糖尿病患者HbA1c水平与白内障术后黄斑中心凹视网膜厚度的相关性研究
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摘要
目的:探讨糖尿病患者糖化血红蛋白(HbA1c)水平与白内障术后黄斑中心凹视网膜厚度的相关性。方法:回顾性分析2013-09/2016-06在我院眼科行白内障手术的糖尿病视网膜病变患者119例119眼,根据术前HbA1c水平将患者分为低HbA1c组(HbA1c≤7.0%,60例60眼)和高HbA1c组(7.0%凹视网膜厚度,并分析其与术前HbA1c水平的相关性。结果:术前1d,高HbA1c组和低HbA1c组患者的HbA1c水平分别为8.29%±2.19%和5.38%±1.49%,差异有统计学意义(P<0.05),高HbA1c组患者5个区域黄斑中心凹视网膜厚度均显著高于低HbA1c组(P<0.05)。术后7d,两组患者5个区域黄斑中心凹视网膜厚度均高于术前1d(P<0.05),且高HbA1c组显著高于低HbA1c组(P<0.05)。直线回归分析显示,术前1d、术后7d CSF及A1～A4 5个区域黄斑中心凹视网膜厚度与术前HbA1c水平均呈显著正相关(P<0.05)。结论:糖尿病患者术前HbA1c水平与白内障术前、术后黄斑中心凹视网膜厚度均有显著相关性,对于监测白内障术后黄斑水肿的发生发展有重要的临床意义。
AIM: To investigate the correlation between glycosylated hemoglobin( HbA1c) level and macular fovea retinal thickness after cataract surgery in diabetic patients.METHODS: By a randomized sampling and retrospective study,from September 2013 to June 2016,a total of 119 cases( 119 eyes) of diabetic retinopathy in our hospital were selected and divided into low HbA1c group( HbA1c≤7. 0%) of 60 cases( 60 eyes) and high HbA1c group( 7. 0% < HbA1c≤9. 0%) of 59 cases( 59 eyes)according to preoperative HbA1c levels. All patients underwent phacoemulsification and posterior chamber intraocular lens implantation. Optical coherence tomography( OCT) was used to detect the retinal thickness of the fovea before and after surgery,and its correlation with preoperative HbA1c levels was analyzed.RESULTS: At preoperative 1 d,HbA1c in the high HbA1c group and the low HbA1c group were 8. 29%±2. 19% and5. 38%±1. 49% respectively,and the differences between two groups were statistically significant( P < 0. 05);macular foveal retinal thickness in the 5 regions of high HbA1c group were significantly higher than that in the low HbA1c group( P<0. 05). At postoperative 7 d of macular fovea retinal thickness in the 5 regions of the two groups was higher than that at postoperative 1 d( P<0. 05),and the high HbA1c group was also significantly higher than that of the low HbA1c group( P<0. 05). Linear regression analysis showed that preoperative 1 d HbA1c were significant positive correlation with preoperative 1 d,postoperative 7 d of macular foveal retinal thickness in 5 regions( P<0. 05).CONCLUSION: HbA1c levels in diabetic patients are significantly correlated with preoperative and postoperative macular foveal retinal thickness. It has important clinical significance for monitoring the occurrence and development of macular edema after cataract surgery.
AIM: To investigate the correlation between glycosylated hemoglobin( HbA1c) level and macular fovea retinal thickness after cataract surgery in diabetic patients.METHODS: By a randomized sampling and retrospective study,from September 2013 to June 2016,a total of 119 cases( 119 eyes) of diabetic retinopathy in our hospital were selected and divided into low HbA1c group( HbA1c≤7. 0%) of 60 cases( 60 eyes) and high HbA1c group( 7. 0% < HbA1c≤9. 0%) of 59 cases( 59 eyes)according to preoperative HbA1c levels. All patients underwent phacoemulsification and posterior chamber intraocular lens implantation. Optical coherence tomography( OCT) was used to detect the retinal thickness of the fovea before and after surgery,and its correlation with preoperative HbA1c levels was analyzed.RESULTS: At preoperative 1 d,HbA1c in the high HbA1c group and the low HbA1c group were 8. 29%±2. 19% and5. 38%±1. 49% respectively,and the differences between two groups were statistically significant( P < 0. 05);macular foveal retinal thickness in the 5 regions of high HbA1c group were significantly higher than that in the low HbA1c group( P<0. 05). At postoperative 7 d of macular fovea retinal thickness in the 5 regions of the two groups was higher than that at postoperative 1 d( P<0. 05),and the high HbA1c group was also significantly higher than that of the low HbA1c group( P<0. 05). Linear regression analysis showed that preoperative 1 d HbA1c were significant positive correlation with preoperative 1 d,postoperative 7 d of macular foveal retinal thickness in 5 regions( P<0. 05).CONCLUSION: HbA1c levels in diabetic patients are significantly correlated with preoperative and postoperative macular foveal retinal thickness. It has important clinical significance for monitoring the occurrence and development of macular edema after cataract surgery.
引文
1王懿,伊恩晖,李妮娜.早期糖尿病视网膜病变眼底检测和监测指标相关性研究.国际眼科杂志2017;17(4):698-701
2 Srinivasan S,Raman R,Swaminathan G,et al.Incidence,progression,and risk factors for cataract in type 2 diabetes.Invest Ophthalmol Vis Sci2017;58(13):5921-5929
3 Peterson SR,Silva PA,Murtha TJ,et al.Cataract Surgery in Patients with Diabetes:Management Strategies.Semin Ophthalmol 2017;11(16):1-8
4 肖玥言,袁梦克,郗平,等.颈动脉斑块与糖尿病视网膜病变的相关性.中华医学杂志2017;97(24):1871-1874
5 Cai Q,Xie X,Wang J,et al.Severe adverse effects associated with corticosteroid treatment in patients with Ig A nephropathy.Kidney Int Rep2017;2(4):603-609
6 Halkiadakis I,Chatziralli I,Drakos E,et al.Causes and management of small pupil in patients with cataract.Oman J Ophthalmol 2017;10(3):220-224
7 韩鹏飞,李双农,李强,等.糖尿病患者脉络膜厚度与血流动力学指数及糖化血红蛋白的相关性.国际眼科杂志2015;14(7):1207-1209
8 Bar-Oz D,Hecht I,Achiron A,et al.Glycemic control and quality of life following cataract surgery in patients with type 2 diabetes and without maculopathy.Curr Eye Res 2017;11(7):1-6
9 Akinciogˇlu D,Kü9ükevciliogˇlu M,Durukan AH,et al.Outcomes of intravitreal dexamethasone implant in the treatment of recalcitrant diabetic macular edema.Turk J Ophthalmol 2017;47(5):274-278
10 李淑婷,王相宁,杜新华,等.2型糖尿病患者糖尿病视网膜病变与肾小球滤过率的相关性研究.中华眼底病杂志2017;33(3):244-248
11 杜瑞斌.OCT技术检测视网膜神经纤维层的厚度变化在早期糖尿病视网膜病变中的意义.河北医药2017;39(18):2845-2847
12 Orzan A,Novac C,Mihu M,et al.The autoimmunity's footprint in pediatrics:type 1 diabetes,coeliac disease,thyroiditis.Maedica(Buchar)2017;12(2):136-142
13 钱锦,忽俊,朱蓓菁,等.糖化血红蛋白水平对糖尿病患者白内障术后黄斑区视网膜厚度的影响.国际眼科杂志2016;16(1):91-93
14 Shah VR,Christian DS,Prajapati AC,et al.Quality of life among elderly population residing in urban field practice area of a tertiary care institute of Ahmedabad city,Gujarat.J Family Med Prim Care 2017;6(1):101-105
15 Matsuda S,Sugawa H,Shirakawa JI,et al.Aphanothece sacrum(Sur.)Okada prevents cataractogenesis in type 1 diabetic mice.J Nutr Sci Vitaminol(Tokyo)2017;63(4):263-268
16 王文英,冀向宁,韩风梅,等.青年2型糖尿病早期视网膜神经纤维层厚度和视觉对比敏感度的动态变化.中华实验眼科杂志2015;33(8):716-721
17 Assaf AR,Bushmakin AG,Joyce N,et al.The relative burden of menopausal and postmenopausal symptoms versus other major conditions:a retrospective analysis of the medical expenditure panel survey data.Am Health Drug Benefits 2017;10(6):311-321
18 Sahu PK,Das GK,Agrawal S,et al.Comparative evaluation of corneal endothelium in patients with diabetes undergoing phacoemulsification.Middle East Afr J Ophthalmol 2017;24(2):74-80
19 周绍英,王真艳,高淼.监测糖化血红蛋白在糖尿病患者白内障术后的应用价值.国际眼科杂志2017;17(3):485-487
20 陈静,王继红.改良全视网膜光凝顺序治疗对重度非增殖期糖尿病性视网膜病变患者黄斑厚度及视力改善的效果.中国临床研究2017;30(1):120-122
21 尹妮,赵帅,朱红娜.康柏西普预处理联合玻璃体切割术治疗增生型糖尿病视网膜病变.眼科新进展2017;37(8):770-772
22 Achiron A.Intraocular pressure spikes following neodymium-doped yttrium aluminum garnet laser capsulotomy:current prevalence and management in israel.J Curr Glaucoma Pract 2017;11(2):63-66
23 吴秋菊,邓青,李蕊,等.不同类型糖尿病黄斑水肿患者视力与黄斑形态的相关性分析.国际眼科杂志2016;16(2):303-306
2 Srinivasan S,Raman R,Swaminathan G,et al.Incidence,progression,and risk factors for cataract in type 2 diabetes.Invest Ophthalmol Vis Sci2017;58(13):5921-5929
3 Peterson SR,Silva PA,Murtha TJ,et al.Cataract Surgery in Patients with Diabetes:Management Strategies.Semin Ophthalmol 2017;11(16):1-8
4 肖玥言,袁梦克,郗平,等.颈动脉斑块与糖尿病视网膜病变的相关性.中华医学杂志2017;97(24):1871-1874
5 Cai Q,Xie X,Wang J,et al.Severe adverse effects associated with corticosteroid treatment in patients with Ig A nephropathy.Kidney Int Rep2017;2(4):603-609
6 Halkiadakis I,Chatziralli I,Drakos E,et al.Causes and management of small pupil in patients with cataract.Oman J Ophthalmol 2017;10(3):220-224
7 韩鹏飞,李双农,李强,等.糖尿病患者脉络膜厚度与血流动力学指数及糖化血红蛋白的相关性.国际眼科杂志2015;14(7):1207-1209
8 Bar-Oz D,Hecht I,Achiron A,et al.Glycemic control and quality of life following cataract surgery in patients with type 2 diabetes and without maculopathy.Curr Eye Res 2017;11(7):1-6
9 Akinciogˇlu D,Kü9ükevciliogˇlu M,Durukan AH,et al.Outcomes of intravitreal dexamethasone implant in the treatment of recalcitrant diabetic macular edema.Turk J Ophthalmol 2017;47(5):274-278
10 李淑婷,王相宁,杜新华,等.2型糖尿病患者糖尿病视网膜病变与肾小球滤过率的相关性研究.中华眼底病杂志2017;33(3):244-248
11 杜瑞斌.OCT技术检测视网膜神经纤维层的厚度变化在早期糖尿病视网膜病变中的意义.河北医药2017;39(18):2845-2847
12 Orzan A,Novac C,Mihu M,et al.The autoimmunity's footprint in pediatrics:type 1 diabetes,coeliac disease,thyroiditis.Maedica(Buchar)2017;12(2):136-142
13 钱锦,忽俊,朱蓓菁,等.糖化血红蛋白水平对糖尿病患者白内障术后黄斑区视网膜厚度的影响.国际眼科杂志2016;16(1):91-93
14 Shah VR,Christian DS,Prajapati AC,et al.Quality of life among elderly population residing in urban field practice area of a tertiary care institute of Ahmedabad city,Gujarat.J Family Med Prim Care 2017;6(1):101-105
15 Matsuda S,Sugawa H,Shirakawa JI,et al.Aphanothece sacrum(Sur.)Okada prevents cataractogenesis in type 1 diabetic mice.J Nutr Sci Vitaminol(Tokyo)2017;63(4):263-268
16 王文英,冀向宁,韩风梅,等.青年2型糖尿病早期视网膜神经纤维层厚度和视觉对比敏感度的动态变化.中华实验眼科杂志2015;33(8):716-721
17 Assaf AR,Bushmakin AG,Joyce N,et al.The relative burden of menopausal and postmenopausal symptoms versus other major conditions:a retrospective analysis of the medical expenditure panel survey data.Am Health Drug Benefits 2017;10(6):311-321
18 Sahu PK,Das GK,Agrawal S,et al.Comparative evaluation of corneal endothelium in patients with diabetes undergoing phacoemulsification.Middle East Afr J Ophthalmol 2017;24(2):74-80
19 周绍英,王真艳,高淼.监测糖化血红蛋白在糖尿病患者白内障术后的应用价值.国际眼科杂志2017;17(3):485-487
20 陈静,王继红.改良全视网膜光凝顺序治疗对重度非增殖期糖尿病性视网膜病变患者黄斑厚度及视力改善的效果.中国临床研究2017;30(1):120-122
21 尹妮,赵帅,朱红娜.康柏西普预处理联合玻璃体切割术治疗增生型糖尿病视网膜病变.眼科新进展2017;37(8):770-772
22 Achiron A.Intraocular pressure spikes following neodymium-doped yttrium aluminum garnet laser capsulotomy:current prevalence and management in israel.J Curr Glaucoma Pract 2017;11(2):63-66
23 吴秋菊,邓青,李蕊,等.不同类型糖尿病黄斑水肿患者视力与黄斑形态的相关性分析.国际眼科杂志2016;16(2):303-306