糖尿病视网膜病变的发生与视网膜神经纤维层厚度的相关性研究

发布时间：2018-06-05 18:28

本文选题：糖尿病视网膜病变 + 视网膜神经纤维层　；参考：《山西医科大学》2014年硕士论文

【摘要】：目的：糖尿病可以诱发大鼠视网膜神经节细胞凋亡，视网膜神经纤维层（retinal nerve fiber layer,RNFL）主要由神经节细胞的轴突组成，早期糖尿病患者RNFL厚度尤其黄斑区RNFL厚度与糖尿病及糖尿病视网膜病变（DiabeticRetinopathy，DR）的发生及发展的关系尚待研究。应用频域光相干断层扫描（optical coherence tomography，，OCT）观察视网膜无血管改变的糖尿病患者（non-diabetic retinopathy，NDR）、非增生性糖尿病视网膜病变（non-proliferativediabetic retinopathy，NPDR）患者较正常人RNFL厚度的改变，分析糖尿病患者视盘周围及黄斑区RNFL厚度与糖尿病及糖尿病视网膜病变的关系，进一步探讨糖尿病早期神经病变的特点及与糖尿病血管病变的关系，为DR的早期发现、诊断及早期干预提供一定依据。方法：正常对照组30人30眼，糖尿病患者56人60眼，通过裂隙灯显微镜、直接检眼镜或者前置镜及眼底荧光血管造影检查，按DR国际临床分型标准分为两组，糖尿病患者视网膜无血管改变组（NDR组,30眼/26人）、轻度及早期中度非增生性糖尿病视网膜病变组（NPDR组，30眼/30人）。应用频域OCT对每组病例行视盘周围及黄斑区RNFL厚度测量，测量数据包括视盘周围及中心凹周围视网膜360°平均（G）及其各自鼻上（NS）、颞上（TS）、颞侧（T）、颞下（TI）、鼻下（NI）、鼻侧（N）区域RNFL厚度。结果：视盘周围RNFL厚度：NDR组视盘周围RNFL厚度视盘360°平均G（97.46±8.65）um、NS（113.84±21.85）um、TS（127.79±15.11）um、T（71.06±10.84）um、TI（137.88±22.13）um、NI（110.85±22.64）um、N（72.74±12.52）um；NPDR组RNFL厚度视盘360°平均G（100.69±16.35）um、NS（117.32±19.05）um、TS（134.01±19.32）um、T（79.83±12.02）um、TI（149.56±24.30）um、NI（115.75±27.56）um、N（70.90.71±16.28）um。正常对照组RNFL厚度视盘360°平均G（109.22±8.69）um、NS（118.20±23.71）um、TS（150.74±17.12）um、T（79.93±6.93）um、TI（158.77±18.27）um、NI（127.79±24.34）um、N（77.89±10.82）um；NDR组各区域RNFL厚度较正常对照组变薄,平均G、TS、T、TI和NI区域差异有统计学差异（P＜0.01），NPDR组各区域RNFL厚度较正常对照组变薄，平均G、TS、N区域差异有统计学差异（G、TS区域P＜0.01;N区域P＜0.05）。黄斑区RNFL厚度：NDR组黄斑区RNFL厚度平均G（33.47±3.39）um、NS（39.27±5.30）um、TS（31.35±3.56）um、T（24.02±2.19）um、TI（34.47±4.20）um、NI（39.89±5.72）um、N（36.31±4.75）um；NPDR组黄斑区RNFL厚度平均G（36.81±3.21）um、NS（44.44±6.96）um、TS（34.40±3.45）um、T（25.71±3.10）um、TI（37.47±4.43）um、NI（43.74±5.54）um、N（40.34±6.47）um。正常对照组黄斑区RNFL厚度平均G（38.18±2.16）um、NS（47.87±5.16）um、TS（36.60±3.22）um、T（28.27±2.37）um、TI（39.28±4.14）um、NI（44.64±4.28）um、N（40.36±2.94）um。NDR组各区域RNFL厚度较正常对照组变薄且差异均有统计学差异（P＜0.01）；NPDR组各区域RNFL厚度较正常对照组变薄, NS、TS、T区域差异有统计学差异（T区域P＜0.01；NS、TS区域P＜0.05）。结论：糖尿病患者在视网膜出现血管改变之前已有RNFL的变薄，RNFL变薄是DR早期视网膜结构的重要改变，可能与DR的发生及发展相关；频域OCT能定量观察视网膜神经纤维层厚度变化，可以观察到糖尿病对视网膜结构的早期影响，可作为糖尿病患者早期视网膜病变的一种诊断方法。
[Abstract]:Objective : To investigate the relationship between RNFL thickness and diabetic retinopathy ( DR ) in diabetic patients with diabetic retinopathy ( NPDR ) and diabetic retinopathy ( DR ) .

Methods : 30 eyes of 30 patients in normal control group and 60 eyes of diabetic patients were examined by slit lamp microscope , direct ophthalmoscope or pre - lens and fundus fluorescein angiography . The patients with diabetes mellitus were divided into two groups according to DR international clinical classification standard ( NPDR group , 30 eyes / 26 people ) , mild and early moderate non - proliferative diabetic retinopathy ( NPDR group , 30 eyes / 30 person ) . The thickness of RNFL in peripheral and macular area of each group of cases was measured by frequency - domain OCT . The measured data consisted of 360 掳 average ( G ) around the optic disc and around the central fovea , and their respective nasal ( NS ) , temporal ( TS ) , temporal ( T ) , temporal ( TI ) , nasal ( NI ) , nasal ( N ) area RNFL thickness .

Results : RNFL thickness around the optic disc : 360 掳 mean G ( 97.46 卤 8.65 ) um , NS ( 13.84 卤 21.85 ) um , TS ( 127.79 卤 15.11 ) um , T ( 71.06 卤 10.84 ) um , TI ( 137.88 卤 22.13 ) um , NI ( 110.85 卤 22.64 ) um , N ( 72.74 卤 12.52 ) um .
The RNFL thickness in NPDR group was 360 掳 mean G ( 100.69 卤 16.35 ) um , NS ( 117.32 卤 19.05 ) um , TS ( 134.01 卤 19.32 ) um , T ( 79.83 卤 12.02 ) um , TI ( 149.56 卤 24.30 ) um , NI ( 15.74 卤 17.12 ) um , T ( 79.93 卤 6.93 ) um , TI ( 158.77 卤 18.27 ) um , NI ( 127.79 卤 24.34 ) um , N ( 77.89 卤 10.82 ) um ;
The RNFL thickness in each region of the NPDR group was significantly different from that of the normal control group ( P < 0.01 ) , and the RNFL thickness in each region of the NPDR group was thinner than that of the normal control group ( P < 0.01 ) . The difference of the average G , TS and N regions was statistically significant ( G , TS region P < 0.01 ; N region P < 0.05 ) .

The RNFL thickness in the macular region : the RNFL thickness in the macular region of the ndr group was average G ( 33.47 卤 3.39 ) um , NS ( 39.27 卤 5.30 ) um , TS ( 31.35 卤 3.56 ) um , T ( 24.02 卤 2.19 ) um , TI ( 34.47 卤 4.20 ) um , NI ( 39.89 卤 5.72 ) um , N ( 36.31 卤 4.75 ) um ;
The RNFL thickness in the macular area of the NPDR group was ( 36.81 卤 3.21 ) um , NS ( 44.44 卤 6.96 ) um , TS ( 34.40 卤 3.45 ) um , T ( 25.71 卤 3.10 ) um , TI ( 37.47 卤 4.43 ) um , NI ( 43.74 卤 5.54 ) um , N ( 39.28 卤 4.14 ) um , NI ( 44.64 卤 4.28 ) um , N ( 40.36 卤 2.94 ) um .
The RNFL thickness in the NPDR group was thinner than that of the normal control group , and the difference of NS , TS and T was significant ( P < 0.01 ) .
NS , TS area ( P < 0.05 ) .

Conclusion : The thinning of RNFL and the thinning of RNFL are the important changes in DR early retinal structure , which may be related to the occurrence and development of DR .
OCT can quantitatively observe the changes of retinal nerve fiber layer thickness , and can observe the early effect of diabetes on retinal structure , and can be used as a diagnostic method for early retinal disease in diabetic patients .
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R587.2;R774.1

【参考文献】