糖尿病性视网膜病变170例随访观察分析

Follow-up of 170 diabetic retinopathy

目的观察糖尿病性视网膜病变各期病程改变及进行危险因素分析。方法随访糖尿病视网膜(DR)单纯性Ⅰ、Ⅱ、Ⅲ期170例290眼。单纯型进展为增殖型糖尿病视网膜病变(PDR)Ⅳ期者,随访2年为42眼(14%),5年为98眼(34%)。结果Ⅰ、Ⅱ、Ⅲ进展至Ⅳ期的发生率:Ⅲ期>Ⅱ期,Ⅱ期>Ⅰ期,差别均有显著性(P<0.005)。糖尿病黄斑水肿随随访年限增长而增加,初诊黄斑水肿70眼,2年内增至86眼,5年内增至110眼。视网膜静脉串珠状改变,视网膜内大量微血管异常和四个象限内存在出血和/微血管瘤是单纯型进展至PDR的危或险性病变。血糖控制不良,糖尿病病程长和高血压可能是单纯型进展至PDR的危险因素。结论为预防或减少DR致盲,应早期发现DR,并给予长期随访。

Objective To investigate the clinical manifestation and risk factors of diabetic retinopathy. Methods 170 cases （290 eyes） with stage Ⅰ , Ⅱ, Ⅲ diabetic retinopathy were included in this study. 42 eyes （14%） developed stage Ⅳ within 2 years and 98 eyes（34%） developed stage Ⅳ within 5 years. Results The occurrence of stage IVin different stage of nonproliferative diabetic refinopathy was different, Ⅲ〉Ⅱ, Ⅱ 〉 Ⅰ （P〈 0.05） The occurrence of diabetic macular edema increased as time passed. There were 70 cases with diabetic macular edema at first visit, 86 eyes within 2 years and 110 eyes within 5 years. The risk factors of proliferative diabetic retinopathy were pearl-like changes of retinal veins, a lot of abnormal retnal capillaries and more than 4 quadrant microaneurysm or bleeding. Unstable blood glucose level, long history of diabete mellitns and hypertentian might be the risks factors of proliferative diabetic retinopathy. Conclusions Early diagnosis and follow-up are important to prophylaxis of proliferative diabetic retinopathy.