青年2型糖尿病早期视网膜神经纤维层厚度和视觉对比敏感度的动态变化  

Dynamic changes of retinal nerve fiber layer thickness and visual contrast sensitivity in young population with type 2 diabetes mellitus

作　　者：王文英[1] 冀向宁[1] 韩风梅[1] 张习[1] 李坤[1] 

机构地区：[1]沧州市中心医院眼科功能检查室,河北省沧州市061001

出　　处：《中华实验眼科杂志》2015年第8期716-721,共6页Chinese Journal Of Experimental Ophthalmology

基　　金：沧州市科学技术研究与发展指导计划项目（1213014ZD）

摘　　要：背景 近些年的研究表明,2型糖尿病（DM）呈现明显的年轻化趋势,但对青年患者早期糖代谢异常造成的视网膜损伤研究较少,患者和医师对此的重视程度不够.目的 对青年2型DM患者的视觉对比敏感度（CS）及视网膜神经纤维层（RNFL）厚度进行连续4年的观察,探讨早期青年2型DM患者糖代谢异常对视网膜结构和功能的动态影响.方法 采用队列研究设计,纳入2010年1-3月在沧州市中心医院体检时确诊的青年2型DM患者136例作为DM组,纳入同期年龄匹配的健康体检者91人作为正常对照组.对纳入的受检者每年检测1次糖化血红蛋白（HbAlc）水平,采用直接检眼镜行眼底观察,采用光学相干断层扫描（OCT）法检测视盘周围RNFL厚度,并对受检者行CS检测,连续观察4年,共实施5次检查,评估患者视盘周围视网膜结构、微血管形态和视网膜功能的动态变化,并分析视网膜结构和功能变化与HbAlc含量的关系.结果 2010-2014年DM组患者连续5次测得的HbAlc水平依次为（7.5±1.6）％、（7.2±1.6）％、（7.4±1.6）％、（7.6±1.6）％和（7.7±1.6）％,其中HbAlc≥7.0％者74例,占54.4％.2010年和2011年DM组与正常对照组间受检者视盘全周、视盘上1/4象限RNFL厚度差异均无统计学意义（均P＞0.05）,而2012年、2013年和2014年DM组受检者视盘全周、视盘上1/4象限RNFL厚度值均明显低于同期的正常对照组,2个组间比较差异均有统计学意义（视盘全周：t=2.216、5.003、7.303,均P＜0.05;视盘上1/4象限：t=2.382、5.657、7.194,均P＜0.05）.随着病程的延长,DM组视盘全周、视盘上1/4象限RNFL厚度值逐渐下降,差异均有统计学意义（F时间=33.359,P=0.000;F时间=36.011,P=0.000）.2013年和2014年DM组视盘全周RNFL厚度分别为（99.94±10.01）μm和（96.32±10.32） μm,明显低于2010年的（104.55±9.23） μm,差异均有统计学意义（t=7.819、13.959,均P＜0.05）;2013年和2014年DM组视Background In recent years,some researches show that getting younger over the diabetes mellitus （DM） was an obrious trend.But studies of early diabetic retinopathy in young people with diabetes were few.Both patients and doctors did not put enough importance on it.Objective This study was to evaluate the earlier dynamic changes of retina morphology and function caused by type 2 DM in young population.Methods A cohort study was designed.One hundred and thirty-six young patients who were initially diagnosed as type 2 DM in Cangzhou Central Hospital were included from January to March in 2010 and 91 healthy individuals with the matched age were enrolled at the same period.Glycated hemoglobin （HbAlc） level in blood was assayed yearly,and ophthalmoscope,optical coherence tomography （OCT） and visual contrast sensitivity （CS） examinations were performed to evaluate the dynamic changes of retinal nerve fiber layer （RNFL） thickness around optical disc,retinal function and retinal microvessels of DM patients.In addition,the correlation between RNFL thickness or CS and average HbAlc level in DM patients was assessed.This study followed Declaration of Helsinki,and written informed consent was obtained from each subject.Results The levels of HbAlc in DM patients were （7.5 ±1.6） %,（7.2 ±1.6） %,（7.4 ±1.6） %,（7.6±1.6）% and （7.7 ±1.6）% in 2010,2011,2012,2013 and 2014,respectively,and HbAlc≥7.0% was observed in 74 patients （54.4%）.The RNFL thicknesses of full optic disk and superior 1/4 quadrant of the optic disk were significantly declined in 2012,2013 and 2014 in the DM group compared with the normal control group （full disk：t =2.216,5.003,7.303;all at P 〈 0.05.superior 1/4 quadrant：t =2.382,5.657,7.194;all at P 〈 0.05）,but no significant differences were found between them in 2010 and 2011 （all at P〉0.05）.In the DM group,RNFL thicknesses of full optic disk were （99.94±10.01） μm and （96.32±10.32） μm in 2013 and 2014,which were significantly lower th

关 键 词：糖尿病/并发症 视网膜病变 视网膜神经纤维层 光学相干断层扫描 视觉对比敏感度 糖化血红蛋白 青年 

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