中心视网膜厚度对非增生型糖尿病视网膜病变眼底血管充盈状态的影响

Central retinal thickness and retinal vascular filling state of diabetic patients without retinopathy or with non- proliferative diabetic retinopathy

目的观察中心视网膜厚度对非增生型糖尿病视网膜病变（NPDR）眼底血管充盈状态的影响。方法眼科及内分泌科住院治疗的无眼底病变的糖尿病患者及NPDR患者248例248只右眼纳入研究。所有患者均行光相干断层扫描（OCT）、荧光素眼底血管造影（FFA）、眼部彩色多普勒血液成像（CDFI）检查。排除中心视网膜有明显水肿、出血、渗出的其它眼底病变者。OCT测量距黄斑中心注视点1、1～3、3～6mm处中心视网膜厚度，将患者按中心视网膜厚度分入视网膜厚度正常、变薄、增厚组。确定中心视网膜厚度正常范围为216．4～304．9btm。中心视网膜厚度介于216．4～304．9μm者纳入视网膜厚度正常组，〈216．4μm者纳入视网膜厚度变薄组，〉304．9μm者纳入视网膜厚度增厚组。FFA检查时，观察并记录臂一视网膜循环时间、视网膜动脉期-静脉期（A—V）荧光充盈时间。CDFI检查时，检测各组患者眼动脉（OA）、视网膜中央动脉（cRA）及睫状后短动脉（PCA）的收缩峰值速度（PSV）、搏动指数（PI）及阻力指数（RI）。对比观察不同视网膜厚度组眼底血管充盈状态及眼部血流动力学指标异同。结果视网膜厚度正常、变薄、增厚组患者的臂-视网膜循环时间分别为（10．42±0．51）、（10．36±0．64）、（12．94±0．46）S；视网膜A—V荧光充盈时间分别为（9．15±1．36）、（6．36±1．15）、（13．56±2．04）S。视网膜厚度增厚组与视网膜厚度正常组间（t=1．93，P=0．04）、视网膜厚度增厚组与视网膜厚度变薄组间（t=4．49，P=0．00）臂视网膜循环时间比较，差异有统计学意义；视网膜厚度变薄组与视网膜厚度正常组间（t=2．13，P=0．03）、视网膜厚度增厚组与视网膜厚度正常组间（t=2．49，P=0．02）、视网膜厚度增厚组与视网膜厚度变薄组间（t=5．38，P=0．00）视网膜A—V荧光充盈时间比较，差异有统计学意义。视网膜厚度增厚组与视网膜厚度变薄组间0A、CRA、PCA的PSV（t=3．290、-5．520、-4．900）、PI（t=-4．310、-5．230、-4．390）、RI（t=4．970、6．160、5．990）比较，差异均有统计学意义（P〈0．05）。结论中心视网膜厚度对无眼底病变的糖尿病患者及NPDR患者眼底血管充盈状态有明显影响。

Objective To study the relationship between central retinal thickness and retinal vascular filling state of patients with non-proliferative diabetic retinopathy （NPDR）. Methods A total of 248 diabetic patients without retinopathy or with NPDR in the hospital were enrolled in the study. Only the right eye of these patients were examined by optical coherence tomography （OCT）, fundus fluorescein angiography （FFA）, color Doppler flow imaging （CDFI）. Patients with central retinal edema, hemorrhage and exudation were excluded from this study. Central retinal thickness was measured by OCT at the points of 1 mm, 1 to 3 ram, and 3 to 6 mm from the fovea. The patients were divided into retinal thickness normal, thinning and thickening groups according to their central retinal thickness. The normal range of central retinal thickness was defined as 216.4 - 304.9μm in this study. The arm retinal circulation time and retinal arterial phase and venous phase （A-V） fluorescence filling time were recorded by FFA examination. The peak systolic velocity （PSV）, pulsatility index （PI） and resistance index （RI） of ophthalmic artery （OA）, central retinal artery （CRA） and posterior ciliary artery （PCA） were measured by CDFI examination. The retinal fundus vascular filling state and ocular hemodynamic indexes were compared between different groups. Results The arm retinal circulation time of retinal thickness normal, thinning, thickening groups was （10.42±0.51）、（10.36±0.64）、（12.94±0.46） seconds respectively; the retinal A-V fluorescence filling time was （9.15±1.36）、（6.36±1.15）、（13.56±2.04） seconds. The difference of the arm retinal circulation time was statistically significant between the thickening and normal groups （t = 1.93, P=0.04）, and between the thickening and thinning groups （t=4.49, P=0.00）. The retinal A-V fluorescence filling time was statistically significant between the thinning and normal groups （t= 2.13, P= 0.03）, and between the thickening and normal groups （t=2.49, P=0.02）, and between the thickening and thinning groups （t=5.38, P=0.00）. The difference of PSV （t=3.290, -5. 520, -4.900）, PI （t= -4. 310, -5.230, -4. 390） and RI （t=4.970, 6. 160, 5. 990） of OA, CRA and PCA was statistically significant between the thickening and thinning groups （P〈0.05）. Conclusion Central retinal thickness can affect the retinal vascular filling state of diabetic patients without retinopathy or with NPDR.