糖尿病视网膜病变患者白内障超声乳化术后黄斑水肿的危险因素及对其视力恢复、心理压力的影响
|
摘要
目的:研究糖尿病视网膜病变患者白内障超声乳化术后黄斑水肿的危险因素及对其视力恢复、心理压力的影响。方法:选取我院2014年4月至2017年4月200例(367只患眼)糖尿病视网膜病变患者为研究对象,所有患者均接受白内障超声乳化术治疗。收集患者年龄、性别、糖尿病病程、糖化血红蛋白、胰岛素治疗、吸烟史、饮酒史、基础疾病等临床资料。术后对患者进行为期6个月随访,诊断黄斑水肿发生情况,评估患者视力水平及心理压力。结果:200例患者共发生黄斑水肿35例,发生率为17.5%。黄斑水肿组年龄≥60岁、糖尿病病程>10年、糖化血红蛋白>7%、胰岛素治疗、合并高血压、合并高脂血症患者比例分别为62.9%、65.7%、68.6%、57.1%、45.7%、40.0%,显著高于无黄斑水肿组的44.2%、41.8%、42.4%、37.0%、23.0%、18.2%(χ~2=4.012,6.638,7.925,4.876,7.538,8.010;P<0.05)。黄斑水肿组术后6个月最佳矫正视力为(0.69±0.14),显著低于无黄斑水肿组的(0.74±0.16)(t=2.288,P<0.05),心理压力总分为(72.28±13.10)分,显著高于无黄斑水肿组的(67.41±12.19)分(t=2.119,P<0.05)。结论:年龄、糖尿病病程、糖化血红蛋白、胰岛素治疗、合并高血压、合并高脂血症等6个因素对糖尿病视网膜病变患者白内障超声乳化术后黄斑水肿发生有显著影响。黄斑水肿不利于患者术后视力恢复,患者可能承受较大心理压力。
Objective:To study the risk factors of macular edema in patients with diabetic retinopathy(DR)after cataract phacoemulsification and the influence on visual recovery and mental pressure.Methods:A total of 200patients(367affected eyes)with DR treated in our hospital during the period from April 2014 to April 2017 were selected as the subjects,and all of them were treated with phacoemulsification.The clinical data such as age,gender,duration of diabetes,glycosylated hemoglobin(HbA1c),insulin therapy,smoking history,drinking history and basic diseases were collected.The patients were followed up for 6 months after surgery.The situation of macular edema was diagnosed and the visual acuity and mental pressure were evaluated.Results:Macular edema occurred in 35 of 200patients,with an incidence of 17.5%.The proportions of patients who were or older than 60 years old,whose duration of diabetes was longer than 10 years,whose HbA1 cwas higher than 7%,who underwent insulin therapy,who had hypertension and who had hyperlipidemia in the macular edema group were significantly higher than those in the non-macular edema group(χ~2=4.012,6.638,7.925,4.876,7.538,8.010;P<0.05).The best corrected visual acuity of macular edema group at 6months after surgery was significantly lower than that of non-macular edema group(t=2.288,P<0.05),while the total mental pressure score was significantly higher than that of non-macular edema group(t=2.119,P<0.05).Conclusion:Age,duration of diabetes,HbA1 c,insulin therapy,hypertension and hyperlipidemia are influencing factors of macular edema in patients with DR after phacoemulsification.Macular edema is not conducive to the recovery of visual acuity after surgery,and patients may suffer great mental pressure.
Objective:To study the risk factors of macular edema in patients with diabetic retinopathy(DR)after cataract phacoemulsification and the influence on visual recovery and mental pressure.Methods:A total of 200patients(367affected eyes)with DR treated in our hospital during the period from April 2014 to April 2017 were selected as the subjects,and all of them were treated with phacoemulsification.The clinical data such as age,gender,duration of diabetes,glycosylated hemoglobin(HbA1c),insulin therapy,smoking history,drinking history and basic diseases were collected.The patients were followed up for 6 months after surgery.The situation of macular edema was diagnosed and the visual acuity and mental pressure were evaluated.Results:Macular edema occurred in 35 of 200patients,with an incidence of 17.5%.The proportions of patients who were or older than 60 years old,whose duration of diabetes was longer than 10 years,whose HbA1 cwas higher than 7%,who underwent insulin therapy,who had hypertension and who had hyperlipidemia in the macular edema group were significantly higher than those in the non-macular edema group(χ~2=4.012,6.638,7.925,4.876,7.538,8.010;P<0.05).The best corrected visual acuity of macular edema group at 6months after surgery was significantly lower than that of non-macular edema group(t=2.288,P<0.05),while the total mental pressure score was significantly higher than that of non-macular edema group(t=2.119,P<0.05).Conclusion:Age,duration of diabetes,HbA1 c,insulin therapy,hypertension and hyperlipidemia are influencing factors of macular edema in patients with DR after phacoemulsification.Macular edema is not conducive to the recovery of visual acuity after surgery,and patients may suffer great mental pressure.
引文
[1]付文,曹日芳,何晓燕,等.社区糖尿病患者的综合心理行为干预及情绪影响因素分析[J].中国健康心理学杂志,2016,24(11):1633-1637
[2]郑虔,赵镇南,廉恒丽,等.轴性高度近视眼超声乳化白内障吸除联合人工晶状体植入术后屈光度数误差分析[J].中华眼科杂志,2015,51(4):276-281
[3]Ishibashi T,Li X,Koh A,et al.The REVEAL Study:Ranibizumab monotherapy or combined with Laser versus laser monotherapy in Asian patients with diabetic macular edema[J].Ophthalmology,2015,122(7):1402-1415
[4]董宁,汤欣,肖林,等.房水中多种细胞因子与2型糖尿病患者白内障术后黄斑水肿的关系[J].中华实验眼科杂志,2015,33(4):356-361
[5]张胜利.糖尿病合并眼底病患者白内障术后黄斑水肿和视力观察[J].西南国防医药,2015,25(12):1311-1313
[6]周访华,南菲菲,邢赛春.浙江省视力和听力残疾人群生存质量调查[J].中国健康心理学杂志,2017,25(1):154-157
[7]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2010年版)[J].中国糖尿病杂志,2012,20(1):81-117
[8]中华医学会眼科学会眼底病学组.我国糖尿病视网膜病变临床诊疗指南(2014年)[J].中华眼科杂志,2014,50(11):851-865
[9]中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华心血管病杂志,2011,39(7):579-616
[10]中国成人血脂异常防治指南制订联合委员会.中国成人血脂异常防治指南[J].中华心血管病杂志,2007,19(5):390-419
[11]Cardena E,Koopman C,Classen C,et al.Psychometric properties of the Stanford Acute Stress Reaction Questionnaire(SASRQ):A valid and reliable measure of acute stress.[J].Journal of Traumatic Stress,2000,13(4):719-734
[12]Jang J W,Kim C H,Kim M Y.Analysis of glycosylated hemoglobin(HbA1c)level on maxillofacial fascial space infection in diabetic patients[J].Journal of the Korean Association of Oral&Maxillofacial Surgeons,2015,41(5):251-258
[13]范玲,钟慧琴,常向云,等.社区2型糖尿病患者糖化血红蛋白达标率及影响因素分析[J].重庆医学,2015,44(21):2967-2970
[14]王静波,张琳.不同的降血糖治疗方案对无眼底并发症的糖尿病患者黄斑部视网膜厚度的影响[J].国际眼科杂志,2016,16(8):1541-1542
[15]Kaidonis G,Burdon K P,Gillies M C,et al.Common sequence variation in the VEGFC,gene is associated with diabetic retinopathy and diabetic macular edema[J].Ophthalmology,2015,122(9):1828-1836
[16]金佩瑶,彭金娟,邹海东,等.上海市新泾社区2型糖尿病居民5年随访的前瞻性调查研究[J].中华实验眼科杂志,2016,34(4):363-367
[17]郭秀伟,周丽英.聊城市城区部分近视和正常视力高中生人格特征及心理健康状况[J].中国健康心理学杂志,2015,23(1):136-139
[18]邓湘慧,王琴,杨峘.综合护理干预对视网膜脱落患者术前心理状态的干预效果[J].中国临床心理学杂志,2016,24(6):1151-1153
[2]郑虔,赵镇南,廉恒丽,等.轴性高度近视眼超声乳化白内障吸除联合人工晶状体植入术后屈光度数误差分析[J].中华眼科杂志,2015,51(4):276-281
[3]Ishibashi T,Li X,Koh A,et al.The REVEAL Study:Ranibizumab monotherapy or combined with Laser versus laser monotherapy in Asian patients with diabetic macular edema[J].Ophthalmology,2015,122(7):1402-1415
[4]董宁,汤欣,肖林,等.房水中多种细胞因子与2型糖尿病患者白内障术后黄斑水肿的关系[J].中华实验眼科杂志,2015,33(4):356-361
[5]张胜利.糖尿病合并眼底病患者白内障术后黄斑水肿和视力观察[J].西南国防医药,2015,25(12):1311-1313
[6]周访华,南菲菲,邢赛春.浙江省视力和听力残疾人群生存质量调查[J].中国健康心理学杂志,2017,25(1):154-157
[7]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2010年版)[J].中国糖尿病杂志,2012,20(1):81-117
[8]中华医学会眼科学会眼底病学组.我国糖尿病视网膜病变临床诊疗指南(2014年)[J].中华眼科杂志,2014,50(11):851-865
[9]中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华心血管病杂志,2011,39(7):579-616
[10]中国成人血脂异常防治指南制订联合委员会.中国成人血脂异常防治指南[J].中华心血管病杂志,2007,19(5):390-419
[11]Cardena E,Koopman C,Classen C,et al.Psychometric properties of the Stanford Acute Stress Reaction Questionnaire(SASRQ):A valid and reliable measure of acute stress.[J].Journal of Traumatic Stress,2000,13(4):719-734
[12]Jang J W,Kim C H,Kim M Y.Analysis of glycosylated hemoglobin(HbA1c)level on maxillofacial fascial space infection in diabetic patients[J].Journal of the Korean Association of Oral&Maxillofacial Surgeons,2015,41(5):251-258
[13]范玲,钟慧琴,常向云,等.社区2型糖尿病患者糖化血红蛋白达标率及影响因素分析[J].重庆医学,2015,44(21):2967-2970
[14]王静波,张琳.不同的降血糖治疗方案对无眼底并发症的糖尿病患者黄斑部视网膜厚度的影响[J].国际眼科杂志,2016,16(8):1541-1542
[15]Kaidonis G,Burdon K P,Gillies M C,et al.Common sequence variation in the VEGFC,gene is associated with diabetic retinopathy and diabetic macular edema[J].Ophthalmology,2015,122(9):1828-1836
[16]金佩瑶,彭金娟,邹海东,等.上海市新泾社区2型糖尿病居民5年随访的前瞻性调查研究[J].中华实验眼科杂志,2016,34(4):363-367
[17]郭秀伟,周丽英.聊城市城区部分近视和正常视力高中生人格特征及心理健康状况[J].中国健康心理学杂志,2015,23(1):136-139
[18]邓湘慧,王琴,杨峘.综合护理干预对视网膜脱落患者术前心理状态的干预效果[J].中国临床心理学杂志,2016,24(6):1151-1153