胰岛素强化治疗后黄斑区视网膜厚度的早期观察

Early assessment of macular thickness after intensive insulin therapy

目的应用海德堡视网膜断层扫描仪（HRTII）和光学相干断层扫描（optical coherencetomography，OCT），对初次进行胰岛素强化治疗的2型糖尿病患者黄斑区视网膜厚度进行评价。方法前瞻性病例研究。对40例初次进行胰岛素强化治疗的合并非增殖期糖尿病性视网膜病变的2型糖尿病患者，分别用HRTⅡ／和OCT检查胰岛素强化治疗前、治疗后1月、3月和6月的黄斑区水肿指数e值和视网膜厚度变化并进行比较。结果黄斑区一环、二环和三环胰岛素强化治疗后1月、3月、6月的e值与强化治疗前比较均差异无统计学意义（P〉0．05）；黄斑区一环胰岛素强化治疗后1月、3月、6月OCT所测的视网膜厚度值分别与强化治疗前视网膜厚度值比较均差异无统计学意义（P〉O．05）；二环强化治疗后1月OCT所测的视网膜厚度值与治疗前相比有统计学意义（P=0．019），治疗后3月、6月与治疗前差异无统计学意义（P〉0．05）；三环胰岛素强化治疗后1月、3月OCT所测的视网膜厚度值与治疗前相比有统计学意义（分别为P=0．010、0．000，），治疗后6月与治疗前差异无统计学意义（P〉0．05）。结论短期胰岛素强化治疗对合并非增殖期糖尿病视网膜病变的2型糖尿病性患者的黄斑厚度改变并无明显影响。

Objective To study the change of macular thickness after intensive insulin therapy by using Heidelberg retinal tomography 11 （HRT Ⅱ） and optical coherence tomography （OCT）. Methods This was a prospective case series study, 80 eyes of 40 patients of type 2 diabetes melli- tus with Non-Proliferative Diabetic Retinopathy （NPDR） under intensive insulin therapy were includ- ed into study. HRT I] was used to obtain the macular edema index （e-value） and the OCT was used to obtain the value of macular thickness. The follow times were at pre-treatment and 1 month, 3 months and 6 months after intensive insulin therapy. The repeated measurement and LSD pairwise comparison were used to analyze the data. Results The e-value and the macular thickness of the first-ring, the second-ring and the third-ring of macular area were analyzed respectively, the differ- ence among the pre-treatment and 1 month, 3 months and 6 months post-treatment had no statistical- ly significant （P 〉 0.05）. Conclusions No significant change of macular thickness of type 2 diabe- tes mellitus with NPDR is observed after a short term intensive insulin therapy.