脈沖激光亞組和傳統(tǒng)激光亞組,各35眼,觀察激光治療后1個(gè)月、3個(gè)月、6個(gè)月、9個(gè)月、12個(gè)月視野恢復(fù)狀況。結(jié)果 DME組糖尿病病程、FPG、HbA1c及HOMA-IR高于N-DME組(P0.05)。各組可置信因子RF15%,提示檢查結(jié)果可靠。DME組和N-DME組平均缺陷值(MD指數(shù))[(7.81±0.75)vs(4.32±0.67)vs(1.14±0.22)dB]、視野丟失方差(LV)[(20.17±4.85)vs(15.34±3.19)vs(4.72±1.11)dB]及視野的刺激丟失方差值(sLV)[(10.71±1.37)vs(7.22±1.12)vs(2.35±0.41)dB]水平均高于NC組,且DME組高于N-DME組(P0.01)。自治療后3個(gè)月起,微脈沖激光亞組MD指數(shù)、LV、及sLV水平均較治療前降低,且均低于傳統(tǒng)激光亞組(P0.05)。傳統(tǒng)激光亞組各時(shí)間點(diǎn)MD指數(shù)、LV及sLV水平比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。多元Logistic回歸分析發(fā)現(xiàn),糖尿病病程、FPG、HbA_1c及HOMA-IR為DEM的危險(xiǎn)因素(P0.01)。結(jié)論 DME患者存在嚴(yán)重的視野缺失,微脈沖激光治療有助于視野恢復(fù),而傳統(tǒng)激光治療對(duì)其無(wú)明顯效果。糖尿病病程及IR程度增加,FPG、HbA1c升高,均增加DME的發(fā)生風(fēng)險(xiǎn)。
[Abstract]:Objective to investigate the correlation between diabetic macular edema (DME) and visual field loss and to observe the effect of micropulse laser. Methods 117 patients with diabetic retinopathy (DRR) were selected. According to the early treatment of diabetic retinopathy in the United States the DME diagnostic criteria for ETDRS. DME group (n = 50, n = 70) and N-DME group (n = 67, n = 79). 40 healthy subjects (n = 40, n = 80) were selected as normal control group (n = 80). The clinical data and biochemical indexes of each group were collected and the visual field was examined. The DME group was divided into two groups: micropulse laser subgroup and traditional laser subgroup. 35 eyes of each group were observed to observe the recovery of visual field in 1 month, 3 months, 6 months, 9 months and 12 months after laser treatment. HbA1c and HOMA-IR were higher in N-DME group than in N-DME group (P 0.05). The confidence factor RF15% in each group was higher than that in N-DME group. The results suggest that the average defect value and MD index of DME and N-DME groups are reliable. [VSD 4.32 鹵0.67 vs 1.14 鹵0.22 dB], visual field loss variance (LVV). [T = 20.17 鹵4.85 vs 15.34 鹵3.19 vs 4.72 鹵1.11dB) and the stimulus loss variance (sLVV) of visual field. [The level of VSD was higher than that of NC group (10.71 鹵1.37 vs 7.22 鹵1.12 鹵2.35 鹵0.41 dB). The levels of MD index and sLV in DME group were lower than those in N-DME group 3 months after treatment. All of them were lower than the conventional laser subgroup (P 0.05). The MD index LV and sLV were compared at different time points in the traditional laser subgroup. There was no significant difference between the two groups (P 0.05). Multiple Logistic regression analysis showed that the course of diabetes was significant. HbA_1c and HOMA-IR were the risk factors for DEM. Conclusion there is serious visual field deficit in patients with DME, and micro-pulse laser therapy is helpful to the recovery of visual field. The course of diabetes and the degree of IR were increased and the risk of DME was increased.
【作者單位】： 鄭州人民醫(yī)院眼科;鄭州大學(xué)第一附屬醫(yī)院眼科;
【分類號(hào)】：R587.2;R779.63
【正文快照】： 糖尿病視網(wǎng)膜病變(DR)是糖尿病特異性慢性并發(fā)癥之一,對(duì)我國(guó)10省的流行病學(xué)調(diào)查[1]顯示,DR的患病率約為31.5%。糖尿病性黃斑水腫(DME)是導(dǎo)致DR患者視力衰退甚至致盲的主要原因之一,可發(fā)生于DR之前或DR發(fā)展進(jìn)程中的任何階段[2]。據(jù)報(bào)道[3],根據(jù)不同病程和糖尿病類型,DME的發(fā)病

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