术前糖化血红蛋白水平与2型糖尿病患者超声乳化术后黄斑区结构功能改变的关系分析

Relationship between preoperative glycosylated hemoglobin level and changes in structure and function of macular area in type 2 diabetes mellitus patients after phacoemulsification

目的探讨术前糖化血红蛋白(HbA_(1c))水平与2型糖尿病(T2DM)患者超声乳化术后黄斑区结构功能改变的关系。方法选取2018年1月至2021年6月合肥市第一人民医院118例行超声乳化术的T2DM白内障患者,均为单眼白内障,根据术前HbA_(1c)水平,将T2DM患者分为高HbA_(1c)组55例(HbA1c>7.0%)和正常HbA_(1c)组63例(HbA1c≤7.0%),比较两组患者黄斑中心凹视网膜厚度(CST)、黄斑总容积(CV)、黄斑中心凹脉络膜厚度(SFCT)及术后黄斑水肿(PCME)发生率,分析患者发生PCME的危险因素。结果超声乳化术后1周、1个月、3个月,高HbA1c组CST水平均显著高于正常HbA_(1c)组[(256.21±19.27)μm比(242.33±14.63)μm、(277.41±16.39)μm比(248.12±11.54)μm、(242.51±11.52)μm比(234.87±9.34)μm],差异有统计学意义(P<0.05);超声乳化术后3个月,高HbA1c组CV水平均显著高于正常HbA1c组[(10.40±0.51)mm^(2)比(10.17±0.47)mm^(2)],差异有统计学意义(P<0.05)。高HbA_(1c)组PCME发生率显著高于正常HbA_(1c)组[25.45%(14/55)比7.94%(5/63)],差异有统计学意义(P<0.05)。术前HbA_(1c)>7.0%、术前存在视网膜病变是导致患者发生PCME的独立危险因素(P<0.05)。结论T2DM白内障患者术前HbA_(1c)水平会影响超声乳化术后黄斑区视网膜及脉络膜结构,且术前HbA_(1c)>7.0%的患者PCME风险增加。

Objective To explore the relationship between preoperative level of glycosylated hemoglobin(HbA_(1c))and changes in structure and function of macular area in patients with type 2 diabetes mellitus(T2DM)after phacoemulsification.Methods A total of 118 patients with T2DM and monocular cataract undergoing phacoemulsification in Hefei First People's Hospital,were enrolled between January 2018 and June 2021.According to preoperative HbA_(1c) level,they were divided into high HbA_(1c) group(HbA_(1c)>7.0%,55 cases)and normal HbA_(1c) group(HbA_(1c)≤7.0%,63 cases).The central macular thickness(CST),central volume(CV),subfoveal choroidal thickness(SFCT)and incidence of postoperative cystoid macular edema(PCME)between the two groups were compared.The risk factors of PCME were analyzed.Results At 1 week,1 month and 3 months after phacoemulsification,CST level in high HbA_(1c) group was significantly higher than that in normal HbA_(1c) group:(256.21±19.27)μm vs.(242.33±14.63)μm,(277.41±16.39)μm vs.(248.12±11.54)μm,(242.51±11.52)μm vs.(234.87±9.34)μm,and there was statistical difference(P<0.05).At 3 months after phacoemulsification,CV level in high HbA_(1c) group was significantly higher than that in normal HbA_(1c) group:(10.40±0.51)mm^(2) vs.(10.17±0.47)mm^(2)(P<0.05).The incidence of PCME in high HbA_(1c) group was significantly higher than that in normal HbA_(1c) group:25.45%(14/55)vs.7.94%(5/63)(P<0.05).Preoperative HbA_(1c)>7.0%and retinopathy were independent risk factors of PCME(P<0.05).Conclusions The preoperative HbA_(1c) level will affect retina and choroid structures in macular area of patients with T2DM and cataract after phacoemulsification.The risk of PCME is higher in patients with preoperative HbA_(1c)>7.0%.