2型糖尿病患者瞳孔改变及其影响因素分析

发布时间：2018-07-03 02:21

本文选题：2型糖尿病 + 瞳孔直径　；参考：《山东大学》2012年硕士论文

【摘要】：目的：探讨2型糖尿病患者的瞳孔功能性改变与糖尿病病程,糖尿病视网膜病变,糖尿病自主神经神经病变的关系。方法：按WHO制定诊断标准,将已确诊为2型糖尿病的住院患者80例80眼(均为右眼),作为2型糖尿病组,其中病程1-8年者27例,9-16年者26例,17-25年以上者27例,根据眼底检查或眼底荧光造影结果将2型糖尿病组分为：无糖尿病视网膜病变(NO-DR),单纯期视网膜病变(PPDR)与增殖性糖尿病视网膜病变(PDR)。使用丹麦维迪公司Keypoint型肌电图诱发电位仪对2型糖尿病组进行交感神经皮肤反应(SSR)测定,根据有无糖尿病自主神经系统损伤,将2型糖尿病组分为有自主神经病变与无自主神经两组。随机抽取我院眼科门诊就诊的50例50眼非糖尿病患者作为对照组。用C2514手提式瞳孔测量仪在暗室环境中测量出2型糖尿病组与对照组光刺激前、光刺激后及散瞳后瞳孔直径,采用SPSS13.0对相关数据进行统计学分析。结果： 1、对照组,不同病程2型糖尿病患者瞳孔直径比较对照组光刺激前瞳孔直径为5.13±0.28mm,光刺激后瞳孔直径为3.10±0.35mm,散瞳后瞳孔直径为7.09±0.34mm,病程1-8年组光刺激前瞳孔直径为4.83±0.26mm,光刺激后瞳孔直径为3.30±0.18mm,散瞳后瞳孔直径为6.77±0.73mm,病程9-16年组光刺激前瞳孔直径为3.80±0.18mm,光刺激后瞳孔直径为6.77±0.73mm,病程9-16年组光刺激前瞳孔直径为3.80±0.18mm,光刺激后瞳孔直径为2.82±0.56mm,散瞳后瞳孔直径为5.42±0.33mm,病程17-25年以上组光刺激前瞳孔直径为3.00±0.24mm,光刺激后瞳孔直径为2.90±0.41mm,,散瞳后瞳孔直径为5.08±0.41mm。对照组与2型糖尿病患者在光照前与散瞳后瞳孔直径相比较,均具有统计学意义(P0.05)；病程17-25年的糖尿病患者在光照前与光照后瞳孔直径相比无明显变化(P0.05)；在光照前与散瞳后,正常组与病程1-8年组瞳孔直径比较均无统计学意义(P0.05),正常组与病程9-16年组及病程17-25年组瞳孔直径差值比较有统计学意义(P＜0.05) 2、对照组,NO-DR、 PPDR、 PDR患者瞳孔直径比较对照组光刺激前瞳孔直径为5.13±0.28mm,光刺激后瞳孔直径为3.10±0.35mm,散瞳后瞳孔直径为7.09±0.34mm,不伴有糖尿病性视网膜病变的糖尿病患者光刺激前瞳孔直径为5.03±0.29mm,光刺激后瞳孔直径为3.12±0.48mm散瞳后瞳孔直径为7.00±0.66mm,单纯期糖尿病性视网膜病变光刺激前瞳孔直径组为4.90±0.28mm,,光刺激后瞳孔直径为2.03±0.16mm,,散瞳后瞳孔直径为5.91±0.23mm,增殖期糖尿病性视网膜病变光刺激前瞳孔直径为3.60±0.16mm,光刺激后瞳孔直径为2.52±0.32mm,散瞳后瞳孔直径为5.73±0.41mm。对照组与2型糖尿病组在光照前与散瞳后瞳孔直径相比较,均具有统计学意义(P0.05)；增殖期糖尿病患者瞳孔直径在光刺激前与光刺激后相比,无明显统计学意义(P0.05);光刺激前,对照组与无糖尿病性视网膜病变和单纯糖尿病性视网膜病变患者瞳孔直径相比无明显统计学意义(PO.05),对照组与增殖期糖尿病性视网膜病变患者瞳孔直径相比均具有统计学意义(P0.05)；散瞳后,对照组与无糖尿病性视网膜病变患者瞳孔直径无明显统计学意义,与单纯期和增殖期糖尿病性视网膜病变患者瞳孔直径相比有统计学意义(P0.05) 3、对照组,2型糖尿病组有无自主神经病变患者瞳孔直径比较对照组光刺激前瞳孔直径为5.13±0.28mm,光刺激后瞳孔直径为3.10±0.35mm,,散瞳后瞳孔直径为7.09±0.34mm,无自主神经病变患者光刺激前瞳孔直径为4.98±0.29mm,光刺激后瞳孔直径为3.03±0.23mm,散瞳后瞳孔直径为6.12±0.53mm,自主神经病变患者患者光刺激前瞳孔直径为3.32±0.16mm,患者,光刺激后瞳孔直径为2.95±0.46mm,散瞳后瞳孔直径为5.01±0.40mm。伴有自主神经病变的糖尿病患者与不伴自主神经病变的糖尿病患者瞳孔直径在散瞳前与光刺激前相比均具有统计学意义(P0.05)；伴有自主神经病变患者的瞳孔直径在光刺激前与光刺激后无明显变化(P0.05)；对照组与无自主神经病变患者瞳孔直径相比光刺激前无统计学意义(P0.05),但是在散瞳后具有统计学意义(P0.05) 结论： 1、2型糖尿病病程越长对瞳孔功能的影响越大 2、糖尿病性视网膜病变可能先于瞳孔功能异常 3、无自主神经病变的糖尿病患者也同样可以存在瞳孔功能的异常,有自主神经病变者瞳孔更难散开,并且对光反射迟纯。
[Abstract]:Purpose :

Objective To investigate the relationship between the changes of pupil function and diabetic history , diabetic retinopathy and diabetic autonomic neuropathy in patients with type 2 diabetes mellitus .

Method :

According to the WHO standard of diagnosis , 80 patients with type 2 diabetes mellitus were diagnosed as type 2 diabetes mellitus ( 80 eyes ) ( right eye ) . Among them , 27 patients with type 2 diabetes mellitus , 27 patients with diabetic retinopathy ( PDR ) and 27 patients with proliferative diabetic retinopathy ( PDR ) were randomly selected according to fundus examination or fundus fluorescein angiography . All 50 patients with type 2 diabetes were randomly selected to be treated with diabetic retinopathy ( NO - DR ) , simple retinal disease ( PPDR ) and proliferative diabetic retinopathy ( PDR ) .

Results :

Comparison of pupil diameters in 1 , control group and 2 diabetic patients with different course of disease

The pupil diameter of pupil after light stimulation was 3.80 卤 0.28mm , pupil diameter was 3.80 卤 0.27mm , pupil diameter was 3.80 卤 0.27mm , pupil diameter was 2.82 卤 0.67mm , pupil diameter was 3.80 卤 0.33mm , pupil diameter was 2.90 卤 0.41 mm , pupil diameter was 5.08 卤 0.41 mm , and the pupil diameter was 5.08 卤 0.41 mm . The diameter of pupil was 5.08 卤 0.41 mm .
There was no significant difference between the diameter of pupil and pupil diameter before illumination ( P0.05 ) .
There was no significant difference between normal group and pupil diameter in 1 - 8 years before and after illumination ( P < 0.05 ) .

2 . Comparison of pupil diameters in control group , NO - DR , PPDR and PDR patients

The pupil diameter of pupil after light stimulation was 5.03 卤 0.28mm , pupil diameter was 3.60 卤 0.28mm , pupil diameter was 3.60 卤 0.23mm , pupil diameter was 2.52 卤 0.32 mm and pupil diameter was 5.73 卤 0.41 mm .
The pupil diameter of diabetic patients with proliferative phase was not statistically significant ( P0.05 ) before and after light stimulation ( P0.05 ) . The control group had no significant difference compared with the pupil diameter of diabetic retinopathy and simple diabetic retinopathy ( P0.05 ) .
There was no significant difference in pupil diameter between the control group and the non - diabetic retinopathy after mydriasis ( P0.05 ) .

Comparison of pupil diameter in 3 , control group and type 2 diabetic group with or without autonomic neuropathy

The pupil diameter of pupil in control group was 5.13 卤 0.28mm , pupil diameter was 3.03 卤 0.23mm , pupil diameter was 3.03 卤 0.23mm , pupil diameter was 3.03 卤 0.23mm , pupil diameter was 5.01 卤 0.40 mm , pupil diameter was 5.01 卤 0.40 mm .
The pupil diameter of patients with autonomic neuropathy did not change significantly before and after light stimulation ( P0.05 ) .
There was no statistical difference between the control group and the pupil diameter of the patients without autonomic neuropathy ( P0.05 ) , but there was statistical significance after mydriasis ( P0.05 ) .

Conclusion :

1 . The longer the duration of the type 2 diabetes , the greater the effect of the function of pupil .

2 . Diabetic retinopathy may be preceded by abnormal pupil function

3 . Patients with diabetes without autonomic neuropathy can also have abnormal pupil function , and the pupil of autonomic nervous lesion is more difficult to disperse and is late to reflect light .
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R587.2;R774.1

【参考文献】