糖尿病视网膜病变患者黄斑中心凹下脉络膜厚度分析

Sub-foveal choroidal thickness of type 2 diabetic patients with diabetic retinopathy

目的 观察糖尿病视网膜病变（DR）不同分期脉络膜厚度的变化。方法 临床检查确诊的2型糖尿病患者150例227只眼纳入研究。其中，男性67例 89只眼，女性83例 138只眼；平均年龄（65.6±8.0）岁；平均糖尿病病程（12.4±6.5）年。所有患者均行最佳矫正视力（BCVA）、屈光度、裂隙灯显微镜、间接检眼镜、频域光相干断层扫描（SD-OCT）检查。参照早期DR治疗研究组制定的分级诊断标准将患者分为无DR（NDR）组、非增生型DR不伴黄斑水肿（NPDR/ME-）组、非增生型DR伴黄斑水肿（NPDR/ME＋）组、增生型DR不伴黄斑水肿（PDR/ME-）组、增生型DR伴黄斑水肿（PDR/ME＋）组，分别为99、64、5、25、5只眼。选取既往行全视网膜激光光凝（PRP）治疗的19例29只眼作为PRP治疗（PRP-DR）组。行PRP治疗的时间距离本研究SD-OCT检查时间为0.25～18.00个月。与患者年龄匹配的正常人17例32只眼作为正常对照组。应用SD-OCT深度增强成像技术测量受检者黄斑中心凹下脉络膜厚度（SFCT）。统计分析时，因NPDR/ME＋组和PDR/ME＋组样本量较小，未行组间比较。结果 正常对照组、NDR组、NPDR/ME-组、PDR/ME-组、PRP-DR组SFCT分别为（310.2±54.8）、（251.1±81.4）、（262.5±83.2）、（286.2±76.8）、（327.4±83.1） μm。与正常对照组SFCT比较，NDR组、NPDR/ME-组SFCT降低，差异有统计学意义（t=2.754、2.140,P＜0.05）。PDR/ME-组SFCT较NDR组增厚，差异有统计学意义（t=-2.114, P＜0.05）。PRP-DR组SFCT较PDR/ME-组增厚，差异有统计学意义（U=271.500, P＜0.05）。结论 早期DR患者SFCT变薄，随病变程度加重，SFCT逐渐增厚；行PRP后早期SFCT增厚。

Objective To observe the changes in choroidal thickness in type 2 diabetes patients with diabetic retinopathy （DR）. Methods A total of 227 eyes from 150 type 2 diabetes patients were enrolled in this study. The patients included 67 males （89 eyes） and 83 females （138 eyes）. The mean age was （65.6±8.0） years, and the mean diabetes duration was （12.4±6.5） years. All the patients were examined for best corrected visual acuity （BCVA）, diopter, slit lamp ophthalmoscopy, indirect ophthalmoscopy and spectral domain optical coherence tomography （SD-OCT） examination. The patients were divided into non-DR （NDR group, 99 eyes）, non-proliferative DR （PDR） without macular edema （ME） group （NPDR/ME- group, 64 eyes）, non-PDR with ME group （NPDR/ME＋ group, 5 eyes）, PDR without ME group （PDR/ME- group, 25 eyes）, PDR with ME group （PDR/ME＋ group, 5 eyes） according to the Early Treatment Diabetic Retinopathy Study. The ones having a history of pan-retinal photocoagulation （PRP） were classified as PRP-DR. Age matched normal subjects were enrolled as the control group. Sub-foveal choroidal thickness （SFCT） was measured by SD-OCT with enhanced depth imaging （EDI）. Results Mean SFCT was （310.2±54.8）, （251.1±81.4）, （262.5±83.2）, （286.2±76.8） and （327.4±83.1） μm respectively in control, NDR, NPDR/ME-,PDR/ME- and PRP-DR groups. Mean SFCT decreased significantly in NDR and NPDR/ME-group （t=2.754,2.140;P〈0.05）. Mean SFCT in PDR/ME-group was thicker than that in NDR （t=-2.114, P〈0.05）. Mean SFCT in PRP-DR group was thicker than that in PDR/ME- group （U=271.500, P〈0.05）. Conclusion SFCT decreased during the early course of diabetics and increased significantly as the severity worsened from NDR to PDR, and increased in the early duration after PRP treatment.