彩色眼底照相与荧光素眼底血管造影在判断糖尿病视网膜病变临床分期中的关联性研究  

Evaluating fundus photography and fundus fluorescein angiography in the grading of diabetic retinopathy

作　　者：徐鼎[1] 张小虎[1] 孙哲[1] 刘晴雨[1] 王方[1] 

机构地区：[1]同济大学附属第十人民医院眼科,上海200072

出　　处：《中华实验眼科杂志》2013年第8期779-782,共4页Chinese Journal Of Experimental Ophthalmology

基　　金：上海市级医院适宜技术联合开发推广应用项目

摘　　要：背景 视网膜激光光凝是治疗糖尿病视网膜病变（DR）的主要方法.临床上,DR患者是否需要接受全视网膜光凝（PRP）主要依据荧光素眼底血管造影（FFA）检查结果,而部分患者由于各种原因不能接受FFA检查,彩色眼底照相成为指导PRP治疗的主要指征.因此研究彩色眼底照相与FFA在判断DR病程和分期中的一致性是非常重要的. 目的 评估彩色眼底照相与FFA对判断DR临床分期的符合程度.方法采用患者自身对比研究设计.纳入2010年6月至2012年3月在同济大学附属第十人民医院眼科就诊的2型DR患者136例238眼,所有受检眼先行数码彩色眼底照相,对5张非立体、50°视野的照片进行拼图,然后行FFA检查.根据2003年国际DR临床分期标准分别对彩色眼底照相和FFA图像进行分析并行DR分期.采用Kappa一致性检验法对两种方法的检查结果进行比较.结果 在238眼中,彩色眼底照相诊断为轻度非增生型DR（NPDR）者41眼,占17.2％；中度NPDR者48眼,占20.2％；重度NPDR者66眼,占27.7％；PDR者83眼,占34.9％.FFA诊断为轻度NPDR者48眼,占20.2％；中度NPDR者42眼,占17.6％；重度NPDR者46眼,占19.3％；PDR者102眼,占42.9％.两者在判断DR临床分期方面的一致性较好（κ=0.653,P＜0.01）.在判断非严重威胁视力的DR（NSTDR）和STDR方面,两种方法的一致性好（κ=0.812,P＜0.01）. 结论 根据5张50°视野彩色眼底照相拼图对DR进行临床分期是一种简便、无创、可靠的方法,临床上可以替代FFA法进行PRP时机的预测,但在判断无血管灌注区、隐匿新生血管时应谨慎.Background Retinal photocoagulation iconsidered to be an effective therapy fodiabetiretinopathy （DR）.Fundufluorescein angiography （FFA） iused to determine if panretinal photocoagulation （PRP） ineeded.SometimeFFiunsuitable fosome Dpatients,and funduphotography igenerally applied.However,whethecolofunduphotography can substitute foFFin evaluating Dgrading and advising foadministering the photocoagulation protocol iunclear.Objective Thistudy wato compare the grading outcomebetween colofunduphotography and FFin assessing DR.Methodprospective case serieself-controlled study wadesigned.Thiclinical study waapproved by the EthiCommittee of Shanghai Tenth People＇Hospital,and written informed consenwaobtained from each patienprioto entering the series.Five 50° non-stereoscopiphotographwere taken in 238 eyeof 136 patientwho methe criteriof type 2 diabetes,and then the FFwaperformed.The imagewere analyzed based on the 2003 International DiabetiRetinopathy Disease Severity Scale.The comparison of the grading outcomein assessing Dbetween colofunduphotography and FFwaevaluated by the Kappagreementesusing SPS17.0.ResultFunduphotography showed mild non-proliferative D（NPDR） in 17.2% of case（41/238）,moderate NPDin 20.2% of case（48/238）,severe NPDin 27.7% of case（66/238） and PDeyein 34.9% of case（83/238）.FFshowed mild NPDin 20.2% of case（48/238）,moderate NPDin 17.6% of case（42/238）,severe NPDin 19.3% of case（46/238） and PDin 42.9% of case（102/238）.The concordance foDgrading between funduphotography and FFwasubstantial （κ =0.653,P〈0.01）.In evaluating whetheiwanecessary to administePRP （to severe NPDand PDpatients）,good concurrence waobserved between funduphotography and FF（κ=0.812,P〈0.01）.ConclusionThe merge image from five 50° non-stereoscopiphotographpresentagood indicatofothe selection of PRP in Dpatientwith type 2 diabetes.However,the physicianshould be cautiouin the evaluation of retinal non-perfusion areand neovascularization by funduphotography.

关 键 词：糖尿病 并发症 视网膜病变 眼底照相术 血管造影术 荧光素眼底血管造影 

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