中华眼底病杂志

中华眼底病杂志

糖尿病黄斑水肿光相干断层扫描分型与糖尿病视网膜病变分期及全身因素的相关性分析

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目的 观察探讨糖尿病(DM)黄斑水肿(DME)的光相干断层扫描(OCT)分型与DM视网膜病变(DR)分期以及全身因素的相关性。 方法 回顾性研究。135例2型DM患者242只眼纳入研究。其中,男性75例138只眼,女性60例104只眼。年龄29~83岁,平均年龄(58.8±11.1)岁。采集患者身高、体重、吸烟史等一般信息并收集糖化血红蛋白(HbAlc)等血糖以及血压、血脂、24 h尿蛋白定量等检查指标。根据眼底彩色照相及OCT检查结果确立DR、DME诊断及DR分期、DME分型。其中,DR分为轻度非增生型DR(NPDR)、中度NPDR、重度NPDR以及增生型DR(PDR);DME分为海绵样黄斑水肿(SME)、囊样黄斑水肿(CME)、浆液性视网膜脱离型黄斑水肿(SRD)及后皮质牵拉型黄斑水肿(PHT)4种类型。应用χ2检验及Fisher精确检验分析DME及其各分型与DR分期的相关性;应用多因素logistic回归分析法分析DME分型与全身因素的相关性。 结果 242只眼中,轻度、中度、重度NPDR及PDR占比分别为30.99%、32.64%、23.14%、13.23%。无DME 43只眼,占17.77%;DME 199只眼,占82.23%。DME占比随DR程度加重而增加。不同分期DR患眼DME占比情况比较,差异有统计学意义(χ2=21.077,P<0.01)。DME 199只眼中,SME、CME、SRD、PHT为165、22、7、5只眼,其占比分别为所有患眼的68.18%、9.09%、2.89%、2.07%。不同分型DME在DR各分期中的分布情况比较,差异有统计学意义(χ2=156.273,P<0.01)。Logistic回归分析结果显示,DM病程、HbA1c及蛋白尿是DME的独立危险因素[比值比(OR)=1.090、1.510、4.123,P<0.05],同时也是DME分型中SME的独立危险因素(OR=1.092、1.445、3.942,P<0.05);蛋白尿是DME分型中CME的独立危险因素(OR=5.146,P<0.05);HbA1c是DME分型中SRD的独立危险因素 (OR=2.337,P<0.05)。 结论 DME不同OCT分型在DR各分期中的分布情况有差异。DM病程、HbA1c及蛋白尿是DME及其分型SME的独立危险因素;蛋白尿、HbA1c分别是DME分型中CME、SRD的独立危险因素。

Objective To investigate the distribution patterns of diabetic macular edema (DME) based on optical coherence tomography (OCT), and explore its correlation with diabetic retinopathy (DR) stages and systemic factors. Methods A total of 135 patients (242 eyes) with type 2 diabetes were included in this retrospective study. There were 75 males (138 eyes) and 60 females (104 eyes), the ages were from 29 to 83 years, with an average age of (58.8±11.1) years. The general information such as height, weight, smoking history and blood glucose [such as glycosylated hemoglobin (HbA1c)], blood pressure, blood lipid, 24 hours urine protein and other examinations were collected. The diagnosis of DR and DME were made, and the staging of DR and typing of DME were performed based on fundus color imaging and OCT. DR were divided into mild non-proliferative DR (NPDR), moderate NPDR, severe NPDR and proliferative DR (PDR). DME were categorized into 4 types including sponge-like retinal swelling (SME), cystoid macular edema (CME), serous retinal detachment (SRD) and posterior hyaloid traction (PHT). The correlation between DME types and DR staging were analyzed byχ2 test and Fisher exact test. Multivariate logistic regression analysis was used to analyze the correlation between DME types and systemic factors. Results In 242 DR eyes the proportions of mild, moderate, severe NPDR and PDR were 30.99%, 32.64%, 23.14% and 13.23%, respectively. There were 199 eyes (82.23%) with DME. There were statistically significant differences in the proportion of DME in different stages of DR (χ2=21.077,P<0.01). In the 199 eyes with DME, There were 165 eyes (68.18%) of SME, 22 eyes (9.09%) of CME, 7 eyes (2.89%) of SRD and 5 eyes (2.07%) of PHT. The distribution of DME patterns in different stages of DR was statistically significant (χ2=156.273,P<0.01). Logistic regression analysis showed that the duration of diabetes, HbA1c and macroalbuminuria were independent risk factors for DME [odds ratio (OR)=1.090, 1.510, 4.123;P<0.05], and were also independent for SME (OR=1.092, 1.445, 3.942;P<0.05); HbA1c was an independent risk factor for SRD (OR=2.337,P<0.05). Conclusions There are differences in the distribution of different DME types in each stage of DR. The duration of diabetes, HbA1c and macroalbuminuria were independent risk factors for DME and SME, and macroalbuminuria and HbA1c for CME and SRD.

关键词: 黄斑水肿/诊断; 糖尿病视网膜病变/诊断; 体层摄影术,光学相干; 危险因素

Key words: Macular edema/diagnosis; Diabetic retinopathy/diagnosis; Tomography, optical coherence; Risk factors

引用本文: 李玮, 杜新华, 李淑婷, 王相宁, 陈永东, 吴强. 糖尿病黄斑水肿光相干断层扫描分型与糖尿病视网膜病变分期及全身因素的相关性分析. 中华眼底病杂志, 2017, 33(3): 262-266. doi: 10.3760/cma.j.issn.1005-1015.2017.03.010 复制

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