全视网膜激光光凝对糖尿病视网膜病变患者黄斑区脉络膜厚度的影响及与预后的相关性

Effect of panretinal photocoagulation on macular choroidal thickness in patients with diabetic retinopathy and its correlation with prognosis

目的探讨全视网膜激光光凝(PRP)治疗糖尿病视网膜病变(DR)对患者黄斑区脉络膜厚度(MCT)的影响,并分析其与预后的相关性。方法纳入我院收治的DR患者51例(102眼),患者均接受PRP治疗,并将其作为DR组。选取同期于我院接受视力检查者51例(102眼)作为对照组,比较2组基线(治疗前)MCT。根据有无糖尿病性黄斑水肿(DME)将DR患眼分成DME组和无DME组,比较2组基线MCT。分别在治疗前及治疗后1周、3个月、6个月检测DR患者的MCT与最佳矫正视力(BCVA),经Pearson相关系数分析基线MCT与治疗后6个月BCVA的相关性。构建多因素Logistic回归模型分析影响DR患者预后的因素。结果DR组基线SFCT、M500、M1500、M2500小于对照组(P<0.05)。DME组的基线SFCT、M500、M1500、M2500大于无DME组(P<0.05)。DR患者治疗后1周的SFCT、M500、M1500、M2500较治疗前增大,且治疗后3个月、6个月各指标较治疗后1周减小(P<0.05);治疗后1周、3个月、6个月的BCVA显著大于治疗前(P=0.000)。Pearson相关系数分析显示,DR患者基线SFCT、M500、M1500、M2500与治疗后1周、3个月、6个月的BCVA呈正相关(P<0.05)。多因素Logistic回归分析显示,基线SFCT、M500、M1500、M2500减小以及糖化血红蛋白(HbA1c)、餐后2 h血糖(2hPG)升高是DR患者预后的影响因素(P<0.05)。结论与正常者相比,DR患者的MCT变小,但经PRP治疗后1周MCT明显增大,在治疗后3~6个月逐渐恢复至治疗前状态,且基线MCT与患者视力预后密切相关。

Objective To explore the effect of panretinal photocoagulation(PRP)on macular choroidal thickness in patients with diabetic retinopathy(DR),and analyze its correlation with prognosis.Methods A total of 51 DR patients(102 eyes)who were admitted to our hospital were included in the study.All these patients were treated with PRP and included into the DR group.A total of 51 cases(102 eyes)who underwent visual inspection in our hospital during the same period were selected as the control group.The baseline(before treatment)MCT between the two groups was compared.According to the presence or absence of diabetic macular edema(DME),DR eyes were divided into the DME group and the non-DME group,and the baseline MCT of the two groups were compared.The MCT and best corrected visual acuity(BCVA)of DR patients were tested before treatment and 1 week,3 months,and 6 months after treatment.The correlation between the baseline MCT and BCVA 6 months after treatment was analyzed by Pearson correlation coefficient analysis.The multivariable Logistic regression model was established to analyze the factors affecting the prognosis of DR patients.Results The baseline SFCT,M500,M1500,and M2500 of the DR group were smaller than those of the control group(P<0.05).The baseline SFCT,M500,M1500 and M2500 of the DME group were greater than those of the non-DME group(P<0.05).For the DR patients,the SFCT,M500,M1500,and M25001 week after treatment were greater than those before treatment,and these indexes 3 months and 6 months after treatment were smaller than those 1 week after treatment(P<0.05).Pearson correlation coefficient analysis indicated that the baseline SFCT,M500,M1500,and M2500 of DR patients were positively correlated with the BCVA 1 week,3 months,and 6 months after treatment(P<0.05).Multivariable Logistic regression analysis showed that the decrease of baseline SFCT,M500,M1500,M2500 and the increase of hemoglobin A1c(HbA1c)and 2-hour plasma glucose(2hPG)were the influencing factors of the prognosis in DR patients(P<0.05).Conclusion Compared with the normal people,the MCT of DR patients is smaller,but it significantly increases 1 week after PRP treatment,and it gradually restores to the state before treatment 3 to 6 months after treatment,and the baseline MCT is closely related to patients’visual prognosis.