糖尿病患者565例视网膜病变初步调查及早期诊断

Incidence and clinical conditions of diabetic retinopathy in 565 patients with type 2 DM by initial investigations and early diagnosis

目的:初步调查门诊2型糖尿病(diabetes mellitus,DM)患者糖尿病视网膜病变(diabetic retinopathy,DR)的发生情况,并探讨早期诊断的方法。方法:对我院眼科门诊及住院治疗的2型DM患者,经WHO有关IDDM诊断标准确诊,共565例1130眼,通过询问获得病史以及相关检查和诊断资料,常规进行视力、眼压,以及散瞳检眼镜检查眼底,并采用眼底视网膜彩色照相检查,对镜下可疑及有明确视网膜病变的患者行荧光素血管造影(fundus fluorescein angiography,FFA)检查。结果:DM患者565例1130眼中检眼镜下有视网膜病变417例825眼,9例为单侧患者,发生率73.80%。病程5a以上患者中,存在1期以上DR占78.0%。417例明确DR患者除造影禁忌证外,372例进行了荧光素眼底血管造影检查,其中1,2,3,4期患者造影确定病情程度与眼底镜下符合率90.6%(337例),9.4%(35例)严重于检眼镜下确定病情程度。检眼镜下无眼底改变0期糖尿病患者148例296眼,病程<5a患者61例,行造影检查38例,确诊DR为1期者12例,占检查人数32%;病程高于5a患者87例,26例行造影检查发现微血管瘤存在,占30%。565例患者中血糖不稳定和控制不好者共327例,占57.9%。结论:门诊2型DM患者DR并发症的高发生率需要密切关注。为避免患者视力丧失,常规检眼镜检查,尤其是数码眼底彩色照相图像分析对早期诊断有重要价值,需引起内科医师重视。

AIM： To examine the prevalence of diabetic retinopathy （DR） in patients with type 2 diabetes mellitus （ DM）, including the incidence and clinical conditions of DR and early diagnosis. METHODS： Totally 565 patients diagnosed DM by the WHO diagnostic criteria attending at Xi＇an Eye Hospital. The median age of patients was 63.2 ± 13.8 years old. All of 565 patients related to IDDM was asked whether the history of inspections and related information, combined with clinical examination such as the acuity vision, the conventional ophthalmoscope fundus examination, fun- dus color photography were performed, and great majority of patients accepted fundus fluorescein angio- graphy （FFA） examination. RESULTS： The result showed that 417 DR cases （173.80%） in 565 DM patients occurred. Above 5 years disease stage DM in these patients diagnosis DR above stage I highly in 78.0%. In 417 cases of diabetic retinopathy in addition to the contraindication, 372 cases were performed fundus fluorescein angiography, in which 1, 2, 3, 4 stage imaging Consistency by fundus microscope was good in ratio of 90.6% （337 cases）. 9.4% （35 cases） in a serious stage eye determined by FFA other than by microscope. Ophthalmoscope under the non-diabetic retinal changes in other 148 patients （296 eyes）, 61 cases with the course of disease less than 5 years, 38 cases accepted FFA examination. Above these, 12 DR cases confirmed by FFA, accounting for 32% the number of inspections. Higher than 5-year course of disease in 87 patients, 26 cases routine microscope examination did not find the existence of microvascular tumor, accounting for 30%. There was a strong correlation between duration of diabetes and some high degree of hyperglycaemia with the presence of diabetic retinopathy. Instability and poor blood sugar control were in 327 cases （57.9%）. CONCLUSION ; These findings emphasis the importance of earlier diagnosis of diabetic retinopathy and its complications. In order to prevent patients from blindness and bad vision, the fundus examination, especially Digital fundus examination on diabetic retinopathy is the effective method on clinical early diagnosis techniques in diabetic militia group.