影响糖尿病视网膜病变激光治疗疗效的因素

目的探讨影响糖尿病视网膜病变（diabeticretinopathy，DR）全视网膜光凝术（PRP）疗效因素。方法经眼底荧光素血管造影术（FFA）检查确诊为DR增殖前期、增殖期早期患者115例（230眼），分为全身情况佳组（A组）67例（134眼），全身情况不佳为组（B组）48例（96眼），均采用PRP治疗，观察PRP术后视力及FFA显示无灌注区及新生血管消褪情况。结果A组PRP后10例20眼（14．93％）视力提高，52例104眼（77．61％）视力不变，5例10眼（7．46％）视力下降；B组PRP术后2例4眼（4．17％）视力提高，38例76眼（79．16％）视力不变，8例16眼（16．67％）视力下降。A组患者治疗有效率94．0％。B组58.3％差异有统计学意义（P〈0．05）。结论PRP术是控制处于增殖前期、增殖期早期糖尿病视网膜病变的有效手段；全身情况正常的DR患者在PRP术后的视力、无灌注区及新生血管消褪程度明显好于全身情况不正常（包括血糖控制不良、糖化血红蛋白高、高尿素氮、高血压、高血脂）患者。糖化血红蛋白、尿素氮和血脂、血压是影响DR激光疗效的危险因素。

Objective To study the relativity between the effect of laser photocoagulation treatment in DR and the systemic multifactors. Methods The clinical data of the 115 patients of type 2 diabetes were collected. Methods Patients were performed by FFA（fluorescein fundus angiography）, diagnosed as DR and graded. Ophthalmic examinations, system complications and medical histories were recorded. Correlation between DR and some factors such as episode age, sex, progress, body mass index （ BMI ） , intraocular pressures, refractive diopter, blood pressure, blood glucose, GHb, Cr, BUN, system complications were analyed. The patients were divided into NDR group, NPDR group and PDR group according to the seriousness of DR.The association of DR with these clinical data was analyzed. Results （ 1 ） Of all 230 eyes after laser photocoagulation treatment, visual acuity improved in 24 eyes （ 10.43% ） , remained unchanged in 180 eyes （ 78.27% ） , decreased in 26 eyes （ 11.30% ） .The retinopathies were effectively treated in 185 eyes.The follow-up of fundus and FFA showed absorption of retinal edema.exudation and bleeding and shrinking of new blood vessels, the effective rate was 80.4%. （ 2 ） Visual acuity improved in 20 eyes （ 14.93% ） , remained unchanged inl04 eyes （ 77.61% ） , decreased in 10 eyes （ 17.46% ） in the group A.Visual acuity improved in 4 eyes （4.17%） , remained unchanged in 79 eyes （ 79.16% ） , decreased in 16 eyes （ 16.67% ） in the group B.FFA showed that the effective rate after laser photocoagulation in the group A was 94.0% and the effective rate in the group B was 58.3%. The effective rate in the group A was significantly higher than that in the group B （ P〈0.05 ） . Conclusions Peripheral neuropathy, GHb and BUN are risk factors associated with DR progression. More monitoring for GHb and BUN should be done for DR patients. More positive treatment is necessary for DR patients combined with peripheral neuropathy.