非增殖期糖尿病视网膜病变与黄斑水肿相关性观察

Correlation analysis of diabetic macular edema and non-proliferative diabetic retinopathy

目的观察非增殖期糖尿病视网膜病变（NPDR）各分期中糖尿病性黄斑水肿（DME）的发生率，研究DME与NPDR病变程度是否平行，了解NPDR眼底病变与DME之间的关系。方法临床病例系列研究。对2013年1月至2014年6月在内蒙古民族大学附属医院确诊NPDR120例（186只眼）患者分析，统计DME在NPDR各分期中的发生率，研究NPDR病变程度与DME发生的相关性；应用多因素方差分析和Logistic回归分析，探讨DME的发生与微动脉瘤（MA）、视网膜点状出血、渗出的关系。结果120例（186只眼）NPDR患者中，发生DME52例（87只眼），其中轻度NPDR12例（20只眼），按眼数比占22．99％（20／87），中度NPDR19例（28只眼），占32．18％（28／87），重度NPDR21例（39只眼），占44．83％（39／87），三组间差异无统计学意义（x^2=O．57，P=O．75）。经过多因素方差分析视网膜微动脉瘤对于DME的影响显著差异有统计学意义（F=11．77，P=0．001），出血和渗出的影响并不显著，差异无统计学意义（F=3．69，P=0．056；F=1．704，P=0．193）。进一步的Logistic回归分析结果发现，只有微动脉瘤变量是独立性危险因素。结论NPDR患者出现DME与NPDR的病变程度并不平行；微动脉瘤是NPDR患者发生DME的独立危险因素。

Objective To analyze the incidence of diabetic macular edema （DME） in each stage of non-proliferative diabetic retinopathy （NPDR） and to investigate the relationship between DME and the retinal signs, so that to clarify the risk factors of DME in NPDR. Methods The data of 120 NPDR cases （186 eyes）, which diagnosed by fundus fluorescein angiography （FFA）, from the ophthalmology department of the Affiliated Hospital of Inner Mongolia University for Nationalities were collected. Then the relationship between the extent of NPDR and the occurrence of DME was determined by investigating the incidence of DME in various stages of NPDR. These subjects were divided into two groups according to the DME appearance or not, and then the logistic regression analysis was applied to explore the correlation between the incidence of DME and the retinal signs （including retinal spotting, exudation, microangioma）. Results There were 52 patients （87eyes） suffered from DME in these subjects： 12 cases （20 eyes） in mild NPDR, 19 cases （28 eyes） in moderate NPDR, 21 cases （39 eyes） in severe NPDR, and no statistically significant difference was found among these groups （x2=0.57, P =0.75）. The retinal microaneurysm was perceived to be an independent risk factor for the occurrence of DME （F =11.77, P =0.001）, and retinal bleeding and exudation with were found no significant relationship to the incidence of DME （F =3.69, P =0.056; F = 1.704, P =0.193） after a multi-factor analysis of variance and Logistic regression analysis. Conclu-sions The NPDR severity is not parallel to the occurrence of DME. Retinal microaneurysm is an independent risk factor for the occurrence of DME in NPDR patients.