目的探讨糖尿病视网膜病变(DR)患者扩张型毛细血管的发生率、眼底影像学特征及其影响因素。方法选取2020年5月至2021年5月就诊于西安交通大学第二附属医院眼科并确诊为DR的患者147例230眼。其中,合并糖尿病性黄斑水肿(DME)者65眼,不合并...目的探讨糖尿病视网膜病变(DR)患者扩张型毛细血管的发生率、眼底影像学特征及其影响因素。方法选取2020年5月至2021年5月就诊于西安交通大学第二附属医院眼科并确诊为DR的患者147例230眼。其中,合并糖尿病性黄斑水肿(DME)者65眼,不合并DME者165眼。观察并分析DR患者眼底吲哚菁绿血管造影(ICGA)、OCT图像、眼底彩照表现及血糖相关指标,总结扩张型毛细血管的发生率及眼底影像学特征,探讨其影响因素。结果本研究230眼DR患眼中扩张型毛细血管的发生率为39.6%。在合并DME的DR患眼(65眼)中扩张型毛细血管的发生率为53.8%,而在未合并DME的DR患眼(165眼)中发生率为33.9%;合并DME的DR患眼的发生率高于未合并DME的DR患眼,差异有统计学意义(χ^(2)=7.728,P=0.005)。在ICGA检查中,扩张型毛细血管开始显影时间为3 min 57 s~7 min 31 s,平均开始显影时间为4 min 58 s,之后染色逐渐增强呈现高荧光,持续至10 min后仍不衰退,并与晚期低背景荧光形成强烈对比。依据ICGA形态学特征可将扩张型毛细血管分为两种类型(1)孤立的圆形扩张型毛细血管,此型较常见,占72.5%;(2)簇状扩张型毛细血管,此型占27.5%。硬性渗出越严重,出现扩张型毛细血管的可能性越大(线性关联值为32.754,P<0.001)。与无扩张型毛细血管眼相比,有扩张型毛细血管眼患者的糖化血清白蛋白、糖化白蛋白含量更高,差异均有统计学意义(均为P<0.05)。两组患者空腹血糖、血清白蛋白含量差异均无统计学意义(均为P>0.05)。结论扩张型毛细血管在DR患眼中的发生率较高,尤其是合并DME的DR患眼;扩张型毛细血管依其在ICGA中的形态学表现可分为孤立的圆形扩张型毛细血管和簇状扩张型毛细血管两种类型;严重的硬性渗出和较差的血糖控制水平与扩张型毛细血管的发生可能具有一定关系。展开更多
BACKGROUND AND OBJECTIVE: Because patients with diabetes mellitus may visit their primary care physician reg-ularly but not their ophthalmologist, a retinal risk assessment in the primary care setting could improve th...BACKGROUND AND OBJECTIVE: Because patients with diabetes mellitus may visit their primary care physician reg-ularly but not their ophthalmologist, a retinal risk assessment in the primary care setting could improve the screening rate for diabetic retinopathy. An imaging system for use in the primary care setting to identify diabetic retinopathy requiring referral to an ophthalmologistwas evaluated. PATIENTS AND METHODS: In a masked prospective study, images were obtained from 111 patients with diabetes mellitus using both the digital retinal imaging system and seven-field stereo color fundus photography. The ability to obtain gradable images and to identify diabetic retinal lesions was compared. RESULTS: Of all images, 85% of digital retinal imaging system images and 88% of seven-field images were gradable. Agreement based on “ no retinopathy” versus “ any retinopathy” was excellent (Kappa=0.96). Agreement based on “ microaneurysms or less retinopathy” versus “ retinal hemorrhages or worse retinopathy” was very good (Kappa=0.83). CONCLUSIONS: The agreement between the digital retinal imaging system and seven-field photography indicates that the digital retinal imaging system may be useful to screen for diabetic retinopathy.展开更多
文摘目的探讨糖尿病视网膜病变(DR)患者扩张型毛细血管的发生率、眼底影像学特征及其影响因素。方法选取2020年5月至2021年5月就诊于西安交通大学第二附属医院眼科并确诊为DR的患者147例230眼。其中,合并糖尿病性黄斑水肿(DME)者65眼,不合并DME者165眼。观察并分析DR患者眼底吲哚菁绿血管造影(ICGA)、OCT图像、眼底彩照表现及血糖相关指标,总结扩张型毛细血管的发生率及眼底影像学特征,探讨其影响因素。结果本研究230眼DR患眼中扩张型毛细血管的发生率为39.6%。在合并DME的DR患眼(65眼)中扩张型毛细血管的发生率为53.8%,而在未合并DME的DR患眼(165眼)中发生率为33.9%;合并DME的DR患眼的发生率高于未合并DME的DR患眼,差异有统计学意义(χ^(2)=7.728,P=0.005)。在ICGA检查中,扩张型毛细血管开始显影时间为3 min 57 s~7 min 31 s,平均开始显影时间为4 min 58 s,之后染色逐渐增强呈现高荧光,持续至10 min后仍不衰退,并与晚期低背景荧光形成强烈对比。依据ICGA形态学特征可将扩张型毛细血管分为两种类型(1)孤立的圆形扩张型毛细血管,此型较常见,占72.5%;(2)簇状扩张型毛细血管,此型占27.5%。硬性渗出越严重,出现扩张型毛细血管的可能性越大(线性关联值为32.754,P<0.001)。与无扩张型毛细血管眼相比,有扩张型毛细血管眼患者的糖化血清白蛋白、糖化白蛋白含量更高,差异均有统计学意义(均为P<0.05)。两组患者空腹血糖、血清白蛋白含量差异均无统计学意义(均为P>0.05)。结论扩张型毛细血管在DR患眼中的发生率较高,尤其是合并DME的DR患眼;扩张型毛细血管依其在ICGA中的形态学表现可分为孤立的圆形扩张型毛细血管和簇状扩张型毛细血管两种类型;严重的硬性渗出和较差的血糖控制水平与扩张型毛细血管的发生可能具有一定关系。
文摘BACKGROUND AND OBJECTIVE: Because patients with diabetes mellitus may visit their primary care physician reg-ularly but not their ophthalmologist, a retinal risk assessment in the primary care setting could improve the screening rate for diabetic retinopathy. An imaging system for use in the primary care setting to identify diabetic retinopathy requiring referral to an ophthalmologistwas evaluated. PATIENTS AND METHODS: In a masked prospective study, images were obtained from 111 patients with diabetes mellitus using both the digital retinal imaging system and seven-field stereo color fundus photography. The ability to obtain gradable images and to identify diabetic retinal lesions was compared. RESULTS: Of all images, 85% of digital retinal imaging system images and 88% of seven-field images were gradable. Agreement based on “ no retinopathy” versus “ any retinopathy” was excellent (Kappa=0.96). Agreement based on “ microaneurysms or less retinopathy” versus “ retinal hemorrhages or worse retinopathy” was very good (Kappa=0.83). CONCLUSIONS: The agreement between the digital retinal imaging system and seven-field photography indicates that the digital retinal imaging system may be useful to screen for diabetic retinopathy.
