非增生型糖尿病视网膜病变患者黄斑区脉络膜厚度的临床观察

Clinical observation of macular choroidal thickness in patients with non-proliferative diabetic retinopathy

摘要:

目的：研究非增生型糖尿病视网膜病变(non-proliferative diabetic retinopathy，NPDR)不同分期的黄斑区脉络膜厚度(choroidal thickness，CT)的变化，探讨糖尿病(diabetes mellitus，DM)患者CT及与糖尿病视网膜病变(diabetic retinopathy，DR)发生发展的关系，评价深度增强成像的光相干断层扫描(enhanced depth imaging optical coherence tomography，EDI-OCT)在早期DR中脉络膜病变的诊断价值。

方法：选择内分泌科确诊为2型DM患者55例85眼，按2014年我国糖尿病视网膜病变临床诊疗指南分期标准将DM组分为无DR(NDR)组19例28眼，轻、中度NPDR组16例27眼，重度NPDR组20例30眼，同时，选取同期正常受试者24例35眼作为对照组。比较四组之间最佳矫正视力(best corrected visual acuity，BCVA)、CT值的差异。采用SPSS18.0软件进行统计学分析处理。

结果：四组中位BCVA(LogMAR)变化：对照组为0.00，NDR组为0.10，轻中度NPDR组为0.15，重度NPDR组为0.30，组间差异具有统计学意义(P<0.01)。随着DR病变程度的加重，BCVA越来越差。不同分期NPDR中黄斑区CT变化：对照组、NDR组、轻中度NPDR组、重度NPDR组中心凹下、T1、T3、N1、N3、S1、S3、I1、I3各对应位点CT比较，组间差异均具有统计学意义(F=3.975、3.365、3.991、4.290、6.208、5.079、3.234、2.907、3.843，均P<0.05)，不同分期NPDR患眼中，轻中度NPDR黄斑区CT变薄，薄于正常人群，随着病变程度的加重，CT却增厚。

结论：不同分期NPDR患眼中，轻中度NPDR黄斑区CT变薄，薄于正常人群，随着病变程度的加重，CT却增厚。提示DM患者眼底病变中不仅视网膜血管发生病变，脉络膜也可能受到不同程度的影响，CT的变化在DR的发生发展过程中起一定作用，推测在DR发生之前可能已有CT的变化，这对DM患者脉络膜病变的早期诊断有一定参考意义。

Abstract:

AIM: To observe the changes of choroidal thickness(CT)in diabetic patients with different stages of non-proliferative diabetic retinopathy(NPDR)and then investigate the relationship between CT and diabetic retinopathy(DR), to assess the value of enhanced depth imaging optical coherence tomography(EDI-OCT)in the diagnosis of choroidopathy in early-stage DR.

METHODS: A total of 85 eyes of 55 patients with type 2 diabetes mellitus(DM)were included in this study. The patients were divided into three groups according to China Clinical Guidelines of DR in 2014, including non-diabetic retinopathy(NDR)group(28 eyes), mild and moderate NPDR group(27 eyes), and severe NPDR group(30 eyes). The control group included 24 normal subjects(35 eyes). The best corrected visual acuity(BCVA)and CT among normal eyes, and eyes with NDR, mild/moderate NPDR and severe NPDR were compared. Data were analyzed using SPSS 18.0.

RESULTS: Visual changes: The median LogMAR BCVA visions were 0.00 in control group, 0.10 in NDR group, 0.15 in mild and moderate NPDR group and 0.30 in severe NPDR group, the difference between each group was statistically significant(P<0.01). The changes of CT in diabetic patients with different stages of NPDR: CT in the subfoveal area and T1, T3, N1, N3, S1, S3, I1 and I3 sites in the four groups were statistically significant(F=3.975, 3.365, 3.991, 4.290, 6.208, 5.079, 3.234, 2.907, 3.843, P<0.05). CT in the mild and moderate NPDR group decreased and were thinner than the control group, but CT in the severe NPDR group increased significantly.

CONCLUSION: CT in the mild and moderate NPDR group decreased, but it increased significantly in the severe NPDR group, suggesting DM affected not only retina but choroids as well. The study hypothesizes that the changes of CT may played an important role in the progression of DR and the changes of CT had been initiated before DR. This provides significance in the early diagnosis of diabetic choroidopathy.