糖尿病性黄斑病变视网膜内外屏障损伤的初步探讨

发布时间：2018-05-21 05:23

本文选题：糖尿病性黄斑病变 + FFA　；参考：《吉林大学》2012年硕士论文

【摘要】：目的：研究糖尿病性黄斑病变视网膜内外屏障的损伤特点。方法：选取2011年1月-2012年3月期间在我院门诊就诊的Ⅱ型糖尿病患者67例（119眼）的临床资料，根据眼底表现及荧光素眼底血管造影(Fundus fluoresceinangiography，FFA)检查结果将病例资料分为正常对照组19例（33眼）和病例组，病例组资料又分为：糖尿病FFA眼底正常组10例（20眼）、糖尿病性视网膜病变（Diabeticretinopathy，DR）微血管瘤拱环未破坏组8例（16眼）、DR拱环破坏组20例（34眼）、DR拱环破坏伴黄斑区硬性渗出组20例（37眼）、DR黄斑水肿组9例（12眼）。所有病例均进行眼底照像、FFA、视网膜电图（Electroretinogram，ERG）及光学相干断层扫描（Optical coherence tomograph，OCT）检查，检查结果经统计学分析。结果：(1)OCT结果：糖尿病黄斑病变组在视网膜内丛状层、内核层、外核层、外丛状层出现颗粒状的高反光，随着黄斑病变发展而加重；黄斑病变继续发展而出现视网膜光感受器层的断裂及视网膜色素上皮层的厚薄不均；在DR拱环破坏组、拱环破坏伴硬性渗出组及黄斑水肿组中有不完全玻璃体后脱离。(2)ERG结果：糖尿病FFA正常组出现最大混合反应a波振幅下降、峰时延迟，随着黄斑病变发展而加重（P＜0.05）;DR拱环破坏组开始出现明视视锥细胞a波振幅下降、峰时延迟,随着黄斑病变发展而加重（P＜0.05）；糖尿病FFA眼底正常组出现暗视视杆细胞b波峰时延迟、最大混合反应b波峰时延迟、明视视锥细胞b波的振幅下降，随着黄斑病变发展而加重（P＜0.05），，并在DR拱环破坏组开始出现暗视视杆细胞b波振幅下降、最大混合反应b波振幅下降、明视视锥细胞b波的波峰时延迟，随着黄斑病变发展而加重（P＜0.05）；OPS振幅下降、峰时延迟，随着黄斑病变发展而加重（P＜0.05）。结论：（1)糖尿病FFA正常组黄斑区视杆、视锥细胞出现功能性改变，并随着黄斑病变发展而加重，并在OCT出现外核层、外丛状层高颗粒状的高反光，随着黄斑病变的发展出现光感受器层的断裂及视网膜色素上皮层的厚薄不均。(2)糖尿病性黄斑病变视网膜内屏障破坏的同时伴有外屏障的损伤。
[Abstract]:Objective: to study the damage characteristics of the inner and outer retinal barrier in diabetic macular disease. Methods: the clinical data of 67 patients with type 2 diabetes mellitus from January 2011 to March 2012 were selected. According to fundus manifestations and fundus fluorescein angiography (FFAA), the patients were divided into normal control group (n = 19, n = 33) and case group (n = 33). The data of the case group were as follows: 10 patients with diabetic FFA fundus normal group, 20 eyes with diabetic retinopathy, 8 patients with undamaged arch ring of diabetic retinopathy, and 20 patients with Dr arch ring destruction with macular area rigid exudation. Group A (n = 20), n = 37 (n = 37), Dr macular edema (n = 9), n = 12 (n = 12). All cases were examined by fundus radiography (FFA), electroretinogram (ERG) and optical coherence tomography (Oct). The results were analyzed statistically. Results the results of Oct showed that in the diabetic macular lesion group, granular high reflectance appeared in the inner plexiform layer, inner layer and outer plexiform layer, which was aggravated with the development of macular lesion. Macular lesions continued to develop with the rupture of the photoreceptor layer of the retina and the uneven thickness of the retinal pigment epithelium. The results of incomplete posterior vitreous detachment in the arch ring destruction with rigid exudation group and macular edema group were as follows: the maximum mixed response a wave amplitude decreased and the peak time delayed in diabetic FFA normal group. With the development of macular lesion, the amplitude of a wave of clear vision cone cell began to decrease, the peak time delayed, and the development of macular lesion aggravated with macular lesion (P < 0.05), and the B wave peak of dark optic rod cells in diabetic FFA fundus normal group was delayed. The peak of b wave in the maximum mixed reaction was delayed, the amplitude of b wave in the clear vision cone cells decreased, and aggravated with the development of macular lesion (P < 0. 05). The b wave amplitude of dark vision rod cells began to decrease and the b wave amplitude of the maximum mixed reaction decreased in Dr arch ring failure group. The peak time of b wave was delayed, the amplitude of OPS was decreased with the development of macular lesion (P < 0.05), the peak time was delayed, and the peak time was aggravated with the development of macular lesion (P < 0.05). Conclusions1) in the normal FFA group, the functional changes of the cone cells in the macular area were observed and aggravated with the development of macular lesions, and the high reflectance of the outer nuclear layer and the outer plexiform layer were observed in the OCT. With the development of macular disease, the photoreceptor layer breaks and the thickness of retinal pigment epithelium is uneven.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R774.1

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