本文選題：糖尿病視網(wǎng)膜病變　切入點：篩查　出處：《河南科技大學》2012年碩士論文　論文類型：學位論文

【摘要】：目的對比直接檢眼鏡、間接檢眼鏡、30°眼底照片和45°眼底照片四種眼底篩查方法，并結合眼底熒光素血管造影（FFA）和甲襞微循環(huán)狀態(tài)檢查，研究甲襞微循環(huán)與DR的相關性，篩選出快捷高效的DR篩查方法。 方法選擇在我院就診的Ⅱ型糖尿病患者80名作為研究對象，對患者分別進行直接和間接檢眼鏡、30°和45°眼底照相、FFA和甲襞微循環(huán)狀態(tài)檢查，評價各種篩查方法與DR分期的相關性，敏感度和特異度。 結果1.病程越長，DR的患病率越高。隨著DR嚴重程度的遞增，＜0.1的視力所占的比率越來越大。 2.在無明顯視網(wǎng)膜改變，中度NPDR，重度NPDR組中各種檢查方法與FFA檢查結果有顯著意義的相關；而輕度NPDR組的檢查結果與FFA檢查無統(tǒng)計學意義。在PDR病變期，直接檢眼鏡和間接檢眼鏡檢查與FFA檢查結果有顯著意義的相關。（P＞0.05）。 3.對于輕、中度NPDR篩查效果分析順序依次為30°眼底照片，45°眼底照片，直接檢眼鏡，間接檢眼鏡；對于重度NPDR篩查效果順序依次是30°眼底照片，直接檢眼鏡，間接檢眼鏡，45°眼底照片；對于PDR期篩查效果順序是直接檢眼鏡，間接檢眼鏡，30°眼底照片，45°眼底照片。以重度NPDR作為篩查臨界值，有效性和實用性依次是30°眼底照片，直接檢眼鏡，間接檢眼鏡，45°眼底照片。經(jīng)x2檢驗，重度NPDR期，直接和檢眼鏡，30°眼底照片之間存在關聯(lián)性（P＜0.05）。45°眼底照片與其他三種方法并無關聯(lián)性（P＞0.05）。 4.甲襞微循環(huán)重度異常合并DR者明顯高于輕、中度異常組，有顯著差異性（P＜0.05）。中度異常組合并DR者高于輕度異常組，但無顯著差異性（P＞0.05）。 5. NPDR甲襞微循環(huán)總積分與PDR總積分值比較，PDR組明顯高于NPDR組（P＜0.05）。各項積分值，除形態(tài)積分無顯著差異外（P＞0.05），微血管的血液流態(tài)和襻周狀態(tài)積分PDR均顯著高于NPDR（P＜0.05）。 6. PDR組血液流速顯著低于NPDR組（P＜0.05）；PDR組細胞聚集度，襻周滲出均高于NPDR組，有顯著差異性（P＜0.05）；PDR組血管襻周出血積分雖高于NPDR組，但無顯著差異性（P＞0.05）。 結論1.糖尿病病程越長，DR的患病率越高病情越嚴重，DM患者的視力損害越嚴重。 2.直接和間接檢眼鏡以及30°和45°眼底照片檢查，對于無明顯視力損害的DM患者來說，雖可作為一種經(jīng)濟實用的篩查方法但觀察范圍有限。 3.甲襞微循環(huán)檢測輔助DR篩查操作方便、觀察直觀、安全無創(chuàng)且有較高的差異性，是一個很實用的篩查新方法。
[Abstract]:Objective to compare four fundus screening methods: direct ophthalmoscope, indirect ophthalmoscope 30 擄fundus photograph and 45 擄fundus photograph, combined with fundus fluorescein angiography (FFAA) and nailfold microcirculation (nailfold microcirculation) to study the correlation between nailfold microcirculation and Dr. A rapid and efficient Dr screening method was screened out. Methods Eighty patients with type 2 diabetes mellitus who were treated in our hospital were examined with FFA and nailfold microcirculation by direct and indirect ophthalmoscope 30 擄and 45 擄respectively. To evaluate the correlation, sensitivity and specificity of various screening methods with Dr staging. Results 1. The longer the course of disease, the higher the prevalence of Dr. With the increase of Dr severity, the proportion of vision < 0.1 was increasing. 2. 2. There was no obvious retinal change, there was a significant correlation between the various examination methods and the results of FFA in the moderate and severe NPDR group, but there was no significant difference between the results of the mild NPDR group and the FFA examination, but in the stage of PDR lesion, there was no significant difference between the results of the examination and the FFA examination in the mild NPDR group. There was significant correlation between direct ophthalmoscope and indirect ophthalmoscope examination and FFA examination results (P > 0.05). 3. For mild and moderate NPDR screening, the order of analysis was 30 擄fundus photographs, 45 擄fundus photographs, direct ophthalmoscope, indirect ophthalmoscope, and 30 擄fundus photographs for severe NPDR screening, direct ophthalmoscope, direct ophthalmoscope, direct ophthalmoscope, direct ophthalmoscope, direct ophthalmoscope, direct ophthalmoscope, and direct ophthalmoscope. Indirect ophthalmoscope was 45 擄fundus photograph, direct ophthalmoscope was the order of PDR screening effect, indirect ophthalmoscope 30 擄fundus photograph was 45 擄fundus photograph. The critical value of severe NPDR screening was 30 擄fundus photograph in order of effectiveness and practicability. Direct ophthalmoscope and indirect ophthalmoscope were 45 擄fundus photographs. After x2 test, there was no correlation between direct and 30 擄fundus photographs in severe NPDR stage (P < 0.05) and other three methods (P > 0.05). 4. The patients with severe abnormal nailfold microcirculation associated with Dr were significantly higher than those with mild and moderate abnormalities (P < 0.05). The patients with moderate abnormal combination with Dr were higher than those with mild abnormality (P > 0.05). 5.Compared with the total integral value of NPDR nailfold microcirculation and PDR, the PDR of NPDR group was significantly higher than that of NPDR group (P < 0.05). Except for the morphological integral, there was no significant difference (P > 0.05), and the PDR of microvascular blood flow and loop was significantly higher than that of NPDR(P < 0.05. 6. The blood flow velocity in PDR group was significantly lower than that in NPDR group (P < 0.05), and the pericyclic exudation in PDR group was higher than that in NPDR group. There was significant difference (P < 0.05) in perivascular haemorrhage score of PDR group compared with NPDR group, but there was no significant difference (P > 0.05). The longer the course of diabetes, the higher the prevalence of Dr and the more serious the visual impairment of DM patients. 2. 2. Direct and indirect ophthalmoscope examination and 30 擄and 45 擄fundus examination, for DM patients without obvious visual impairment, can be used as an economical and practical screening method, but the scope of observation is limited. 3. Nailfold microcirculation detection is a new and practical method for Dr screening, which is convenient, intuitive, safe and non-invasive.
【學位授予單位】：河南科技大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R774.1;R587.1

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