HbA1c水平对糖尿病患者白内障超声乳化术后角膜内皮细胞的影响

Effect of HbA1c Levels on Corneal Endothelial Cells After Phacoemulsification in Diabetic Patients

目的探讨白内障超声乳化术前糖化血红蛋白(HbA1c)水平对患者术后角膜内皮细胞的影响。方法将2017年2—11月在我院眼科行白内障超声乳化手术的(120例158眼)患者按术前HbA1c水平分为四组(所有患者入组前均排除眼部基础疾病):对照组:A组为实施白内障超声乳化手术的非糖尿病患者36例47眼;糖尿病组根据术前HbA1c水平分为3组:B组(HbA1c≤4.0%)25例31眼、C组(4.0%<HbA1c≤6.0%)27例34眼、D组(HbA1c>6.0%)32例46眼。在手术前、手术后第1天、手术后1周通过日本TOPCON SP3000P非接触式角膜内皮细胞仪检查角膜内皮细胞密度(CD)、变异系数(CV)、平均细胞面积(AVE)和六边形细胞比率(6A)等参数,并对结果进行统计学分析。结果术前四组角膜内皮细胞的CD、CV、AVE比较差异均无统计学意义(P>0.05),只有D组的6A较对照组减少,差异有统计学意义(P<0.05)。术后第1天及1周四组的CD、6A与术前相比明显减少而CV明显增多,差异均具有统计学意义(P<0.05),该变化与术前HbA1c控制水平呈负相关。只有D组的AVE在术后第1天及1周时与对照组比较,差异具有统计学意义(P<0.05)。结论对照组患者白内障超声乳化术后反应轻、角膜内皮细胞损伤较小,糖尿病组患者损伤严重,且与术前HbA1c水平呈负相关。

Objective To investigate the effect of HbA1c level on corneal endothelial cells after phacoemulsification in diabetic patients. Methods One hundred and twenty patients(158 eyes) who have been performed cataract phacoemulsification from February to November 2017 in our hospital were divided into four groups according to the preoperative HbA1c level preoperative( all patients were excluded from basic ocular diseases before entering the group). Control group: group A was 36 non diabetic patients with cataract phacoemulsification and 47 eyes. The diabetic group was divided into 3 groups according to the preoperative HbA1c level: Group B(HbA1c ≤ 4.0%): 31 eyes of 25 cases, Group C(4.0% < HbA1c ≤ 6.0%): 34 eyes of 27 cases, Group D(HbA1c > 6.0%): 46 eyes of 3 cases. Corneal endothelial cell density(CD), coefficient of variation(CV), average cell area(AVE), and percentage of regular hexagonal cells(6 A) were measured by TOPCON SP3000 P noncontact corneal endothelial microscopy in the first day and one week after surgery. Results There were no significant difference in CD, CV and AVE of the corneal endothelial cells in all groups before operation(P > 0.05). Only the 6 A in the D group was less than the control group, and the difference was statistically significant(P < 0.05). In the 1 day and 1 week after operation, the CD and 6 A in the four groups were significantly decreased compared with that before the operation, while the CV increased significantly, the difference was statistically significant(P < 0.05). The change was negatively correlated with the level of HbA1c control before operation. Only the AVE in the D group was compared with the control group at 1 day and 1 week after the operation, the difference was statistically significant(P < 0.05). Conclusion In phacoemulsification surgery, the level of hba1 c in diabetic patients can induce corneal endothelial cell injury. And this change was negatively correlated with preoperative HbA1c levels.