短期胰岛素强化治疗患者视网膜厚度变化的海德堡视网膜断层扫描仪检查

Retinal thickness changes of diabetes patients after short-term insulin intensive treatment

目的观察短期胰岛素强化治疗的糖尿病（DM）患者视网膜厚度的变化。方法接受短期胰岛素强化治疗的2型DM患者32例32只眼纳入本研究。患者均合并非增生型糖尿病视网膜病变（DR）。其中，男性12例，女性20例。年龄35～72岁，平均年龄（56±9）岁。利用二代海德堡视网膜断层扫描仪（HRTⅡ）对所有患者眼底黄斑水肿指数（MED）和视盘结构参数进行检测。对比观察治疗前和治疗后1、3、6个月MED值以及视杯面积（CA）、盘沿面积（RA）、视杯容积（CV）、盘沿容积（RV）、平均视网膜神经纤维层厚度（mRNFLT）、视盘轮廓线高度变化（HVC）、视杯／视盘面积比值（C／DAR）等7个视盘结构参数。采用重复分析和最小显著差数法（LSD）两两比较分析对各组数据进行统计学处理。结果短期胰岛素强化治疗1、3、6个月，黄斑第1、2环MED值与治疗前MED值比较，差异均有统计学意义（t=2．169、2．261、2．306，t=2．293、2．147、2．038；P〈0．05）；第3环MED值与治疗前MED值比较，差异无统计学意义（t=1．719，1．145，1．280；P〉0．05）；CA、RA、CV、RV、mRNFLT、C／DAR检测值与治疗前比较，差异均无统计学意义；治疗后1个月HVC检测值与治疗前比较，差异有统计学意义（t=-2．242，P=0．037）；而治疗后3、6个月HVC检测值与治疗前比较，差异无统计学意义（t=-1．485，-0．527；P〉0．05）。结论短期胰岛素强化治疗后6个月内，DM患者MED较治疗前下降，视盘结构参数无明显变化。

Objective To observe retinal thickness changes of diabetes patients after short-term insulin intensive treatment. Methods Thirty two eyes of 32 diabetes patients with non-proliferative diabetic retinopathy who underwent short term insulin intensive treatment were enrolled in this study. There were 12 males and 20 females. The patients aged from 35 to 72 years with a mean age of （56±9） years. The macular edema index （MED） and morphosis parameter of the optic disc including cup area （CA）, rim area （RA）, cup volume （CV）, rim volume （RV）, mean retinal nerve fiber layer thickness （mRNFLT）, height variation contour （HVC）, the ratio of cup/rim area （C/DAR） in all the patients were measured by Heidelberg retinal tomography Ⅱ （HRT Ⅱ） before treatment and at the 1st, 3rd and 6th month after treatment. The repeated measurement and least-significant difference （LSD） pairwise comparison statistical methods were used to analyze the data. Results At the 1st, 3rd and 6th month after treatment, the 1st ring and the 2nd ring MED both decreased after treatment, which were significantly different compared with before treatment （lst-ring： t=2. 169, 2. 261, 2. 306; P〈0.05. 2nd-ring： t=2. 293, 2. 147, 2.038; P〈 0.05）. There was no significant difference on the 3rd-ring MED between before and after treatment （t= 1. 719, 1. 145, 1. 280; P〉0.05）. There was no significant difference in CA, RA, CV, RV, mRNFLT and C/DAR between before and after treatment. There was significant difference in HVC between before treatment and at the 1st month after treatment （t=-2.242, P=0.037）, but no significant differences at the 3rd and 6th month after treatment （t = - 1. 485, - 0. 527 ; P 〉 0.05）. Conclusions The MED of diabetes patients decreases within six months after short-term insulin intensive treatment, but there is no obvious change in morphosis parameters of the optic disc.