餐后血糖水平对糖尿病性视网膜病变进程的影响  

The association of postprandial blood glucose levels with the progression of diabetic retinopathy

作　　者：丁体英[1] 吕秀霞[1] 

机构地区：[1]河南省人民医院眼科,郑州450003

出　　处：《中华眼科医学杂志（电子版）》2014年第3期144-148,共5页Chinese Journal of Ophthalmologic Medicine(Electronic Edition)

摘　　要：目的探讨糖尿病性视网膜病变(DR)患者在空腹血糖有效控制下,而餐后血糖失控时对视网膜病变进程的影响。方法收集2012年12月至2013年12月河南省人民医院眼科收治的141例(282只眼)确诊为2型DR患者的临床资料。统计患者日间血糖波动值,并分析不同血糖水平状况与DR荧光素眼底血管造影和光学相干断层扫描变化的相关性。将其中77例(154只眼)依从性好的患者作为调控组接受调控方案,严格调控饮食起居,适当变更胰岛素和其他治疗药物;将另外64例(128只眼)依从性较差的患者作为非调控组,未实施调控方案。比较两组患者末次随访时的视力变化情况、眼底病变情况、血糖波动情况及治疗效果,随诊时间均为12个月以上。两组患者血糖波动情况和治疗效果的比较采用卡方检验。结果 141例(282只眼)患者中,非增殖性DR患者54例(108只眼),占38.30%,增殖性DR患者87例(174只眼),占61.70%;玻璃体积血患者16例(32只眼),占11.35%,视网膜大面积出血患者21例(42只眼),占14.89%,眼底可视者105例(105只眼),占27.23%,并发黄斑囊样水肿者59例(118只眼),占41.84%。患者总体晨起空腹血糖4.8~7.7 mmol/L,其中】7 mmol/L者56例(39.72%);餐后2 h血糖8~21.2 mmol/L,其中】11 mmol/L者128例(90.78%),以午餐后高血糖最为明显。患者日间血糖波动范围【4 mmol/L者21例(14.89%),日间血糖波动范围4~7 mmol/L者54例(38.30%),日间血糖波动范围7~10 mmol/L者37例(26.24%),日间血糖波动范围】10 mmol/L者29例(20.57%),日间血糖波动范围控制在4 mmol/L以下的患者仅占14.89%,大多数患者血糖波动幅度超出正常范围。非增殖性DR患者血糖波动【7 mmol/L者39例(72.22%),血糖波动7~10 mmol/L者10例(18.52%),血糖波动】10 mmol/L者5例(9.26%);增殖性DR患者血糖波动【7 mmol/L者21例(24.14%),血糖波动7~10 mmol/L者27例(31.03%),血糖波动】10 mmol/L者39例(44.83%),增殖性DR患者日间血糖波动度�Objective To assess the association of postprandial blood glucose levels with the progression of diabetic retinopathy ( DR ) in subjects with a good control of the fasting blood glucose. Methods Clinical records of 141 patients ( 282 eyes ) who were diagnosed with type II DR in the Department of Ophthalmology,Henan Provincial People′s Hospital between December,2012 and December, 2013 obtained.Of these patients,77 had good compliance and underwent dietary intervention together with insulin therapy at adjustable doses while the remaining 64 served as control subjects and received no dietary intervention.Data on levels of daytime blood glucose in association with fundus fluorescein angiographic and optical coherence tomographic findings,visual acuity,and retinopathy at the end of 12 month were analyzed byχ2 test.Results Out of the 141 DR cases,54 (38.30%) were non-proliferative and 87 (61.70%) were proliferative;16 ( 11.35%) presented with vitreous hemorrhage, 21 ( 14.89%) with large-area retinal hemorrhage,105 (105 eyes,27.23%) with fundus visualization,and 59 (41.84%) with concurrent cystoid macular edema.The morning fasting blood glucose concentration was averaged at 4.8-7.7 mmol/L in the 141 patients and was >7 mmol/L in 56 (39.72%) cases.The blood glucose concentration 2 h after a meal was averaged at 8-21.2 mmol/L in the 141 patients and was >11 mmol/L in 128 ( 90.78%) cases;postprandial hyperglycemia was most pronounced after lunch as compared to breakfast and dinner.The daytime blood glucose fluctuation was <4 mmol/L in 21 (14.89%) cases,4-7 mmol/L in 54 (38.30%) cases,7-10 mmol/L in 37 (26.24%) cases,and >10 mmol/L in 29 (20.57%) cases;the fluctuation was out of the normal range in most cases.In patients with non-proliferative DR, the blood glucose fluctuation was <7 mmol/L in 39 (72.22%) cases,7-10 mmol/L in 10 (18.52%) cases,and >10 mmol/L in 5 (9.26%) cases.In patients with proliferative DR, the blood glucose fluctuation was <7 mmol/L in 21 (24.14%) cases,7-10 mmol/L in 27 (31.03%) cases,and >10 mmol/

关 键 词：糖尿病性视网膜病变 餐后血糖 糖化血红蛋白 

分 类 号：R587.2[医药卫生—内分泌] R774.1[医药卫生—内科学]