糖尿病视网膜病变患者扩张型毛细血管的发生率、眼底影像学特征及其影响因素  

Prevalence,fundus imaging features and influencing factors of telangiectatic capillaries in diabetic retinopathy

作　　者：张怡[1] 姚静[1] 王建明[1] 庾苗 郭晓 周爱意[1] ZHANG Yi;YAO Jing;WANG Jianming;YU Miao;GUO Xiao;ZHOU Aiyi(Department of Ophthalmology,the Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,Shaanxi Province,China)

机构地区：[1]西安交通大学第二附属医院眼科,陕西省西安市710004

出　　处：《眼科新进展》2022年第6期461-464,共4页Recent Advances in Ophthalmology

基　　金：陕西省自然科学基础研究计划项目(编号2022JQ-857)。

摘　　要：目的探讨糖尿病视网膜病变(DR)患者扩张型毛细血管的发生率、眼底影像学特征及其影响因素。方法选取2020年5月至2021年5月就诊于西安交通大学第二附属医院眼科并确诊为DR的患者147例230眼。其中,合并糖尿病性黄斑水肿(DME)者65眼,不合并DME者165眼。观察并分析DR患者眼底吲哚菁绿血管造影(ICGA)、OCT图像、眼底彩照表现及血糖相关指标,总结扩张型毛细血管的发生率及眼底影像学特征,探讨其影响因素。结果本研究230眼DR患眼中扩张型毛细血管的发生率为39.6%。在合并DME的DR患眼(65眼)中扩张型毛细血管的发生率为53.8%,而在未合并DME的DR患眼(165眼)中发生率为33.9%;合并DME的DR患眼的发生率高于未合并DME的DR患眼,差异有统计学意义(χ^(2)=7.728,P=0.005)。在ICGA检查中,扩张型毛细血管开始显影时间为3 min 57 s~7 min 31 s,平均开始显影时间为4 min 58 s,之后染色逐渐增强呈现高荧光,持续至10 min后仍不衰退,并与晚期低背景荧光形成强烈对比。依据ICGA形态学特征可将扩张型毛细血管分为两种类型(1)孤立的圆形扩张型毛细血管,此型较常见,占72.5%;(2)簇状扩张型毛细血管,此型占27.5%。硬性渗出越严重,出现扩张型毛细血管的可能性越大(线性关联值为32.754,P<0.001)。与无扩张型毛细血管眼相比,有扩张型毛细血管眼患者的糖化血清白蛋白、糖化白蛋白含量更高,差异均有统计学意义(均为P<0.05)。两组患者空腹血糖、血清白蛋白含量差异均无统计学意义(均为P>0.05)。结论扩张型毛细血管在DR患眼中的发生率较高,尤其是合并DME的DR患眼;扩张型毛细血管依其在ICGA中的形态学表现可分为孤立的圆形扩张型毛细血管和簇状扩张型毛细血管两种类型;严重的硬性渗出和较差的血糖控制水平与扩张型毛细血管的发生可能具有一定关系。Objective To investigate the prevalence,fundus imaging features and influencing factors of telangiectatic capillaries(TCs)in diabetic retinopathy(DR).Methods Totally 147 patients(230 eyes)with DR diagnosed in the Department of Ophthalmology of the Second Affiliated Hospital of Xi’an Jiaotong University from May 2020 to May 2021 were included in this study.Among them,65 eyes had diabetic macular edema(DME)and 165 eyes had no DME.The fundus indocyanine green angiography(ICGA),optical coherence tomography(OCT)images,fundus color photographs,and blood glucose related indicators of DR patients were analyzed to summarize the prevalence and fundus imaging features of TCs and explore their influencing factors.Results In 230 DR eyes,the prevalence of TCs was 39.6%.In 65 eyes with DME,the prevalence of TCs was 53.8%,while in 165 eyes without DME,the prevalence of TCs was 33.9%.The former was significantly higher than the latter(χ^(2)=7.728,P=0.005).In ICGA,the developing time of TCs was 3 min 57 s-7 min 31 s,with an average of 4 min 58 s.After developing,the staining gradually increased and showed high fluorescence,which did not decline after 10 min,forming a strong contrast with the low background fluorescence in the later period.According to the morphological characteristics shown by ICGA,TCs were divided into two types(1)isolated circular TCs,accounting for 72.5%;(2)clustered TCs,accounting for 27.5%.The severer the hard exudation was,the greater the possibility of TCs was(the linear correlation value was 32.754,P<0.001).Compared with non-TCs eyes,patients with TCs eyes had higher levels of glycosylated serum albumin and glycosylated albumin,and the differences were statistically significant(both P<0.05).There was no significant difference in fasting blood glucose and serum albumin between the two groups(both P>0.05).Conclusion TCs are more likely to occur in DR eyes,especially in DR eyes with DME.According to their morphological manifestations in ICGA,TCs can be divided into isolated circular TCs and clustered TCs.S

关 键 词：糖尿病视网膜病变 扩张型毛细血管 吲哚菁绿血管造影 眼底影像学 

分 类 号：R774[医药卫生—眼科]