發(fā)布時(shí)間：2018-05-21 05:23

  本文選題：糖尿病性黃斑病變 + FFA　； 參考：《吉林大學(xué)》2012年碩士論文

【摘要】：目的：研究糖尿病性黃斑病變視網(wǎng)膜內(nèi)外屏障的損傷特點(diǎn)。 方法：選取2011年1月-2012年3月期間在我院門診就診的Ⅱ型糖尿病患者67例（119眼）的臨床資料，根據(jù)眼底表現(xiàn)及熒光素眼底血管造影(Fundus fluoresceinangiography，F(xiàn)FA)檢查結(jié)果將病例資料分為正常對照組19例（33眼）和病例組，病例組資料又分為：糖尿病FFA眼底正常組10例（20眼）、糖尿病性視網(wǎng)膜病變（Diabeticretinopathy，DR）微血管瘤拱環(huán)未破壞組8例（16眼）、DR拱環(huán)破壞組20例（34眼）、DR拱環(huán)破壞伴黃斑區(qū)硬性滲出組20例（37眼）、DR黃斑水腫組9例（12眼）。所有病例均進(jìn)行眼底照像、FFA、視網(wǎng)膜電圖（Electroretinogram，ERG）及光學(xué)相干斷層掃描（Optical coherence tomograph，OCT）檢查，檢查結(jié)果經(jīng)統(tǒng)計(jì)學(xué)分析。 結(jié)果：(1)OCT結(jié)果：糖尿病黃斑病變組在視網(wǎng)膜內(nèi)叢狀層、內(nèi)核層、外核層、外叢狀層出現(xiàn)顆粒狀的高反光，隨著黃斑病變發(fā)展而加重；黃斑病變繼續(xù)發(fā)展而出現(xiàn)視網(wǎng)膜光感受器層的斷裂及視網(wǎng)膜色素上皮層的厚薄不均；在DR拱環(huán)破壞組、拱環(huán)破壞伴硬性滲出組及黃斑水腫組中有不完全玻璃體后脫離。(2)ERG結(jié)果：糖尿病FFA正常組出現(xiàn)最大混合反應(yīng)a波振幅下降、峰時(shí)延遲，隨著黃斑病變發(fā)展而加重（P＜0.05）;DR拱環(huán)破壞組開始出現(xiàn)明視視錐細(xì)胞a波振幅下降、峰時(shí)延遲,隨著黃斑病變發(fā)展而加重（P＜0.05）；糖尿病FFA眼底正常組出現(xiàn)暗視視桿細(xì)胞b波峰時(shí)延遲、最大混合反應(yīng)b波峰時(shí)延遲、明視視錐細(xì)胞b波的振幅下降，隨著黃斑病變發(fā)展而加重（P＜0.05），，并在DR拱環(huán)破壞組開始出現(xiàn)暗視視桿細(xì)胞b波振幅下降、最大混合反應(yīng)b波振幅下降、明視視錐細(xì)胞b波的波峰時(shí)延遲，隨著黃斑病變發(fā)展而加重（P＜0.05）；OPS振幅下降、峰時(shí)延遲，隨著黃斑病變發(fā)展而加重（P＜0.05）。 結(jié)論：（1)糖尿病FFA正常組黃斑區(qū)視桿、視錐細(xì)胞出現(xiàn)功能性改變，并隨著黃斑病變發(fā)展而加重，并在OCT出現(xiàn)外核層、外叢狀層高顆粒狀的高反光，隨著黃斑病變的發(fā)展出現(xiàn)光感受器層的斷裂及視網(wǎng)膜色素上皮層的厚薄不均。(2)糖尿病性黃斑病變視網(wǎng)膜內(nèi)屏障破壞的同時(shí)伴有外屏障的損傷。
[Abstract]:Objective: to study the damage characteristics of the inner and outer retinal barrier in diabetic macular disease. Methods: the clinical data of 67 patients with type 2 diabetes mellitus from January 2011 to March 2012 were selected. According to fundus manifestations and fundus fluorescein angiography (FFAA), the patients were divided into normal control group (n = 19, n = 33) and case group (n = 33). The data of the case group were as follows: 10 patients with diabetic FFA fundus normal group, 20 eyes with diabetic retinopathy, 8 patients with undamaged arch ring of diabetic retinopathy, and 20 patients with Dr arch ring destruction with macular area rigid exudation. Group A (n = 20), n = 37 (n = 37), Dr macular edema (n = 9), n = 12 (n = 12). All cases were examined by fundus radiography (FFA), electroretinogram (ERG) and optical coherence tomography (Oct). The results were analyzed statistically. Results the results of Oct showed that in the diabetic macular lesion group, granular high reflectance appeared in the inner plexiform layer, inner layer and outer plexiform layer, which was aggravated with the development of macular lesion. Macular lesions continued to develop with the rupture of the photoreceptor layer of the retina and the uneven thickness of the retinal pigment epithelium. The results of incomplete posterior vitreous detachment in the arch ring destruction with rigid exudation group and macular edema group were as follows: the maximum mixed response a wave amplitude decreased and the peak time delayed in diabetic FFA normal group. With the development of macular lesion, the amplitude of a wave of clear vision cone cell began to decrease, the peak time delayed, and the development of macular lesion aggravated with macular lesion (P < 0.05), and the B wave peak of dark optic rod cells in diabetic FFA fundus normal group was delayed. The peak of b wave in the maximum mixed reaction was delayed, the amplitude of b wave in the clear vision cone cells decreased, and aggravated with the development of macular lesion (P < 0. 05). The b wave amplitude of dark vision rod cells began to decrease and the b wave amplitude of the maximum mixed reaction decreased in Dr arch ring failure group. The peak time of b wave was delayed, the amplitude of OPS was decreased with the development of macular lesion (P < 0.05), the peak time was delayed, and the peak time was aggravated with the development of macular lesion (P < 0.05). Conclusions1) in the normal FFA group, the functional changes of the cone cells in the macular area were observed and aggravated with the development of macular lesions, and the high reflectance of the outer nuclear layer and the outer plexiform layer were observed in the OCT. With the development of macular disease, the photoreceptor layer breaks and the thickness of retinal pigment epithelium is uneven.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R774.1

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