糖尿病视网膜病变筛查方法的对比研究

发布时间：2018-03-15 18:16

本文选题：糖尿病视网膜病变　切入点：筛查　出处：《河南科技大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的对比直接检眼镜、间接检眼镜、30°眼底照片和45°眼底照片四种眼底筛查方法，并结合眼底荧光素血管造影（FFA）和甲襞微循环状态检查，研究甲襞微循环与DR的相关性，筛选出快捷高效的DR筛查方法。方法选择在我院就诊的Ⅱ型糖尿病患者80名作为研究对象，对患者分别进行直接和间接检眼镜、30°和45°眼底照相、FFA和甲襞微循环状态检查，评价各种筛查方法与DR分期的相关性，敏感度和特异度。结果1.病程越长，DR的患病率越高。随着DR严重程度的递增，＜0.1的视力所占的比率越来越大。 2.在无明显视网膜改变，中度NPDR，重度NPDR组中各种检查方法与FFA检查结果有显著意义的相关；而轻度NPDR组的检查结果与FFA检查无统计学意义。在PDR病变期，直接检眼镜和间接检眼镜检查与FFA检查结果有显著意义的相关。（P＞0.05）。 3.对于轻、中度NPDR筛查效果分析顺序依次为30°眼底照片，45°眼底照片，直接检眼镜，间接检眼镜；对于重度NPDR筛查效果顺序依次是30°眼底照片，直接检眼镜，间接检眼镜，45°眼底照片；对于PDR期筛查效果顺序是直接检眼镜，间接检眼镜，30°眼底照片，45°眼底照片。以重度NPDR作为筛查临界值，有效性和实用性依次是30°眼底照片，直接检眼镜，间接检眼镜，45°眼底照片。经x2检验，重度NPDR期，直接和检眼镜，30°眼底照片之间存在关联性（P＜0.05）。45°眼底照片与其他三种方法并无关联性（P＞0.05）。 4.甲襞微循环重度异常合并DR者明显高于轻、中度异常组，有显著差异性（P＜0.05）。中度异常组合并DR者高于轻度异常组，但无显著差异性（P＞0.05）。 5. NPDR甲襞微循环总积分与PDR总积分值比较，PDR组明显高于NPDR组（P＜0.05）。各项积分值，除形态积分无显著差异外（P＞0.05），微血管的血液流态和襻周状态积分PDR均显著高于NPDR（P＜0.05）。 6. PDR组血液流速显著低于NPDR组（P＜0.05）；PDR组细胞聚集度，襻周渗出均高于NPDR组，有显著差异性（P＜0.05）；PDR组血管襻周出血积分虽高于NPDR组，但无显著差异性（P＞0.05）。结论1.糖尿病病程越长，DR的患病率越高病情越严重，DM患者的视力损害越严重。 2.直接和间接检眼镜以及30°和45°眼底照片检查，对于无明显视力损害的DM患者来说，虽可作为一种经济实用的筛查方法但观察范围有限。 3.甲襞微循环检测辅助DR筛查操作方便、观察直观、安全无创且有较高的差异性，是一个很实用的筛查新方法。
[Abstract]:Objective to compare four fundus screening methods: direct ophthalmoscope, indirect ophthalmoscope 30 掳fundus photograph and 45 掳fundus photograph, combined with fundus fluorescein angiography (FFAA) and nailfold microcirculation (nailfold microcirculation) to study the correlation between nailfold microcirculation and Dr. A rapid and efficient Dr screening method was screened out. Methods Eighty patients with type 2 diabetes mellitus who were treated in our hospital were examined with FFA and nailfold microcirculation by direct and indirect ophthalmoscope 30 掳and 45 掳respectively. To evaluate the correlation, sensitivity and specificity of various screening methods with Dr staging. Results 1. The longer the course of disease, the higher the prevalence of Dr. With the increase of Dr severity, the proportion of vision < 0.1 was increasing. 2. 2. There was no obvious retinal change, there was a significant correlation between the various examination methods and the results of FFA in the moderate and severe NPDR group, but there was no significant difference between the results of the mild NPDR group and the FFA examination, but in the stage of PDR lesion, there was no significant difference between the results of the examination and the FFA examination in the mild NPDR group. There was significant correlation between direct ophthalmoscope and indirect ophthalmoscope examination and FFA examination results (P > 0.05). 3. For mild and moderate NPDR screening, the order of analysis was 30 掳fundus photographs, 45 掳fundus photographs, direct ophthalmoscope, indirect ophthalmoscope, and 30 掳fundus photographs for severe NPDR screening, direct ophthalmoscope, direct ophthalmoscope, direct ophthalmoscope, direct ophthalmoscope, direct ophthalmoscope, direct ophthalmoscope, and direct ophthalmoscope. Indirect ophthalmoscope was 45 掳fundus photograph, direct ophthalmoscope was the order of PDR screening effect, indirect ophthalmoscope 30 掳fundus photograph was 45 掳fundus photograph. The critical value of severe NPDR screening was 30 掳fundus photograph in order of effectiveness and practicability. Direct ophthalmoscope and indirect ophthalmoscope were 45 掳fundus photographs. After x2 test, there was no correlation between direct and 30 掳fundus photographs in severe NPDR stage (P < 0.05) and other three methods (P > 0.05). 4. The patients with severe abnormal nailfold microcirculation associated with Dr were significantly higher than those with mild and moderate abnormalities (P < 0.05). The patients with moderate abnormal combination with Dr were higher than those with mild abnormality (P > 0.05). 5.Compared with the total integral value of NPDR nailfold microcirculation and PDR, the PDR of NPDR group was significantly higher than that of NPDR group (P < 0.05). Except for the morphological integral, there was no significant difference (P > 0.05), and the PDR of microvascular blood flow and loop was significantly higher than that of NPDR(P < 0.05. 6. The blood flow velocity in PDR group was significantly lower than that in NPDR group (P < 0.05), and the pericyclic exudation in PDR group was higher than that in NPDR group. There was significant difference (P < 0.05) in perivascular haemorrhage score of PDR group compared with NPDR group, but there was no significant difference (P > 0.05). The longer the course of diabetes, the higher the prevalence of Dr and the more serious the visual impairment of DM patients. 2. 2. Direct and indirect ophthalmoscope examination and 30 掳and 45 掳fundus examination, for DM patients without obvious visual impairment, can be used as an economical and practical screening method, but the scope of observation is limited. 3. Nailfold microcirculation detection is a new and practical method for Dr screening, which is convenient, intuitive, safe and non-invasive.
【学位授予单位】：河南科技大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R774.1;R587.1

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