背景型糖尿病视网膜病变患者视功能评价的临床研究

发布时间：2018-04-15 02:10

本文选题：糖尿病视网膜病变 + 背景型　；参考：《中国人民解放军军医进修学院》2010年博士论文

【摘要】： 糖尿病(diabetes mellitus, DM)是一种复杂的代谢性疾病,近年来全世界发病人数已经超过2.4亿,最新调查显示我国20岁以上人群患病率达9.7%,患病人数已超过9240万。作为糖尿病的主要并发症之一—糖尿病视网膜病变(diabetic retinopathy, DR)已成为糖尿病患者致盲的首要原因。相对于国内外糖尿病视网膜微血管病变的基础和临床研究,糖尿病患者视功能的评价尚比较薄弱。DR的发生不仅预示着视功能损害的开始,同时提示视网膜的功能也将不可逆转。早期掌握视功能的变化规律,有助于我们及时采取治疗干预措施,遏制DR的发生和发展,从而挽救和保护糖尿病患者的视功能。本研究我们从视觉对比敏感度(contrast sensitivity, CS)、色觉(colour vision)、视野(visual field)等方面了解背景型糖尿病患者的视功能情况,以揭示糖尿病视网膜病变不同时期视功能改变的一般规律,为临床治疗提供全面而准确的依据。目的 1.研究背景型糖尿病视网膜病变(DRⅠ期,DRⅡ期,DRⅢ期)患者视觉对比敏感度的变化规律及其在视功能评价中的意义； 2.分析背景型糖尿病视网膜病变患者色觉异常及其损害特征； 3.探讨中心视野在背景型糖尿病视网膜病变患者的改变规律。方法 1.对比敏感度的测试：应用美国OPTEC6500型对比敏感度测试仪,对背景型糖尿病视网膜病变患者(DRⅠ期,DRⅡ期,DRⅢ期)及无眼底病变的糖尿病患者(DR0期)进行无眩光条件下5个空间频率的远、近距离的视觉对比敏感度测试,记录统计糖尿病视网膜病变各组及对照组5个空间频率的视觉对比敏感度范围,比较DRⅠ期、DRⅡ期、DRⅢ期患者与DR0期患者之间对比敏感度的差异特点,探讨不同分期患者视觉对比敏感度变化的规律；了解各期糖尿病患者CS与年龄的关系。 2.色觉检查：采用法国Farnsworth Munsell-100型色觉测试仪,分别对无眼底改变糖尿病患者(DR0期)及背景型糖尿病视网膜病变患者(DRⅠ期,DRⅡ期,DRⅢ期)进行色觉测试,分析DRⅠ期、DRⅡ期、DRⅢ期患者与DR0期患者之间在总错误得分(total error score,TES)、总错误分平方根(√TES),红、绿、蓝色觉的错误得分及其平方根之间的差别,同时了解糖尿病患者年龄与色觉变化的关系。 3.视野检查：采用德国产Humphery HFAⅡ型计算机自动视野计SITA-standard程序,分别对糖尿病视网膜病变患者(DRⅠ期,DRⅡ期,DRⅢ期)及对照组(DR0期)进行中心视野检查,对其结果进行分析,比较背景型糖尿病视网膜病变各组与对照组之间在平均缺损(MD)、图形标准差(PSD)、缺损点数等的差异,并探讨各期视野缺损的特点。结果 1.视觉对比敏感度：(1)背景型糖尿病视网膜病变患者与无眼底病变糖尿病患者视觉对比敏感度各频率无论在远距离还是近距离均存在显著性差异(P0.05),高频区更为明显；(2)背景型糖尿病视网膜病变不同分期组组之间CS值也存在差异,分期越重,差异呈增加趋势；不同年龄组CS值的差异体现在高频区；(3)随着DR分期的增加,对比敏感度曲线的峰值左移,由中频区6cpd过渡到低频区3cpd,DRⅢ期组CSF呈倒“L”字形。 2.色觉：(1)糖尿病视网膜病变各组与对照组在TES以及√TES方面存在显著性差异(P0.05)；(2)糖尿病视网膜病变各组与对照组在红、绿、蓝色觉的错误得分及其平方根之间均存在显著性差异(P0.05),其中绿、蓝轴向色觉损害较为显著而红色轴向损害较为轻微；(3)色觉损害与糖尿病视网膜病变分期有关,眼底病变越重,则色觉损害越明显。 3.视野：(1)DRⅠ期组视野缺损点数高于DR0期组。DRⅡ期组、DRⅢ期组视野平均缺损(MD)、图形标准差(PSD)及视野缺损点数高于DR0期组。 (2)DR0期组异常视野的百分比为33.4%,DRⅠ期组和DRⅡ期组异常视野的百分比在50%左右,DRⅢ期组异常视野的百分比高达71.4%。(3)DRⅠ期组患者的中心视野表现为点状或片状缺损；DRⅡ～Ⅲ期组患者的中心视野表现为片状及团状缺损,不沿神经纤维走行分布,多数暗区出现在视野中周部20°-30°范围内。结论 1.视觉对比敏感度在背景型糖尿病视网膜病变患者出现全频段CS值下降,其中多数患者高频段CS值的下降明显,并与年龄相关,是评价背景型糖尿病视网膜病变患者视功能的敏感指标。 2.红色、绿色及蓝色觉在背景型糖尿病视网膜病变患者均出现损害,其中绿色、蓝色觉损害更为显著,随糖尿病视网膜病变分级的增加而加重,并与年龄有一定的关系,可以作为背景型糖尿病视网膜病变患者视功能评价的敏感指标。 3.随着糖尿病视网膜病变分级的增加,背景型糖尿病视网膜病变中心视野损害呈逐渐加重趋势,视野缺损的特点为点状、片状及团状,多出现在中周部20°-30°范围内。
[Abstract]:Diabetes (diabetes mellitus DM) is a complex metabolic disease, in recent years the number of incidence in the world has more than 240 million, the latest survey shows that China's population above 20 years old the prevalence rate reached 9.7%, the number of patients has more than 92 million 400 thousand. As one of the major complications of diabetes and diabetic retinopathy (diabetic, retinopathy, DR) has to become the leading cause of blindness in patients with diabetes. Compared with the basic and clinical research on diabetic microangiopathy home and abroad, not only marked the start of visual function damage is still weak.DR evaluation of visual function in patients with diabetes mellitus, and suggests that the retinal function will be irreversible. Master the early changes of retinal function, help us take timely treatment intervention to curb the occurrence and development of DR, so as to save and protect visual function in patients with diabetes. In this study, we from the vision Contrast sensitivity (contrast, sensitivity, CS) (colour vision), color vision (visual field) and other aspects of understanding visual function in patients with type 2 diabetes mellitus background, to reveal the general law of diabetic retinopathy in different periods of visual function change, for clinical treatment to provide comprehensive and accurate data.
objective
1., we studied the change rule of visual contrast sensitivity and its significance in visual function evaluation of background diabetic retinopathy (stage DR, DR II, DR III).
2. to analyze the color abnormalities and their damage characteristics in patients with background diabetic retinopathy.
3. to investigate the change of central visual field in patients with background diabetic retinopathy.
Method
1. contrast sensitivity test: the application of OPTEC6500 contrast sensitivity tester for patients with background diabetic retinopathy (DR stage, DR stage, DR stage III) and diabetic patients without retinopathy (DR0) without glare conditions at 5 spatial frequencies, visual contrast sensitivity test in near distance, each record of diabetic retinopathy and the control group of 5 spatial frequency contrast sensitivity range, DR stage, DR stage, DR between patients in stage III patients with DR0 phase contrast sensitivity difference characteristics, to explore the patients with different stages of visual contrast sensitivity changes; understand the relationship CS and age in patients with diabetes.
2. color: by French Farnsworth Munsell-100 type color vision tester, respectively on the fundus changes in patients with diabetes mellitus (DR0) patients and background diabetic retinopathy (DR stage, DR stage, DR stage III) color vision test analysis, DR stage, DR stage, DR stage III patients and between patients DR0 in the total error score (total error score, TES), the total error of square root (root TES), red, green, blue felt and error scores between the square root of the differences, and understand the relationship between age and color change in patients with diabetes mellitus.
3.: the automatic perimetry vision of German Humphery HFA type computer SITA-standard program, respectively in patients with diabetic retinopathy (DR stage, DR stage, DR stage III) and control group (DR0) of central visual field examination, the results of the analysis, comparison between the background diabetic retinopathy group and in the control group (MD), mean defect pattern standard deviation (PSD), differences in defective points etc., and discusses the characteristics of each stage of visual field loss.
Result
1. visual contrast sensitivity: (1) patients with background diabetic retinopathy and diabetic patients without retinopathy visual contrast sensitivity of each frequency in long distance or close and there was significant difference (P0.05), high frequency region is more obvious; (2) there are differences between different stages of background diabetic retinopathy group the value of CS staging, the heavier, the difference increased among different age groups; the CS value is reflected in the high frequency region; (3) with the increase of DR staging, the peak contrast sensitivity curve of the left shift, the transition from 6cpd to 3cpd if the low frequency region, DR III group CSF inverted "L" shape.
2. color: (1) diabetic retinopathy group and control group there were significant differences in TES and TES V (P0.05); (2) diabetic retinopathy group and control group in the red, green, and there was significant difference between the score and the error square root feel blue (P0.05), which is green, blue axial color damage is significant while the red axial relatively minor damage; (3) the color damage and stages of diabetic retinopathy, retinopathy is more serious, the color damage is more obvious.
3. field of vision: (1) the number of visual field defects in DR phase I group was higher than that in DR0 group.DR phase II group. The average visual field defect (MD) in DR III group was higher than that in DR0 stage group.
(2) the percentage of DR0 patients the abnormal visual field is 33.4%, the first stage of DR group and DR group II abnormal vision percentage is about 50%, the percentage of DR phase III group abnormal vision up to 71.4%. (3) DR of central visual field groups showed punctate or patchy central visual field defect; II ~ DR stage III patients showed patchy and nodular defects along the nerve fibers distribution, the majority of the dark zone in the field around 20 DEG -30 DEG range.
conclusion
1., visual contrast sensitivity in the background diabetic retinopathy patients showed a decrease in the whole frequency CS value. Most of them had a significant decrease in CS value at high frequency and correlated with age. It is a sensitive index for evaluating the visual function of patients with background diabetic retinopathy.
2. red, green and blue sleep damage were found in the patients with background diabetic retinopathy among the green, blue sleep damage is more obvious, with the increase of diabetic retinopathy grade increased, and there is a certain relationship with age, can be used as sensitive indexes of background diabetic retinopathy treated patients with visual function evaluation.
3., with the increase of the classification of diabetic retinopathy, the central visual field damage of background diabetic retinopathy is gradually increasing. The characteristics of visual field defect are punctate, lamellar and cluster like. Most of them appear in the range of 20 degree -30 degrees in the middle part of the retina.

【学位授予单位】：中国人民解放军军医进修学院
【学位级别】：博士
【学位授予年份】：2010
【分类号】：R774.1

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