彩色多普勒超声对糖尿病视网膜病变诊断价值

Diagnostic value of color doppler ultrasonography in diabetic retinopathy

目的探讨彩色多普勒超声对2型糖尿病患者视网膜病变的诊断价值。方法按眼底病变情况将136例(268眼)2型糖尿病患者分为不伴视网膜病变组(NDR组)48例、非增殖性视网膜病变组(NPR组)40例、增殖性视网膜病变组(PR组)48例,另选择年龄、性别、体质量指数与2型糖尿病患者相称的健康人69例(138眼)作为对照组。应用彩色多普勒超声监测入选者视网膜中央动脉(CRA)、眼动脉(OA)的最大收缩期血流速度(PSV)、舒张末期血流速度(EDV)、阻力指数(RI),同时测定入选者空腹血糖(FBG)、糖化血红蛋白(Hb A1c)、空腹胰岛素(FINS)、血脂、肝功能、肾功能、尿微量白蛋白/尿肌酐值(Up/Ucr)。结果NDR组眼动脉频谱呈三峰双切迹;NPR组和PR组第一峰降低,波形低而圆钝呈半圆形;4组间CRA、OA的PSV、EDV和RI比较差异均有统计学意义(P均<0.05);CRA、OA的PSV、EDV均与FBG、Hb A1c、胰岛素抵抗指数(IRI)、Up/Ucr呈显著负相关关系(P均<0.05),CRA、OA的RI与FBG、Hb A1c、IRI、Up/Ucr呈显著正相关关系(P均<0.05)。结论彩色多普勒超声监测眼底血流动力学参数能反映糖尿病眼部血管改变情况,对早期发现糖尿病视网膜病变有重要价值。

Objective It is to investigate the diagnostic value of color doppler ultrasonography in type two diabetic retinop- athy. Methods According to the fundus lesions, 136 patients with type two diabete were divided into the non diabetic retinopa- thy （NDR） group with 48 cases, non proliferative retinopathy （NPR） group with 40 cases, and proliferative retinopathy （PR） group with 48 cases, and 69 matched healthy candidates were selected for the control group. The color doppler uhrasonography were applied to measured the peak systolic velocity （PSV） , the end diastolic velocity （EDV） and the resistance index （RI） of central retinal artery （CRA） and ocular artery （OA） in all groups. At the same time, the indexes of FBG, HbAlc, FINS, serum lipids, liver function, renal function, urinary albumin/creatinine ratio were detected. Results There were three peaks and double incisures of NDR group by artery spectrum and there was reduction of the first peak and waveform round blunt like a semicircle of NPR group and PR group. There was significant difference among the four groups of PSV, EDV and RI of CRA and OA （P 〈0.05）. There were negative correlation between the PSV, EDV of CRA, OA and FBG, HbAlc, insulin resist- ance index, urinary albumin/creatinine ratio. There were positive correlation between the RI and FBG, HbAlc, insulin resist- ance index, urinary albumin/creatinine ratio （ P 〈 0. 05 ）. Conclusion Color doppler ultrasonography can reflect accurately the change of diabetic retinopathy by monitoring the fundus hemodynamic parameters change. It also has important value for detec- ting early retinal hemodynamic changes.