本文選題：糖尿病視網(wǎng)膜病變 + 背景型　； 參考：《中國人民解放軍軍醫(yī)進修學(xué)院》2010年博士論文

【摘要】： 糖尿病(diabetes mellitus, DM)是一種復(fù)雜的代謝性疾病,近年來全世界發(fā)病人數(shù)已經(jīng)超過2.4億,最新調(diào)查顯示我國20歲以上人群患病率達9.7%,患病人數(shù)已超過9240萬。作為糖尿病的主要并發(fā)癥之一—糖尿病視網(wǎng)膜病變(diabetic retinopathy, DR)已成為糖尿病患者致盲的首要原因。相對于國內(nèi)外糖尿病視網(wǎng)膜微血管病變的基礎(chǔ)和臨床研究,糖尿病患者視功能的評價尚比較薄弱。DR的發(fā)生不僅預(yù)示著視功能損害的開始,同時提示視網(wǎng)膜的功能也將不可逆轉(zhuǎn)。早期掌握視功能的變化規(guī)律,有助于我們及時采取治療干預(yù)措施,遏制DR的發(fā)生和發(fā)展,從而挽救和保護糖尿病患者的視功能。本研究我們從視覺對比敏感度(contrast sensitivity, CS)、色覺(colour vision)、視野(visual field)等方面了解背景型糖尿病患者的視功能情況,以揭示糖尿病視網(wǎng)膜病變不同時期視功能改變的一般規(guī)律,為臨床治療提供全面而準確的依據(jù)。 目的 1.研究背景型糖尿病視網(wǎng)膜病變(DRⅠ期,DRⅡ期,DRⅢ期)患者視覺對比敏感度的變化規(guī)律及其在視功能評價中的意義； 2.分析背景型糖尿病視網(wǎng)膜病變患者色覺異常及其損害特征； 3.探討中心視野在背景型糖尿病視網(wǎng)膜病變患者的改變規(guī)律。 方法 1.對比敏感度的測試：應(yīng)用美國OPTEC6500型對比敏感度測試儀,對背景型糖尿病視網(wǎng)膜病變患者(DRⅠ期,DRⅡ期,DRⅢ期)及無眼底病變的糖尿病患者(DR0期)進行無眩光條件下5個空間頻率的遠、近距離的視覺對比敏感度測試,記錄統(tǒng)計糖尿病視網(wǎng)膜病變各組及對照組5個空間頻率的視覺對比敏感度范圍,比較DRⅠ期、DRⅡ期、DRⅢ期患者與DR0期患者之間對比敏感度的差異特點,探討不同分期患者視覺對比敏感度變化的規(guī)律；了解各期糖尿病患者CS與年齡的關(guān)系。 2.色覺檢查：采用法國Farnsworth Munsell-100型色覺測試儀,分別對無眼底改變糖尿病患者(DR0期)及背景型糖尿病視網(wǎng)膜病變患者(DRⅠ期,DRⅡ期,DRⅢ期)進行色覺測試,分析DRⅠ期、DRⅡ期、DRⅢ期患者與DR0期患者之間在總錯誤得分(total error score,TES)、總錯誤分平方根(√TES),紅、綠、藍色覺的錯誤得分及其平方根之間的差別,同時了解糖尿病患者年齡與色覺變化的關(guān)系。 3.視野檢查：采用德國產(chǎn)Humphery HFAⅡ型計算機自動視野計SITA-standard程序,分別對糖尿病視網(wǎng)膜病變患者(DRⅠ期,DRⅡ期,DRⅢ期)及對照組(DR0期)進行中心視野檢查,對其結(jié)果進行分析,比較背景型糖尿病視網(wǎng)膜病變各組與對照組之間在平均缺損(MD)、圖形標準差(PSD)、缺損點數(shù)等的差異,并探討各期視野缺損的特點。 結(jié)果 1.視覺對比敏感度：(1)背景型糖尿病視網(wǎng)膜病變患者與無眼底病變糖尿病患者視覺對比敏感度各頻率無論在遠距離還是近距離均存在顯著性差異(P0.05),高頻區(qū)更為明顯；(2)背景型糖尿病視網(wǎng)膜病變不同分期組組之間CS值也存在差異,分期越重,差異呈增加趨勢；不同年齡組CS值的差異體現(xiàn)在高頻區(qū)；(3)隨著DR分期的增加,對比敏感度曲線的峰值左移,由中頻區(qū)6cpd過渡到低頻區(qū)3cpd,DRⅢ期組CSF呈倒“L”字形。 2.色覺：(1)糖尿病視網(wǎng)膜病變各組與對照組在TES以及√TES方面存在顯著性差異(P0.05)；(2)糖尿病視網(wǎng)膜病變各組與對照組在紅、綠、藍色覺的錯誤得分及其平方根之間均存在顯著性差異(P0.05),其中綠、藍軸向色覺損害較為顯著而紅色軸向損害較為輕微；(3)色覺損害與糖尿病視網(wǎng)膜病變分期有關(guān),眼底病變越重,則色覺損害越明顯。 3.視野：(1)DRⅠ期組視野缺損點數(shù)高于DR0期組。DRⅡ期組、DRⅢ期組視野平均缺損(MD)、圖形標準差(PSD)及視野缺損點數(shù)高于DR0期組。 (2)DR0期組異常視野的百分比為33.4%,DRⅠ期組和DRⅡ期組異常視野的百分比在50%左右,DRⅢ期組異常視野的百分比高達71.4%。(3)DRⅠ期組患者的中心視野表現(xiàn)為點狀或片狀缺損；DRⅡ～Ⅲ期組患者的中心視野表現(xiàn)為片狀及團狀缺損,不沿神經(jīng)纖維走行分布,多數(shù)暗區(qū)出現(xiàn)在視野中周部20°-30°范圍內(nèi)。 結(jié)論 1.視覺對比敏感度在背景型糖尿病視網(wǎng)膜病變患者出現(xiàn)全頻段CS值下降,其中多數(shù)患者高頻段CS值的下降明顯,并與年齡相關(guān),是評價背景型糖尿病視網(wǎng)膜病變患者視功能的敏感指標。 2.紅色、綠色及藍色覺在背景型糖尿病視網(wǎng)膜病變患者均出現(xiàn)損害,其中綠色、藍色覺損害更為顯著,隨糖尿病視網(wǎng)膜病變分級的增加而加重,并與年齡有一定的關(guān)系,可以作為背景型糖尿病視網(wǎng)膜病變患者視功能評價的敏感指標。 3.隨著糖尿病視網(wǎng)膜病變分級的增加,背景型糖尿病視網(wǎng)膜病變中心視野損害呈逐漸加重趨勢,視野缺損的特點為點狀、片狀及團狀,多出現(xiàn)在中周部20°-30°范圍內(nèi)。
[Abstract]:Diabetes (diabetes mellitus DM) is a complex metabolic disease, in recent years the number of incidence in the world has more than 240 million, the latest survey shows that China's population above 20 years old the prevalence rate reached 9.7%, the number of patients has more than 92 million 400 thousand. As one of the major complications of diabetes and diabetic retinopathy (diabetic, retinopathy, DR) has to become the leading cause of blindness in patients with diabetes. Compared with the basic and clinical research on diabetic microangiopathy home and abroad, not only marked the start of visual function damage is still weak.DR evaluation of visual function in patients with diabetes mellitus, and suggests that the retinal function will be irreversible. Master the early changes of retinal function, help us take timely treatment intervention to curb the occurrence and development of DR, so as to save and protect visual function in patients with diabetes. In this study, we from the vision Contrast sensitivity (contrast, sensitivity, CS) (colour vision), color vision (visual field) and other aspects of understanding visual function in patients with type 2 diabetes mellitus background, to reveal the general law of diabetic retinopathy in different periods of visual function change, for clinical treatment to provide comprehensive and accurate data.
objective
1. research background diabetic retinopathy (DR stage, DR stage, DR stage III) meaning changes of patients with visual contrast sensitivity and visual function of the;
2. analysis of background diabetic retinopathy and the damage characteristics of chromatopsia;
3. to investigate the changes in the central visual field in patients with background diabetic retinopathy.
Method
1. contrast sensitivity test: the application of OPTEC6500 contrast sensitivity tester for patients with background diabetic retinopathy (DR stage, DR stage, DR stage III) and diabetic patients without retinopathy (DR0) without glare conditions at 5 spatial frequencies, visual contrast sensitivity test in near distance, each record of diabetic retinopathy and the control group of 5 spatial frequency contrast sensitivity range, DR stage, DR stage, DR between patients in stage III patients with DR0 phase contrast sensitivity difference characteristics, to explore the patients with different stages of visual contrast sensitivity changes; understand the relationship CS and age in patients with diabetes.
2. color: by French Farnsworth Munsell-100 type color vision tester, respectively on the fundus changes in patients with diabetes mellitus (DR0) patients and background diabetic retinopathy (DR stage, DR stage, DR stage III) color vision test analysis, DR stage, DR stage, DR stage III patients and between patients DR0 in the total error score (total error score, TES), the total error of square root (root TES), red, green, blue felt and error scores between the square root of the differences, and understand the relationship between age and color change in patients with diabetes mellitus.
3.: the automatic perimetry vision of German Humphery HFA type computer SITA-standard program, respectively in patients with diabetic retinopathy (DR stage, DR stage, DR stage III) and control group (DR0) of central visual field examination, the results of the analysis, comparison between the background diabetic retinopathy group and in the control group (MD), mean defect pattern standard deviation (PSD), differences in defective points etc., and discusses the characteristics of each stage of visual field loss.
Result
1. visual contrast sensitivity: (1) patients with background diabetic retinopathy and diabetic patients without retinopathy visual contrast sensitivity of each frequency in long distance or close and there was significant difference (P0.05), high frequency region is more obvious; (2) there are differences between different stages of background diabetic retinopathy group the value of CS staging, the heavier, the difference increased among different age groups; the CS value is reflected in the high frequency region; (3) with the increase of DR staging, the peak contrast sensitivity curve of the left shift, the transition from 6cpd to 3cpd if the low frequency region, DR III group CSF inverted "L" shape.
2. color: (1) diabetic retinopathy group and control group there were significant differences in TES and TES V (P0.05); (2) diabetic retinopathy group and control group in the red, green, and there was significant difference between the score and the error square root feel blue (P0.05), which is green, blue axial color damage is significant while the red axial relatively minor damage; (3) the color damage and stages of diabetic retinopathy, retinopathy is more serious, the color damage is more obvious.
3. view: (1) the first stage of DR group was higher than that of DR0 group the number of visual field defect in.DR stage group, DR stage group mean defect of visual field (MD), pattern standard deviation (PSD) and visual field defect points higher than that of DR0 group.
(2) the percentage of DR0 patients the abnormal visual field is 33.4%, the first stage of DR group and DR group II abnormal vision percentage is about 50%, the percentage of DR phase III group abnormal vision up to 71.4%. (3) DR of central visual field groups showed punctate or patchy central visual field defect; II ~ DR stage III patients showed patchy and nodular defects along the nerve fibers distribution, the majority of the dark zone in the field around 20 DEG -30 DEG range.
conclusion
1. visual contrast sensitivity in diabetic retinopathy patients with background type full band CS decreased, which decreased significantly in most patients with high frequency CS, and correlated with age, is a sensitive indicator of the visual function of patients with retinopathy evaluation background of diabetes.
2. red, green and blue sleep damage were found in the patients with background diabetic retinopathy among the green, blue sleep damage is more obvious, with the increase of diabetic retinopathy grade increased, and there is a certain relationship with age, can be used as sensitive indexes of background diabetic retinopathy treated patients with visual function evaluation.
3. with the increase of the grade of diabetic retinopathy, diabetic retinopathy visual field damage Center showed a gradually increasing trend in the background, characteristics of visual field defect as a point sheet and bulk, more appear in the peripheral part of 20 DEG -30 DEG range.

【學(xué)位授予單位】：中國人民解放軍軍醫(yī)進修學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2010
【分類號】：R774.1

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