全程化血糖管理在改善无明显视网膜病变的2型糖尿病性白内障患者术后视力的效果分析:基于视觉电生理和OCTA研究  

The clinical effect of the whole process blood glucose management on improving postoperative vision in T2DM cataract patients with non-diabetic retinopathy based on visual electrophysiology and OCTA study

作　　者：唐娟 兰芬 孟林霞 张琴琴 戴传强 雷证 方其林 李盈 吴小利 李涛 TANG Juan;LAN Fen;MENG Linxia;ZHANG Qinqin;DAI Chuanqiang;LEI Zheng;FANG Qilin;LI Ying;WU Xiaoli;LI Tao(Department of Endocrinology,the Ziyang Central Hospital,Ziyang 641300,Sichuan,China;Department of Endocrinology,the Ziyang Key Laboratory of Ophthalmology,Ziyang 641300,Sichuan,China;不详)

机构地区：[1]资阳市中心医院内分泌科,四川资阳641300 [2]资阳市眼科重点实验室,四川资阳641300 [3]西部战区总医院眼科,四川成都641000 [4]资阳市精神病医院内四科,四川资阳641300 [5]资阳市中心医院医教部,四川资阳641300 [6]资阳市中心医院重症医学科,四川资阳641300 [7]资阳市中心医院眼科,四川资阳641300

出　　处：《实用医学杂志》2024年第20期2888-2899,共12页The Journal of Practical Medicine

基　　金：四川省老年医学学会课题计划项目(24SCLN0115);资阳市医学科学课题计划项目(编号:KY2023001和KY2023023);资阳市科学技术局计划项目(编号:zykjjsc20-yyjc-2023-04,zykjjsc20-yyjc-2023-35)。

摘　　要：目的应用视觉电生理和光学相关断层扫描血管成像(OCTA)探讨无明显视网膜病变的2型糖尿病性白内障(DC)患者术前视网膜功能差异,以及全程化血糖管理在改善DC患者术后视力的临床应用效果。方法检测不同2型糖尿病(T2DM)病程、空腹血糖(FBG)、糖化血红蛋白(HbA1c)状态下,DC患者术前与术后视觉电生理(N75、P100、明视FERG、暗视FERG)、视盘旁视网膜神经纤维层厚度(pRNFL)和视盘旁放射状毛细血管网血流密度(ppVD)变化差异,以及全程化血糖管理干预情况下上述数据变化趋势。结果随着T2DM病程延长、FBG和HbA1c升高,术后各时间点单独分析,患者N75和P100潜伏期逐渐变长,暗视FERG、暗视FERG、p RNFL和ppVD数值均逐渐下降,同时患者术后最佳矫正视力均逐渐下降(P<0.05)。与术后1周比较,A组(未采取全程化血糖管理)视力在术后1个月和术后3个月逐渐增加,但术后1年时呈下降趋势,B组(采取全程化血糖管理)术后1个月时视力逐渐趋于稳定,且术后各时间点B组视力均优于A组;结果显示A组N75和P100均高于B组,同时A组明视FERG、暗视FERG、pRNFL和ppVD(%)均低于B组,并且A组患者N75和P100术后各时间点呈现逐渐延长趋势,明视FERG、暗视FERG、pRNFL和ppVD(%)呈现逐渐下降趋势,但B组患者上述数据在DC术后3个月逐渐趋于稳定,接近于该组术前水平(P<0.05)。在全程化血糖管理状态下,术后1周时N75和P100虽然均达到最长时间,明视FERG和暗视FERG、pp VD下降至最低,pRNFL呈现高度水肿状态,但术后1个月和术后3个月时间点N75、P100和pRNFL呈现逐渐下降趋势,明视FERG、暗视FERG和ppVD(%)逐渐上升(P<0.05),术后3个月至1年各时间点比较,上述指标整体趋势稳定,接近于术前水平(P>0.05)。结论基于视觉电生理和OCTA定量分析,在无明显视网膜病变的DC患者中,随着糖尿病病情加重,患者视网膜功能呈现下降趋势,但全程化血糖管理可以有效改�Objective Visual electrophysiology and optical correlation tomography angiography(OCTA)were used to investigate differences in preoperative retinal function in patients with type 2 diabetic cataract(DC)without obvious retinopathy(NDR)and to determine the clinical application of whole-process blood glucose management(WBGM)for improving postoperative vision in DC patients.Methods This study investigated the preoperative and postoperative visual electrophysiology(N75,P100,photopic FERG,and scotopic FERG),peripapillary retinal nerve fiber layer(pRNFL)and peripapillary capillary vessel density(ppVD)data,as well as trends in these data changes during blood glucose management intervention.Results As the course of T2DM progressed,FBG and HbA1c increased,the N75 and P100 lategraduancy periods of patients gradually lengthened,and the photopic FERG,scotopic FERG,pRNFL,and ppVD values decreased at each postoperative time point.At the same time,the best corrected visual acuity(BCVA)of patients after surgery gradually decreased(P<0.05).Compared with that at 1 week after surgery,the BCVA of Group A(without whole-process blood glucose management)gradually increased at 1 month and 3 months after surgery but showed a downward trend at 1 year after surgery.The BCVA of Group B(with whole-process blood glucose management)gradually stabilized at 1 month after surgery,and at all time points after surgery,the BCVA of Group B was better than that of Group A.The results showed that N75 and P100 in Group A were greater than those in Group B,while the photopic and scotopic FERG,pRNFL,and ppVD(%)in Group A were lower than those in Group B.In addition,N75 and P100 in Group A showed a gradual prolongation trend at various time points after surgery,while photopic FERG,scotopic FERG,pRNFL,and ppVD(%)showed a gradually decreasing trend.However,the above data in Group B gradually stabilized at 3 months after DC surgery,approaching the preoperative level of the group(P<0.05).In the state of whole blood glucose management,although N75 and P100 both

关 键 词：2型糖尿病 视觉电生理 OCTA 全程化血糖管理 视网膜功能 

分 类 号：R771[医药卫生—眼科]