作　　者： (时倩倩）; (高彦）; (孙广莉）;

机构地区： 郑州人民医院眼科,450053

出　　处： 《中国糖尿病杂志》 2017年第8期711-715,共5页

摘　　要： 目的探讨糖尿病性黄斑水肿(DME)与视野缺失的相关性并观察微脉冲激光治疗的效果。方法选取糖尿病视网膜病变(DR)患者117例(149眼),根据美国糖尿病视网膜病变早期治疗研究小组(ETDRS)DME诊断标准,分为DME组50例(70眼)和N-DME组67例(79眼)。选取体检健康者40名(80眼)作为正常对照(NC)组。收集各组临床资料和生化指标并进行视野检查。另将DME组分为微脉冲激光亚组和传统激光亚组,各35眼,观察激光治疗后1个月、3个月、6个月、9个月、12个月视野恢复状况。结果 DME组糖尿病病程、FPG、HbA1c及HOMA-IR高于N-DME组(P<0.05)。各组可置信因子RF<15%,提示检查结果可靠。DME组和N-DME组平均缺陷值(MD指数)[(7.81±0.75)vs(4.32±0.67)vs(1.14±0.22)dB]、视野丢失方差(LV)[(20.17±4.85)vs(15.34±3.19)vs(4.72±1.11)dB]及视野的刺激丢失方差值(sLV)[(10.71±1.37)vs(7.22±1.12)vs(2.35±0.41)dB]水平均高于NC组,且DME组高于N-DME组(P<0.01)。自治疗后3个月起,微脉冲激光亚组MD指数、LV、及sLV水平均较治疗前降低,且均低于传统激光亚组(P<0.05)。传统激光亚组各时间点MD指数、LV及sLV水平比较,差异均无统计学意义(P>0.05)。多元Logistic回归分析发现,糖尿病病程、FPG、HbA_1c及HOMA-IR为DEM的危险因素(P<0.01)。结论 DME患者存在严重的视野缺失,微脉冲激光治疗有助于视野恢复,而传统激光治疗对其无明显效果。糖尿病病程及IR程度增加,FPG、HbA1c升高,均增加DME的发生风险。 Objective To discuss the relationship between diabetic macular edema（DME） and visual field defects and evaluatethe therapeutic effect of micro-pulse laser. Methods A total of 117 patients （149 eyes） with diabetic retinopathy（DR） were enrolled in this study and divided into two groups according to early treatment diabetic retinopathy study（ETDRS） DME diagnostic criteria：DME group（n= 50,70 eyes） and N-DME group（n=67,79 eyes）. Healthy subjects（n= 40,80 eyes） were selected as NC group in thisstudy. The clinical data and biochemical index were collectedand visual fields were examined in all the subjects. Then the DME group was {urther divided into two subgroups： micro-pulse laser subgroup（35 eyes） and conventional laser subgroup（35 eyes）. The vision recovery after treatment was evaluated on different time points. Results Diabetes duration, FPG, HbAlc and HOMA-IR were significantly higher in DME group than in N-DME group （P〈0.05）. RF value was less than 15% in each group,suggestingreliable test results. The levels of MD indexE（7. 81±0. 75） vs （4. 32±0. 67） vs （1.14±0.22） dB], LV[（20.17± 4.85） vs （15.34±3.19） vs （4.72±1.11） dB] and sLV[（10. 71±1.37） vs （7.22±1.12） vs （2.35±0.41） dB] were significantly higher in DME group and N-DME group than in NC group,and those in DME group were higher than in N-DME group（P〈0.01）. After three month＇s treatment,the levels of MD index, LV and sLV were lower in micro-pulse laser subgroup than in conventional laser subgroup（P〈0.05）. There were no statistically significant difference in MID index,LV and sLV in conventional laser subgroup on different time points （P〉0.05 ）. Multiple logistic regression analysis showed that DM duration, FPG, HbA1 c and HOMA-IR were riskfactors for DME（all P〈0.01）. Conclusion Patients with DIME have severe vision loss. Micro-pulse laser therapy is helpful invision recovery, while conventional laser therapy have no obvious effect on it. Longer d

关 键 词： 糖尿病视网膜病变 黄斑水肿 视野缺失 微脉冲激光