本文選題：糖尿病視網(wǎng)膜病變 + 視網(wǎng)膜神經(jīng)纖維層�。� 參考：《山西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：糖尿病可以誘發(fā)大鼠視網(wǎng)膜神經(jīng)節(jié)細(xì)胞凋亡，視網(wǎng)膜神經(jīng)纖維層（retinal nerve fiber layer,RNFL）主要由神經(jīng)節(jié)細(xì)胞的軸突組成，早期糖尿病患者RNFL厚度尤其黃斑區(qū)RNFL厚度與糖尿病及糖尿病視網(wǎng)膜病變（DiabeticRetinopathy，DR）的發(fā)生及發(fā)展的關(guān)系尚待研究。應(yīng)用頻域光相干斷層掃描（optical coherence tomography，，OCT）觀察視網(wǎng)膜無血管改變的糖尿病患者（non-diabetic retinopathy，NDR）、非增生性糖尿病視網(wǎng)膜病變（non-proliferativediabetic retinopathy，NPDR）患者較正常人RNFL厚度的改變，分析糖尿病患者視盤周圍及黃斑區(qū)RNFL厚度與糖尿病及糖尿病視網(wǎng)膜病變的關(guān)系，進(jìn)一步探討糖尿病早期神經(jīng)病變的特點(diǎn)及與糖尿病血管病變的關(guān)系，為DR的早期發(fā)現(xiàn)、診斷及早期干預(yù)提供一定依據(jù)。 方法：正常對(duì)照組30人30眼，糖尿病患者56人60眼，通過裂隙燈顯微鏡、直接檢眼鏡或者前置鏡及眼底熒光血管造影檢查，按DR國際臨床分型標(biāo)準(zhǔn)分為兩組，糖尿病患者視網(wǎng)膜無血管改變組（NDR組,30眼/26人）、輕度及早期中度非增生性糖尿病視網(wǎng)膜病變組（NPDR組，30眼/30人）。應(yīng)用頻域OCT對(duì)每組病例行視盤周圍及黃斑區(qū)RNFL厚度測(cè)量，測(cè)量數(shù)據(jù)包括視盤周圍及中心凹周圍視網(wǎng)膜360°平均（G）及其各自鼻上（NS）、顳上（TS）、顳側(cè)（T）、顳下（TI）、鼻下（NI）、鼻側(cè)（N）區(qū)域RNFL厚度。 結(jié)果：視盤周圍RNFL厚度：NDR組視盤周圍RNFL厚度視盤360°平均G（97.46±8.65）um、NS（113.84±21.85）um、TS（127.79±15.11）um、T（71.06±10.84）um、TI（137.88±22.13）um、NI（110.85±22.64）um、N（72.74±12.52）um；NPDR組RNFL厚度視盤360°平均G（100.69±16.35）um、NS（117.32±19.05）um、TS（134.01±19.32）um、T（79.83±12.02）um、TI（149.56±24.30）um、NI（115.75±27.56）um、N（70.90.71±16.28）um。正常對(duì)照組RNFL厚度視盤360°平均G（109.22±8.69）um、NS（118.20±23.71）um、TS（150.74±17.12）um、T（79.93±6.93）um、TI（158.77±18.27）um、NI（127.79±24.34）um、N（77.89±10.82）um；NDR組各區(qū)域RNFL厚度較正常對(duì)照組變薄,平均G、TS、T、TI和NI區(qū)域差異有統(tǒng)計(jì)學(xué)差異（P＜0.01），NPDR組各區(qū)域RNFL厚度較正常對(duì)照組變薄，平均G、TS、N區(qū)域差異有統(tǒng)計(jì)學(xué)差異（G、TS區(qū)域P＜0.01;N區(qū)域P＜0.05）。 黃斑區(qū)RNFL厚度：NDR組黃斑區(qū)RNFL厚度平均G（33.47±3.39）um、NS（39.27±5.30）um、TS（31.35±3.56）um、T（24.02±2.19）um、TI（34.47±4.20）um、NI（39.89±5.72）um、N（36.31±4.75）um；NPDR組黃斑區(qū)RNFL厚度平均G（36.81±3.21）um、NS（44.44±6.96）um、TS（34.40±3.45）um、T（25.71±3.10）um、TI（37.47±4.43）um、NI（43.74±5.54）um、N（40.34±6.47）um。正常對(duì)照組黃斑區(qū)RNFL厚度平均G（38.18±2.16）um、NS（47.87±5.16）um、TS（36.60±3.22）um、T（28.27±2.37）um、TI（39.28±4.14）um、NI（44.64±4.28）um、N（40.36±2.94）um。NDR組各區(qū)域RNFL厚度較正常對(duì)照組變薄且差異均有統(tǒng)計(jì)學(xué)差異（P＜0.01）；NPDR組各區(qū)域RNFL厚度較正常對(duì)照組變薄, NS、TS、T區(qū)域差異有統(tǒng)計(jì)學(xué)差異（T區(qū)域P＜0.01；NS、TS區(qū)域P＜0.05）。 結(jié)論：糖尿病患者在視網(wǎng)膜出現(xiàn)血管改變之前已有RNFL的變薄，RNFL變薄是DR早期視網(wǎng)膜結(jié)構(gòu)的重要改變，可能與DR的發(fā)生及發(fā)展相關(guān)；頻域OCT能定量觀察視網(wǎng)膜神經(jīng)纖維層厚度變化，可以觀察到糖尿病對(duì)視網(wǎng)膜結(jié)構(gòu)的早期影響，可作為糖尿病患者早期視網(wǎng)膜病變的一種診斷方法。
[Abstract]:Objective : To investigate the relationship between RNFL thickness and diabetic retinopathy ( DR ) in diabetic patients with diabetic retinopathy ( NPDR ) and diabetic retinopathy ( DR ) .

Methods : 30 eyes of 30 patients in normal control group and 60 eyes of diabetic patients were examined by slit lamp microscope , direct ophthalmoscope or pre - lens and fundus fluorescein angiography . The patients with diabetes mellitus were divided into two groups according to DR international clinical classification standard ( NPDR group , 30 eyes / 26 people ) , mild and early moderate non - proliferative diabetic retinopathy ( NPDR group , 30 eyes / 30 person ) . The thickness of RNFL in peripheral and macular area of each group of cases was measured by frequency - domain OCT . The measured data consisted of 360 擄 average ( G ) around the optic disc and around the central fovea , and their respective nasal ( NS ) , temporal ( TS ) , temporal ( T ) , temporal ( TI ) , nasal ( NI ) , nasal ( N ) area RNFL thickness .

Results : RNFL thickness around the optic disc : 360 擄 mean G ( 97.46 鹵 8.65 ) um , NS ( 13.84 鹵 21.85 ) um , TS ( 127.79 鹵 15.11 ) um , T ( 71.06 鹵 10.84 ) um , TI ( 137.88 鹵 22.13 ) um , NI ( 110.85 鹵 22.64 ) um , N ( 72.74 鹵 12.52 ) um .
The RNFL thickness in NPDR group was 360 擄 mean G ( 100.69 鹵 16.35 ) um , NS ( 117.32 鹵 19.05 ) um , TS ( 134.01 鹵 19.32 ) um , T ( 79.83 鹵 12.02 ) um , TI ( 149.56 鹵 24.30 ) um , NI ( 15.74 鹵 17.12 ) um , T ( 79.93 鹵 6.93 ) um , TI ( 158.77 鹵 18.27 ) um , NI ( 127.79 鹵 24.34 ) um , N ( 77.89 鹵 10.82 ) um ;
The RNFL thickness in each region of the NPDR group was significantly different from that of the normal control group ( P < 0.01 ) , and the RNFL thickness in each region of the NPDR group was thinner than that of the normal control group ( P < 0.01 ) . The difference of the average G , TS and N regions was statistically significant ( G , TS region P < 0.01 ; N region P < 0.05 ) .

The RNFL thickness in the macular region : the RNFL thickness in the macular region of the ndr group was average G ( 33.47 鹵 3.39 ) um , NS ( 39.27 鹵 5.30 ) um , TS ( 31.35 鹵 3.56 ) um , T ( 24.02 鹵 2.19 ) um , TI ( 34.47 鹵 4.20 ) um , NI ( 39.89 鹵 5.72 ) um , N ( 36.31 鹵 4.75 ) um ;
The RNFL thickness in the macular area of the NPDR group was ( 36.81 鹵 3.21 ) um , NS ( 44.44 鹵 6.96 ) um , TS ( 34.40 鹵 3.45 ) um , T ( 25.71 鹵 3.10 ) um , TI ( 37.47 鹵 4.43 ) um , NI ( 43.74 鹵 5.54 ) um , N ( 39.28 鹵 4.14 ) um , NI ( 44.64 鹵 4.28 ) um , N ( 40.36 鹵 2.94 ) um .
The RNFL thickness in the NPDR group was thinner than that of the normal control group , and the difference of NS , TS and T was significant ( P < 0.01 ) .
NS , TS area ( P < 0.05 ) .

Conclusion : The thinning of RNFL and the thinning of RNFL are the important changes in DR early retinal structure , which may be related to the occurrence and development of DR .
OCT can quantitatively observe the changes of retinal nerve fiber layer thickness , and can observe the early effect of diabetes on retinal structure , and can be used as a diagnostic method for early retinal disease in diabetic patients .
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R587.2;R774.1

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本文編號(hào)：1983004