眼轴长度与糖尿病视网膜病变程度的关系

Relationship between axial length and severity of diabetic retinopathy

目的研究眼轴长度与糖尿病视网膜病变(diabetic retinopathy,DR)程度的关系,并探讨其临床意义。方法按照眼轴长度将84例(160眼)2型糖尿病患者分为3组:眼轴长度≤24mm(87眼)、24～26mm(48眼)、>26mm(25眼)。采用国际标准视力表检查视力;使用裂隙灯显微镜检查眼前节,托品酰胺眼液散瞳(排除高眼压后),双目间接检眼镜和荧光素眼底血管造影术(fluorescein fundus angiography,FFA)检查眼底,A型超声波测量眼轴长度。根据患者视网膜病变的严重程度分为无DR期组,非增生性DR组和增生性DR组(proliferative diabetic retinopathy,PDR)。屈光不正程度与DR分期的相关性分析采用Kendall和Spearman检验,不同屈光不正程度患者中PDR发生率的比较采用卡方检验。结果患眼眼轴越长,DR病变程度越轻,二者之间存在等级相关,且为负相关,3组NPDR眼数分别为23眼、12眼、16眼,PDR眼数分别为62眼、33眼、2眼,差异均有统计学意义(Kendall检验P<0.05,r=-0.34;Spearman检验P<0.01,r=-0.367)。眼轴>26mm组患者与其他2组患者的PDR发生率之间差异有统计学意义(χ2=34.457,P<0.05)。结论眼轴较长的患者,DR病变程度较轻。长眼轴作为PDR的保护性因素,对DR临床处理有一定的指导意义。

Objective To investigate the relationship between axial length and severity of diabetic retinopathy（DR）,and explore its clinical significance.Methods Eighty-four type-2 diabetic patients（160 eyes） were divided into three groups according to axial length：shorter than 24 mm（87 eyes）,between 24 mm and 26 mm（48 eyes）,longer than 26 mm（25 eyes）.Visual acuity was examined in each group by international standard visual acuity chart,and the anterior segment was examined by slit lamp microscope.Fundus was examined by binocular indirect ophthalmoscope and fluorescein fundus angiography under dilated pupil.Axial length was measured by type-A ultrasound.The patients were divided into three groups according to the severity of DR：no DR,none proliferative DR（PDR） and PDR.The relationship between axial length and the severity of DR was analysis by Kendall test and Spearman＇s rank-correlation coefficient test.The comparison of PDR morbidity in three groups was performed by chi-square test.Results With the axial length increased,the severity of DR reduced,which showed the negative ranked relation,there were statistical differences（Kendall test,P〈0.05,r=-0.34;Spearman＇s rank-correlation coefficient test,P〈0.01,r=-0.367）,and there was statistical difference in the incidence of PDR between axial length longer than 26 mm group and other two groups（χ2=34.457,P〈0.05）.Conclusions When the axial length becomes longer,the severity of DR reduces.As a protective factor of PDR,long axial length is significant to predict DR development and guide the treatment of DR.