糖尿病性视网膜病变术后CRT、SFCT、mALB、MBG、HbA1c水平的变化及相关性
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摘要
本研究通过观察糖尿病性视网膜病变术后患者黄斑中心凹视网膜厚度,脉络膜厚度,尿微量白蛋白、血糖、糖化血红蛋白的水平,试图了解其差异及相关性。我们选取2016年1月至2017年12月于我院就诊的糖尿病性视网膜病变患者200例,根据其有无视网膜病变、有无肾病、术后有无黄斑水肿分为合并组和未合并组,同时选取100例正常成年人作为对照。观察糖尿病患者和对照组、未合并和合并并发症糖尿病患者的黄斑中心凹视网膜厚度(central retinal thickness, CRT),凹下脉络膜厚度(subfoveal choroidal thickness,SFCT),尿微量白蛋白(microAlbunminuria, mALB)、平均血糖(mean blood glucose, MBG)和糖化血红蛋白(glycated haemoglobin, HbA1c)水平,进一步分析了糖尿病黄斑水肿患者的尿微量白蛋白水平与黄斑中心凹视网膜厚度、脉络膜厚度、血糖、糖化血红蛋白的相关性。研究结果表明,糖尿病组患者的CRT水平较对照组低,SFCT、mALB、MBG和HbA1c水平高于对照组;合并视网膜病变、合并肾病和合并黄斑水肿组患者的CRT水平较未合并组低,SFCT、mALB、MBG和HbA1c水平均高于未合并组;黄斑水肿患者的m ALB水平与CRT水平负相关,与SFCT、MBG和HbA1c水平正相关。本研究得出结论:糖尿病性视网膜病变术后患者黄斑中心凹视网膜厚度(CRT)较薄,脉络膜厚度(SFCT)变厚,且与尿微量白蛋白密切相关。
In this study, the central retinal thickness(CRT), subfoveal choroidal thickness(SFCT), microalbuminuria(mALB), Mean Blood Glucose(MBG) and glycated hemoglobin(HbA1 c) were observed after the operation of patients with diabetic retinopathy in an attempt to understand the differences and correlations. We selected 200 diabetic retinopathy patients who were treated in our hospital from January 2016 to December 2017. According to the presence of retinopathy, nephropathy and postoperative macular edema, the patients were divided into the combined group and the non-combined group, and 100 cases of normal adults were selected as the control group. The levels of central retinal cyst(CRT), subfoveal choroidal masses(SFCT), microalbuminuria(mALB), Mean Blood Glucose(MBG) and glycosylated hemoglobin(HbA1 c) were observed in diabetic patients and the control group as well as the patients with uncombined and complicated diabetes mellitus, and the correlation between microalbuminuria(mALB)level and central retinal thickness(CRT), subfoveal choroidal thickness(SFCT), Mean Blood Glucose(MBG) and glycated hemoglobin(HbA1 c) were further analyzed. The results showed that the CRT level of the diabetic group was lower than that of the control group, and the levels of SFCT, m ALB, MBG and HbA1 c were higher than those of the control group. The CRT levels of patients with retinopathy, nephropathy and macular edema were lower than those of the uncombined group, and the levels of SFCT, m ALB, MBG and HbA1 c were higher than those of the uncombined group. MALB level in patients with macular edema was negatively correlated with CRT level, and positively correlated with SFCT, MBG and HbA1 c levels. In this study, it was concluded that the central retinal thickness(CRT) in patients with diabetic retinopathy after operation might be relatively thin, while the subfoveal choroidal thickness(SFCT) might be thickened, which might be closely related to microalbuminuria(mALB).
In this study, the central retinal thickness(CRT), subfoveal choroidal thickness(SFCT), microalbuminuria(mALB), Mean Blood Glucose(MBG) and glycated hemoglobin(HbA1 c) were observed after the operation of patients with diabetic retinopathy in an attempt to understand the differences and correlations. We selected 200 diabetic retinopathy patients who were treated in our hospital from January 2016 to December 2017. According to the presence of retinopathy, nephropathy and postoperative macular edema, the patients were divided into the combined group and the non-combined group, and 100 cases of normal adults were selected as the control group. The levels of central retinal cyst(CRT), subfoveal choroidal masses(SFCT), microalbuminuria(mALB), Mean Blood Glucose(MBG) and glycosylated hemoglobin(HbA1 c) were observed in diabetic patients and the control group as well as the patients with uncombined and complicated diabetes mellitus, and the correlation between microalbuminuria(mALB)level and central retinal thickness(CRT), subfoveal choroidal thickness(SFCT), Mean Blood Glucose(MBG) and glycated hemoglobin(HbA1 c) were further analyzed. The results showed that the CRT level of the diabetic group was lower than that of the control group, and the levels of SFCT, m ALB, MBG and HbA1 c were higher than those of the control group. The CRT levels of patients with retinopathy, nephropathy and macular edema were lower than those of the uncombined group, and the levels of SFCT, m ALB, MBG and HbA1 c were higher than those of the uncombined group. MALB level in patients with macular edema was negatively correlated with CRT level, and positively correlated with SFCT, MBG and HbA1 c levels. In this study, it was concluded that the central retinal thickness(CRT) in patients with diabetic retinopathy after operation might be relatively thin, while the subfoveal choroidal thickness(SFCT) might be thickened, which might be closely related to microalbuminuria(mALB).
引文
Feng X.F.,Li A.M.,Xu S.L.,Jia P.,and Shen S.M.,2017,Diagnostic value of glomerular filtration rate,microalbuminuria,β2-microglobulin and cystatin C for renal function in patients with diabetic nephropathy,Zhonghua Heyixue Yu Fenziyingxiangxue Zazhi(Chinese Journal of Nuclear Medicine and Molecular Imaging),37(6):331-336(冯雪凤,李爱梅,许守林,贾鹏,沈山梅,2017,肾小球滤过率,尿微量白蛋白,血β2-微球蛋白和胱抑素C诊断糖尿病肾病的临床价值,中华核医学与分子影像杂志,37(6):331-336)
Han P.F.,Li S.N.,Li Q.,and Zhang W.L.,2015,Relationship between subfoveal choroidal thickness and both choroidal hemodynamic index and glycosylated hemoglobin in diabetic subjects,Guoji Yanke Zazhi(International Journal of Ophthalmology),11(7):1207-1209(韩鹏飞,李双农,李强,张伟亮,2015,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,11(7):1207-1209)
Hua D.H.,Xu Y.S.,and Xing Y.Q.,2017,The correlation of oxygen saturation of retinal vessels and diabetic retinophathy stages or HbAlc levels in patients with diabetic retinophathy,Zhonghua Yandibing Zazhi(Chinese Journal of Ocular Fundus Diseases),33(1):36-39(花蒂豪,徐奕爽,邢怡桥,2017,糖尿病视网膜病变患者的病变程度及糖化血红蛋白水平与视网膜血管血氧饱和度相关性研究,中华眼底病杂志,33(1):36-39)
Luo J.,Yang H.J.,and Li X.P.,2015,Application comparative study on frequency domain OCT and FFA in patients with diabetic retinopathy,Yanke Xin Jinzhan(Recent Advances in Ophthalmology),35(5):463-466(罗洁,杨海军,李小平,2015,频域OCT与FFA在糖尿病视网膜病变患者中的应用,眼科新进展,35(5):463-466)
Tang X.J.,Liu Q.,Yu J.,Ding Y.Y.,and Wu J.,2016,The relationship between macular edema and the thickness of macular subfoveal choroid in diabetic retinopathy patients,Shiyong Yixue Zazhi(The Journal of Practical Medicine),32(8):1302-1305(唐晓娟,刘琼,于健,丁媛媛,吴京,2016,糖尿病性视网膜病变以及黄斑水肿和黄斑中心凹下脉络膜厚度的关系,实用医学杂志,32(8):1302-1305)
Teng J.,Chen X.H.,Chen M.Z.,Wang Y.P.,and Yu H.Y.,2017,Relationship between macular edema and subfoveal choroidal thickness in patients with non proliferative diabetic retinopathy,Yanke Xin Jinzhan(Recent Advances in Ophthalmology),37(3):244-247(滕娟,陈小红,陈梅珠,王云鹏,余海跃,2017,非增生型糖尿病视网膜病变患者黄斑水肿与中心凹下脉络膜厚度的关系,眼科新进展,37(3):244-247)
Wang J.W.,Jie C.H.,Tao Y.J.,Wu Z.Z.,and Zhang H.,2017,Correlation of macular visual function and macular central retinal thickness in diabetic macular edema eyes,Zhong hua Yandibing Zazhi(Chinese Journal of Ocular Fundus Diseases),33(3):267-270(王建伟,接传红,陶永健,吴正正,张红,2017,糖尿病黄斑水肿患眼黄斑区视功能与黄斑中心凹视网膜厚度的相关性分析,中华眼底病杂志,33(3):267-270)
Wang S.C.,Lin S.Y.,Zheng Y.Z.,Di F.S.,Cao X.,Liu C.,and Yang J.K.,2015,Association of choroldal thickness with diabetic retinopathy at different stages,Zhonghua Yixue Zazhi(National Medical Journal of China),95(32):2584-2588(王少程,林思勇,郑曰忠,邸阜生,曹曦,刘畅,杨金奎,2015,2型糖尿病患者脉络膜厚度与视网膜病变严重程度的关系,中华医学杂志,95(32):2584-2588)
Wang W.C.,Zhang J.,Wang H.,Liu S.B.,Wang X.,Wu T.,Liang Y.,and Ren Q.H.,2015,Relationship between the levels of tear fluid TCF-α,serum TNF-αand diabetic retinopathy in middle-aged elderly diabetes patients,Zhongguo Quanke Yixue(Chinese General Practice),11(35):4288-4292(王伟超,张洁,王虹,刘素波,王欣,吴韬,梁屹,任巧华,2015,社区中老年糖尿病患者泪液和血清肿瘤坏死因子α及血清糖化血红蛋白与糖尿病视网膜病变的关系,中国全科医学,11(35):4288-4292)
Zhang X.F.,2015,Influence of intravitreal injection of ranibizumab on visual acuity and GAS6,SDF-1 and VEGF in serum of patients with proliferative diabetic retinopathy lesions,Zhongguo Yaofang(China Pharmacy),26(26):3700-3702(张新芳,2015,玻璃体腔注射雷珠单抗对增殖性糖尿病性视网膜病变患者视力及血清GAS6,SDF-1与VEGF的影响,中国药房,26(26):3700-3702)
Han P.F.,Li S.N.,Li Q.,and Zhang W.L.,2015,Relationship between subfoveal choroidal thickness and both choroidal hemodynamic index and glycosylated hemoglobin in diabetic subjects,Guoji Yanke Zazhi(International Journal of Ophthalmology),11(7):1207-1209(韩鹏飞,李双农,李强,张伟亮,2015,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,11(7):1207-1209)
Hua D.H.,Xu Y.S.,and Xing Y.Q.,2017,The correlation of oxygen saturation of retinal vessels and diabetic retinophathy stages or HbAlc levels in patients with diabetic retinophathy,Zhonghua Yandibing Zazhi(Chinese Journal of Ocular Fundus Diseases),33(1):36-39(花蒂豪,徐奕爽,邢怡桥,2017,糖尿病视网膜病变患者的病变程度及糖化血红蛋白水平与视网膜血管血氧饱和度相关性研究,中华眼底病杂志,33(1):36-39)
Luo J.,Yang H.J.,and Li X.P.,2015,Application comparative study on frequency domain OCT and FFA in patients with diabetic retinopathy,Yanke Xin Jinzhan(Recent Advances in Ophthalmology),35(5):463-466(罗洁,杨海军,李小平,2015,频域OCT与FFA在糖尿病视网膜病变患者中的应用,眼科新进展,35(5):463-466)
Tang X.J.,Liu Q.,Yu J.,Ding Y.Y.,and Wu J.,2016,The relationship between macular edema and the thickness of macular subfoveal choroid in diabetic retinopathy patients,Shiyong Yixue Zazhi(The Journal of Practical Medicine),32(8):1302-1305(唐晓娟,刘琼,于健,丁媛媛,吴京,2016,糖尿病性视网膜病变以及黄斑水肿和黄斑中心凹下脉络膜厚度的关系,实用医学杂志,32(8):1302-1305)
Teng J.,Chen X.H.,Chen M.Z.,Wang Y.P.,and Yu H.Y.,2017,Relationship between macular edema and subfoveal choroidal thickness in patients with non proliferative diabetic retinopathy,Yanke Xin Jinzhan(Recent Advances in Ophthalmology),37(3):244-247(滕娟,陈小红,陈梅珠,王云鹏,余海跃,2017,非增生型糖尿病视网膜病变患者黄斑水肿与中心凹下脉络膜厚度的关系,眼科新进展,37(3):244-247)
Wang J.W.,Jie C.H.,Tao Y.J.,Wu Z.Z.,and Zhang H.,2017,Correlation of macular visual function and macular central retinal thickness in diabetic macular edema eyes,Zhong hua Yandibing Zazhi(Chinese Journal of Ocular Fundus Diseases),33(3):267-270(王建伟,接传红,陶永健,吴正正,张红,2017,糖尿病黄斑水肿患眼黄斑区视功能与黄斑中心凹视网膜厚度的相关性分析,中华眼底病杂志,33(3):267-270)
Wang S.C.,Lin S.Y.,Zheng Y.Z.,Di F.S.,Cao X.,Liu C.,and Yang J.K.,2015,Association of choroldal thickness with diabetic retinopathy at different stages,Zhonghua Yixue Zazhi(National Medical Journal of China),95(32):2584-2588(王少程,林思勇,郑曰忠,邸阜生,曹曦,刘畅,杨金奎,2015,2型糖尿病患者脉络膜厚度与视网膜病变严重程度的关系,中华医学杂志,95(32):2584-2588)
Wang W.C.,Zhang J.,Wang H.,Liu S.B.,Wang X.,Wu T.,Liang Y.,and Ren Q.H.,2015,Relationship between the levels of tear fluid TCF-α,serum TNF-αand diabetic retinopathy in middle-aged elderly diabetes patients,Zhongguo Quanke Yixue(Chinese General Practice),11(35):4288-4292(王伟超,张洁,王虹,刘素波,王欣,吴韬,梁屹,任巧华,2015,社区中老年糖尿病患者泪液和血清肿瘤坏死因子α及血清糖化血红蛋白与糖尿病视网膜病变的关系,中国全科医学,11(35):4288-4292)
Zhang X.F.,2015,Influence of intravitreal injection of ranibizumab on visual acuity and GAS6,SDF-1 and VEGF in serum of patients with proliferative diabetic retinopathy lesions,Zhongguo Yaofang(China Pharmacy),26(26):3700-3702(张新芳,2015,玻璃体腔注射雷珠单抗对增殖性糖尿病性视网膜病变患者视力及血清GAS6,SDF-1与VEGF的影响,中国药房,26(26):3700-3702)