糖尿病性黄斑水肿的FFA与OCT特征及其中医证型相关研究  

FFA and OCT features of diabetic macular edema and its relationship with patients' TCM syndrome types

作　　者：刘雪[1,2] 詹宇坚[1] 余杨桂[1] 段崧岚 

机构地区：[1]广州中医药大学第一附属医院,广州510405 [2]山东淄博市第一医院

出　　处：《中国中医眼科杂志》2014年第1期32-36,共5页China Journal of Chinese Ophthalmology

摘　　要：目的探讨FFA与OCT两种检查手段对黄斑水肿类型判断的符合率及其规律,并探讨中医证型与视力、黄斑水肿(DME)类型等的关系。方法采用横断面研究,选取选择符合标准的DME患者30例(58眼),在同一天内均分别行眼科常规检查、FFA和OCT检查,并进行中医症状和体征的采集。记录平均血糖水平、最佳矫正视力、糖尿病视网膜病变分期、FFA各项指标、OCT各项指标。应用SAS统计软件进行相关分析。结果 FFA黄斑弥漫性水肿者在OCT中75%表现为海绵样水肿,FFA囊样水肿者在OCT中60%表现为囊样水肿,二者有较高的一致性。但10例经OCT检查未发现黄斑区视网膜增厚的眼中,FFA检查却有不同程度的黄斑水肿。结合中医证型,气阴两虚者多表现为黄斑弥漫性荧光渗漏(FFA)或海绵样水肿(OCT);脾肾两虚者多表现为弥漫性荧光渗漏、囊样荧光积存(FFA)或海绵样水肿、囊样水肿(OCT);痰瘀互结者FFA检查多表现为囊样荧光积存、弥漫性荧光渗漏,而OCT检查表现为海绵样水肿、囊样水肿。结论 FFA与OCT对黄斑水肿的判断有较高的一致性,但FFA较OCT更敏感,可在黄斑区厚度变化之前更早的发现荧光素渗漏。中医证型与FFA黄斑水肿类型、OCT黄斑水肿类型、视力及血糖水平之间均存在相关性。OBJECTIVE To investigate the features and diagnostic coincidence rate of FFA and OCT in macular edema type, and the relationship of TCM syndrome type, visual acuity, and different macular edema type. METHODS Cross-sectional method was used in this study. We randomly selected 30 patients （58 eyes） with classic DME. All the patients were examined by routine ophthalmologic examination, FFA and OCT. TCM symptoms and signs of patients were collected on the same day. Other parameters like mean blood glucose level, best corrected vi- sual acuity and diabetic retinopathy stage were also recorded. We analyzed the data using SAS statistical software. RESULTS It was found that 75% eyes with diffuse macular edema in FFA presented sponge-like edema in OCT, while 60% eyes with cystoid macular edema in FFA were also cystoid edema in OCT, which showed a high diagnostic coincidence rate. However, there were 10 eyes presented fluorescein leakage while they showed normal macular in OCT. Combining the analysis of the TCM syndromes, we found that most patients with deficient Qi and Yin showed diffuse macular fluorescein leakage in FFA or sponge-like edema in OCT. Most patients with Deficient Spleen and Kidney Qi showed diffuse macular fluorescein leakage or cystoid macular fluorescence accumulation in FFA,and sponge-like edema or eystoid macular edema in OCT.Most of patients with combined phlegm and stasis presented with diffuse macular fluorescein leakage or cystoid macular fluorescence accumulation in FFA,and sponge-like ede- ma or cystoid macular edema in OCT. CONCLUSIONS Diagnosis of macular edema by FFA and OCT had a high consistency. FFA was more sensitive, because it could find fluorescein leakage before the macular thickness change in OCT. TCM syndrome types were correlated with the macular edema types determined by FFA and OCT,vi- sual acuity and mean blood glucose levels.

关 键 词：糖尿病性黄斑水肿 荧光素眼底血管造影 光学相干断层扫描 黄斑水肿 中医证型 

分 类 号：R774.5[医药卫生—眼科] R587.1[医药卫生—临床医学]