无蛋白尿早期糖尿病患者黄斑区微视野功能改变

Changes in Macular Microvisual Field Function in Early Diabetic Patients without Proteinuria

目的:探讨无蛋白尿早期糖尿病(DM)患者黄斑区微视野功能的改变。方法:选取2018年7月-2020年6月于揭阳市人民医院就诊的100例无蛋白尿早期糖尿病患者(200眼),正常对照组为50例健康体检人群(100眼)。所有入组人员均进行尿常规、24 h微量白蛋白尿、肌酐(Cr)、尿素、糖化血红蛋白(HbA1c)检测。DM患者按照国际标准获取眼底照相为无糖尿病视网膜病变者,并进行眼底荧光造影分组:无糖尿病视网膜病变(NDR)组50例100眼,轻度非增殖性糖尿病视网膜病变(NPDR)组50例100眼。采用MP-3微视野计对所有研究者进行黄斑区微视野检查,记录受检者黄斑区20°范围内视网膜平均视敏感度及2°、4°固视稳定性。结果:NDR组和轻度NPDR组微量白蛋白尿、尿素、Cr水平均高于正常对照组,且轻度NPDR组均高于NDR组,差异均有统计学意义(P<0.05)。NDR组和轻度NPDR组糖化血红蛋白比较,差异无统计学意义(P>0.05)。NDR组和轻度NPDR组HbA1c均高于正常对照组,差异均有统计学意义(P<0.05)。NDR组和轻度NPDR组平均视敏感度均低于正常对照组,且轻度NPDR组低于NDR组,差异均有统计学意义(P<0.05)。三组平均视敏感度比较,差异有统计学意义(P<0.01)。三组黄斑区微视野低视敏感度刺激点出现率的比较,差异有统计学意义(P=0.001)。轻度NPDR组和正常对照组低视敏感度刺激点出现率比较,差异有统计学意义(P<0.05)。轻度NPDR组与NDR组低视敏感度刺激点出现率比较,差异有统计学意义(P<0.05)。NDR组和正常对照组低视敏感度刺激点出现率比较,差异无统计学意义(P>0.05)。三组固视稳定性比较,差异无统计学意义(P>0.05)。结论:糖尿病肾病前期且眼底图片诊断NDR患者,黄斑区20°范围内视网膜光敏感度普遍下降,且随着视网膜形态学出现改变而加剧,但其固视稳定程度较正常人尚无明显改变。

Objective:To investigate the changes of macular microvisual field function in early patients with diabetes mellitus (DM) without proteinuria.Method:A total of 100 early DM patients without proteinuria (200 eyes) treated in the People’s Hospital of Jieyang City from July 2018 to June 2020 were selected,and 50 healthy people (100 eyes) were included in the normal control group.Routine urine,24 h microalbuminuria,creatinine (Cr),urea and glycated hemoglobin (HbA1c) were detected in all subjects.According to international standards,the fundus photography of DM patients was obtained as those without diabetic retinopathy (DR) and fundus fluorescence angiography was divided into the following groups:50 cases (100 eyes) in the group without DR,and another 50 cases (100 eyes) with nonproliferative diabetic retinopathy (NPDR) in the group with mild NPDR.The MP-3 microperimeter was used to examine the microfield in the macular area of all subjects,and the average retinal visual sensitivity at 20° and fixation stability at 2° and 4° in the macular area of the subjects were recorded.Result:The levels of microalbuminuria,blood urea and Cr in NDR group and mild NPDR group were higher than those in normal control group,and those in mild NPDR group were higher than those in NDR group,the differences were statistically significant (P<0.05).There was no significant difference in HbA1c between NDR group and mild NPDR group (P>0.05).HbA1c in NDR group and mild NPDR group were higher than that in normal control group,the differences were statistically significant (P<0.05).The average visual sensitivity in NDR group and mild NPDR group were lower than that in normal control group,and the mild NPDR group was lower than that in NDR group,the differences were statistically significant (P<0.05).There was significantly difference in average visual sensitivity among three groups (P<0.01).There was statistically significant difference in the occurrence rate of low visual sensitivity stimulation points in macular microfield among three groups (P=0.001).There was significant difference in the occurrence rate of low visual sensitivity stimulation points between mild NPDR group and normal control group (P<0.05).There was statistically significant difference in the occurrence rate of low visual sensitivity stimuli between mild NPDR group and NDR group (P<0.05).There was no significant difference in the occurrence rate of low visual sensitivity stimuli between NDR group and normal control group (P>0.05).There was no significant difference in fixation stability among three groups (P>0.05).Conclusion:Retinal light sensitivity at 20° in macular area is generally decreased and aggravate with changes in retinal morphology in patients,which are pre-diabetic nephropathy and without DR diagnosed by fundus images.But the degree of fixation stability is not significantly changed compared with normal people.