焦虑对糖尿病患者青光眼白内障联合手术后炎症反应及眼压影响

Influence of Anxiety on Inflammatory Reaction and Intraocular Pressure after Glaucoma and Cataract Surgeries in Diabetic Patients

目的观察焦虑对糖尿病患者实施青光眼白内障联合手术后炎症反应及眼压的影响。方法选择糖尿病并青光眼白内障拟行手术患者80例(80只眼),根据汉密顿焦虑量表评定总分将其分为焦虑组26例和非焦虑组54例,测定手术当天血清血清肿瘤坏死因子(TNF-α)和白细胞介素-6(IL-6)浓度,观察术后1、3、7 d前房炎症反应及术后3个月眼压情况。结果术后1、3、7 d前房炎症反应焦虑组明显重于非焦虑组,差异有统计学意义(P<0.05)。手术当天焦虑组血清IL-6及TNF-α含量分别为(24.47±2.02)ng/L、(36.8±3.49)ng/L,非焦虑组分别为(22.95±1.68)ng/L、(34.23±3.34)ng/L,两组比较差异均有统计学意义(P<0.05)。术后3个月眼压值焦虑组平均(16.69±1.23)mmHg,非焦虑组平均(15.78±1.16)mmHg,两组比较差异有统计学意义(P<0.05)。结论焦虑可加重糖尿病患者青光眼白内障联合手术后炎症反应,影响手术效果,TNF-α和IL-6是其重要相关因子。

Objective To observe influence of anxiety on intraocular pressure after glaucoma and cataract surgeries in dia- betic patients. Methods Eighty patients （eighty eyes） with diabetes who would underwent glaucoma and cataract surgeries were divided into anxiety group （n =26） and non-anxiety group （n =54） by the Hamilton Anxiety Rating Scale （HAMA）. The serum level of tumor necrosis factor alpha （TNF-α） and interleukin 6 （IL-6） were detected, and aqueous inflammatory reaction at 1 d, 3 d and 7 d after combined surgery and intraocular pressure （IOP） 3 months after combined surgery were observed. Results The aqueous inflammatory reaction at 1 d, 3 d and 7 d after combined surgery in anxiety group were significantly stronger than those in non-anxiety group （P 〈0. 05）. On the day of surgeries the concentrations of TNF-α were （36.8 ＋3.49）ng/L in anxiety group and （34.23 ±3.34）ng/L in non-anxiety group, the concentration of IL-6 were （24.47 ± 2.02）ng/L in anxiety group and （22.95 ± 1.68）ng/L in non-anxiety group, and the differences of the two groups were statistically significant（P 〈0.05）. The average IOP in anxiety group and non-anxiety group 3 months after surgery were（ 16.69 ±1.23）mmHg and （15.78 ± 1.16）mmHg respectively, and the differences of the two groups were also statistically significant （P 〈 0. 05 ）. Conclusion High preoperative level of anxiety is a risk factor of inflammatory reaction in diabetic patients after combined glaucoma and cataract surgeries, which may be associated with worse outcome from combined surgeries. TNF-α and IL-6 are important correlative factors.