重度糖尿病视网膜病变患者糖化血红蛋白控制水平与眼底黄斑区微血管变化的定量分析  

Quantitative analysis of the control level of HbAlc on microvascular changes in macular area of patients with severe diabetic retinopathy

作　　者：高健[1] 饶材花 刘伦[1] Gao Jian;Rao Caihua;Liu Lun(Department of Ophthalmology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院眼科,合肥230022

出　　处：《临床眼科杂志》2021年第4期289-293,共5页Journal of Clinical Ophthalmology

基　　金：国家自然科学基金(81700856);安徽省自然科学基金(1808085QH280)。

摘　　要：目的观察分析重度非增生期及增生期糖尿病视网膜病变(DR)患者糖化血红蛋白(HbAlc)控制水平对眼底黄斑区微血管的影响。方法回顾性病例研究。重度非增生期及增生期DR患者31例(31只眼)纳入研究,均为单眼,收集患者最佳矫正视力(BCVA)、裂隙灯显微镜、眼底检查、相干光层析血管成像术(OCTA)结果。收集HbAlc、肾功能检测结果,根据患者HbAlc水平,将纳入患者分为HbAlc控制理想组(HbAlc<7.0%)以及HbAlc控制不佳组(HbAlc≥7.0%)。收集所有患者眼底OCTA扫描结果,获得黄斑区一系列参数,包括黄斑中心凹无血管区(FAZ)面积、FAZ周长以及非圆指数,黄斑区浅层及深层旁中心凹视网膜血流密度,将收集数据进行统计分析。结果HbAlc控制不佳组与HbAlc控制理想组比较,HbAlc有显著统计学差异(t=8.352,P<0.05)。两组间黄斑中心凹1 mm视网膜厚度比较差异无统计学意义(t=0.331,P>0.05),两组间黄斑中心凹无血管区面积(t=0.455,P=0.653),周长(t=0.660,P=0.515),非圆指数(u=98.5,P=0.401)比较差异无统计学意义。两组间黄斑旁中心凹浅层视网膜血流密度比较差异无统计学意义(t=-0.878,P=0.387),而两组间黄斑旁中心凹深层视网膜血流密度比较差异有显著统计学意义(t=-2.932,P=0.007)。结论重度DR患者中,HbAlc控制理想者黄斑旁中心凹深层视网膜血流密度高于HbAlc控制不佳者;同时,深层视网膜血流灌注更容易受到血糖控制水平的影响。Objective To observe and analyze the effect of HbAlc control level on microvascular changesin macular area of patients with severe nonproliferative and proliferative diabetic retinopathy.Methods This was a retrospective study.31 patients(31 eyes)with severe nonproliferative and proliferative diabetic retinopathy were enrolled in this study.Best corrected visual acuity(BCVA),slit lamp microscopy,fundus examination and optical coherence tomography angiography(OCTA)examination were collected.The history of diabetes and hypertension were recorded.HbAlc and renal function were collected.According to the level of HbAlc,the patients were divided into two groups:ideal control group(HbAlc<7.0%)and poor control group(HbAlc≥7.0%).The macular area of all patients was scanned with OCTA,and the macular fovea was taken as the center.A series of parameters of macular area,including FAZ area,FAZ perimeter and acircularity index,and the parafoveal vessel density for the superficial and the deep capillary plexus were obtained.Results HbAlc level had significant difference between the two groups(t=8.352,P<0.05).There was no significant difference in macular fovea 1 mm retinal thickness between the two groups(t=0.331,P>0.05).There was no significant difference in the area(t=0.455,P=0.653),perimeter(t=0.660,P=0.515)and noncircular index(U=98.5,P=0.401)of foveal avascular zone.There was no significant difference in parafoveal vessel density for the superficial capillary plexus between the to groups(t=-0.878,P=0.387),but there was significant difference in the parafoveal vessel density for the deep capillary plexus between the two groups(t=-2.932,P=0.007).Conclusions The parafoveal vessel density for deep capillary plexus in patients with ideal HbAlc control is higher than that in patients with poor HbAlc control when diabetic retinopathy progressed into severe nonproliferative and proliferative stage.The retinal blood flow perfusion for deep capillary plexus is more easily affected by the level of blood glucose control.

关 键 词：糖尿病视网膜病变 糖化血红蛋白 黄斑区 微血管 

分 类 号：R58[医药卫生—内分泌]