血小板平均体积与糖尿病性视网膜病变的相关性研究

Research of the correlation between mean platelet volume and diabetic retinopathy

目的探讨血小板平均体积（MPV）和视网膜厚度（RT）两项指标在糖尿病性视网膜病变（DR）中的临床意义，并分析MPV与RT在糖尿病各期的相关性，为早期诊断黄斑水肿、判断DR严重程度提供临床诊断依据。方法选取确诊为2型糖尿病（DM）患者80例（159眼），其中男42例（84眼），女38例（75眼），将DM患者分为糖尿病无视网膜病变组（NDR）、非增殖性视网膜病变组（NPDR）和增殖性视网膜病变组（PDR），检测DR患者不同分期的MPV，观察糖尿病黄斑水肿在光学相干断层扫描（OCT）中的形态。定量测定黄斑区RT，并与30例健康成年人（对照组）比较。结果4组MPV比较差异有统计学意义（P〈0．01）；NPDR组和PDR组与对照组比较差异有统计学意义（P〈0.01）；NDR组与NPDR组比较差异有统计学意义（P〈0．05）；NDR及NPDR组与PDR组比较差异均有统计学意义（P〈0．05）。黄斑区以中心凹1mm为直径RT对照组为（243．35±1176）um、NDR组（249．95±10．81）um、NPDR组（279．50±34．67）pm、PDR组（305．12±66．01）μm。4组A1～A9的RT比较，NPDR、PDR组与对照组差异有统计学意义（P〈0．05）。NDR组与NPDR、PDR组及NPDR与PDR组比较差异均有统计学意义（均P〈0．05）。NDR、NPDR和PDR组的MPV与黄斑区中心凹的RT均呈正相关（r=0．54、0．72、0．85，均P=0．00）。对照组的MPV与黄斑区中心凹的RT不相关（r=0．27，P=0．14）。结论MPV增大是DM患者发生DR的危险因素；黄斑区RT与DR严重程度有关，DR程度越重，RT增大的概率就越大，RT大小与是否发生DME相关；DR患者MPV和RT呈正相关，且随着DR分级的加重，相关度越来越高。

Objective To assay the mean platelet volume （MPV） of different stages of paints with diabetic retinopathy（DR）, to morphologically observe in optical coherence tomography （OCT） scanning diabetic macular edema （DME） of diabetes, and quantitatively assay the retina thickness（RT） of macular area and compare with that of healthy adults. Methods Select 80 patients （159 eyes） who were diagnosed as diabetes mellitus （DM） between January to February 2014 in Zhejiang Putuo People＇s Hospital. Among them there were 42 male patients（84 eyes）, 38 female patients（75 eyes）. They were divided into non-diabetic retinopathy （NDR） group, non-proliferative diabetic retinopathy （NPDR） group and proliferative diabetic retinopathy （PDR） group. The MPV and RT of the patients were assayed and compared with that of 30 healthy people as control group. To analyze DR patients in 3 groups （NDR, NPDR, PDR） and 30 healthy people in terms of MPV and RT changes, analyze the significance of MPV and RT in the DR classification and treatment, and discussing the correlation between MPV and RT of patients with DM and its clinical significance. Results There was significant difference comparing MPV of 4 groups （P〈0.01）. Comparing NPDR group and PDR group with control group, there was significant difference （P〈0.01）; NDR group comparing with NPDR group, there was significant difference （P〈0.05）; NDR group and NPDR group comparing with PDR group, there was significant difference （P〈0.05）. The RT of Macular center lmm diameter area of control group is （243.35 ±11.76）μm, NDR group （249.95 ±10.81）μm, NPDR group （279.50 ± 34.67）μm, PDR group （305.12± 66.01）μm. The comparison of A1-A9 RT of 4 groups： comparing NPDR, PDR groups with control group, there was significant difference （P〈0.05）. Comparing NDR group with NPDR, and PDR group with PDR group, there was both significant difference （P〈0.05）. MPV of NDR, NPDR and DR groups showed positive correlation with RT of Macular center lmm diameter area： （r=0.54, 0.72, 0.85, P=0.00 for all）. MPV of control group showed no correlation with RT of Macular center lmm diameter area （r=0.27, P=0.14）. Conclusion The increasing of MPV is a risk factor of DR development in patients with DM; RT has close relation with the severity of DR： more severe DR, more odds for increased RT. RT value is closely related to whether DME occurs. MPV and RT of macular center of patients with DR showed positive correlation, and with further progress ot DR, such correlation becomes higher.