非增殖期糖尿病视网膜病变微血管直径的变化

Changes of microvascular diameter in non-proliferative diabetic retinopathy

摘要:

目的：探讨不同分期下的非增殖期糖尿病视网膜病变微血管直径的变化。

方法：前瞻性病例对照研究。选取2020-09/2021-03于本院内分泌科室住院的2型糖尿病并糖尿病视网膜病变患者，据我国中华医学会于1985年制定的“糖尿病视网膜病变分期标准”将其分为糖尿病无视网膜病变组(50例50眼)、糖尿病视网膜病变Ⅰ期组(50例50眼)、糖尿病视网膜病变Ⅱ期组(50例50眼)、糖尿病视网膜病变Ⅲ期组(50例50眼)，另取体检正常的对照组50例50眼，共计250例250眼。摄取眼底彩照图，录入ARIA1.0自动分析软件，记录不同范围内动静脉与毛细血管直径，每个范围取值4段，每组为200段，进行统计学分析。

结果：不同分期的非增殖期糖尿病视网膜病变的视网膜动脉直径均无差异(P>0.05)，不同分期的非增殖期糖尿病视网膜病变的视网膜静脉直径、黄斑周围毛细血管直径均有差异(P<0.05)，视网膜静脉直径与黄斑周围毛细血管直径的不同组别事后多重比较均有差异(P<0.01)，0～<0.5PD和0.5～1.0PD范围的视网膜静脉直径组别平均值得分对比结果为“视网膜病变Ⅲ期组>视网膜病变Ⅱ期组>视网膜病变I期组>糖尿病无视网膜病变组>正常对照组”，黄斑周围毛细血管直径组别平均值得分对比结果为“视网膜病变Ⅲ期组>视网膜病变Ⅰ期组>正常对照组； 视网膜病变Ⅲ期组>糖尿病无视网膜病变组； 视网膜病变Ⅱ期组>视网膜病变Ⅰ期组>正常对照组； 视网膜病变Ⅱ期组>糖尿病无视网膜病变组； 糖尿病无视网膜病变组>正常对照组”，而视网膜病变Ⅲ期组与视网膜病变Ⅱ期组，视网膜病变Ⅰ期组与糖尿病无视网膜病变组均无显著差异(P>0.05)。

结论：视网膜动脉直径在非增殖期糖尿病视网膜病变不同分期中无明显变化； 糖尿病患者视网膜静脉及黄斑周围毛细血管扩张，在非增殖期糖尿病视网膜病变不同分期中，静脉与黄斑周围毛细血管的直径呈逐渐增宽的趋势。

Abstract:

AIM:To investigate the changes of microvascular diameter in non-proliferative diabetic retinopathy(NPDR)at different stages.

METHODS: Prospective case-control study. Patients with type 2 diabetes mellitus complicated with diabetic retinopathy(DR)who were hospitalized in the Endocrine Department of our hospital from September 2020 to March 2021 were selected and divided into diabetic non-retinopathy group(50 cases and 50 eyes), DR stage Ⅰ group(50 cases and 50 eyes), DR stage Ⅱ group(50 cases and 50 eyes), DR stage Ⅲ group(50 cases and 50 eyes)according to the “Clinical Diabetic Retinopathy Disease Severity Scale” formulated by the Chinese Medical Association in 1985. In addition, 50 cases and 50 eyes of a control group with normal physical examination were selected, totally 250 cases and 250 eyes. The fundus color photos were taken and entered into the ARIA1.0 automatic analysis software to record the diameters of arterio-venous and capillary vessels in different ranges, with 4 segments in each range and 200 segments in each group for statistical analysis.

RESULTS: There was no significant difference in the diameter of retinal artery between different stages of NPDR(P>0.05), and there was significant difference in the diameter of retinal vein and diameter of perimacular capillary amorg different stages of NPDR(P<0.05). The multiple comparison of retinal vein diameter and perimacular capillary diameter in different groups was statistically significant(P<0.01). The average score of retinal vein diameter in the range of 0-0.5PD was “stage Ⅲ course > stage Ⅱ course>stage Ⅰ course>normal group>control group”. The average score of retinal vein diameter group in the range of 0.5-1.0PD(including 0.5)was “stage Ⅲ course > stage Ⅱ course > stage Ⅰ course > normal group > control group”, the average score of perimacular capillary diameter group was “stage Ⅲ course > stage Ⅰ course > control group; Stage Ⅲ course > normal group; Stage Ⅱ course > stage Ⅰ course > control group; Stage Ⅱ course > normal group; The diseased normal group > the control group”, while there was no significant difference between the stage Ⅲ course and the stage Ⅱ course, the stage Ⅰ course and the diseased normal group(P>0.05).

CONCLUSION: Retinal artery diameter has no obvious change in NPDR stages. The retinal vein and perimacular capillary in diabetic patients are dilated. In different stages of NPDR, the diameter of the vein and perimacular capillary is gradually widened.