糖尿病无明显视力下降患者黄斑区血流密度观察及中医证型研究
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R587.2

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广东省医学科学技术研究基金(C2019127)


Observation on Macular Blood Flow Density of Patients with No Obvious Sight Loss Caused by Diabetes and Study on Traditional Chinese Medicine Syndrome Types
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    摘要:

    目的:探讨糖尿病无明显视力下降患者黄斑区血流密度及中心凹无血管区(FAZ) 面积变化,及 不同中医证型黄斑区血流密度变化规律。方法:收集2 型糖尿病患者98 例(192 眼) 设为糖尿病组,并根据 VOLK 镜+90D 裂隙灯前置镜眼底检查结果分为2 个亚组,即有视网膜微血管病变且处于非增殖期者设为糖尿 病非增殖组(NPDR 组) 46 例(91 眼),无视网膜病变者设为糖尿病0 期组52 例(101 眼);另选取正常健康 人44 例(84 眼) 设为对照组。所有入组受试者均接受光学相干断层扫描血管成像技术(OCTA) 检査,获得 视网膜浅层黄斑区血流密度及黄斑区FAZ 面积值。比较各组黄斑区血流密度及FAZ 面积,同时对糖尿病患者 不同性别、糖尿病病程、糖化血红蛋白、空腹血糖、餐后2 h 血糖、中医证型与黄斑区血流密度、FAZ 面积的 相关性进行分析。结果:糖尿病患者中男、女患者黄斑区血流密度、FAZ 面积比较,差异无统计学意义(P> 0.05)。不同病程的糖尿病患者的黄斑血流密度差异有统计学意义(P<0.05);两两比较,病程≥10 年者血流 密度低于病程<5 年者(P<0.05);病程5~10 年者血流密度与病程<5 年、病程≥10 年者比较,差异无统计 学意义(P>0.05);不同病程的患者FAZ 面积比较,差异均无统计学意义(P>0.05)。不同糖化血红蛋白水平 的糖尿病黄斑区血流密度、FAZ 面积差异有统计学意义(P<0.05);两两比较,糖化血红蛋白>9%患者黄斑 血流密度低于糖化血红蛋白水平<7%、7%~9%者(P<0.05),FAZ 面积大于<7%、7%~9%者(P<0.05); 糖化血红蛋白7%~9%者黄斑区血流密度低于糖化血红蛋白<7%者(P<0.05),FAZ 面积大于糖化血红蛋 白<7%者。糖尿病患者空腹血糖水平与黄斑区血流密度、FAZ 面积均不存在相关性(P>0.05)。不同中医证 型的糖尿病黄斑区血流密度、FAZ 面积差异有统计学意义(P<0.05);两两比较,气阴两虚证、阴阳两虚证患 者黄斑区血流密度低于痰湿内蕴证及阴虚内热证(P<0.05);气阴两虚证、阴阳两虚证FAZ 面积均大于痰湿 内蕴证、阴虚内热证(P<0.05),阴阳两虚证FAZ 面积大于气阴两虚证(P<0.05)。空腹血糖水平与黄斑血流 密度、FAZ 面积均不存在相关性(P>0.05);餐后2 h 血糖水平与黄斑血流密度存在负相关(P<0.05),与 FAZ 面积存在正相关(P<0.05)。糖尿病NPDR 组、糖尿病0 期组、对照组黄斑区血流密度、FAZ 面积组间差 异有统计学意义(P<0.05);两两比较,糖尿病NPDR 组、0 期组黄斑区血流密度均低于对照组(P<0.05), 糖尿病NPDR 组黄斑区血流密度值低于糖尿病0 期组(P<0.05);糖尿病NPDR 组FAZ 面积大于糖尿病0 期 组及对照组(P<0.05),糖尿病0 期组FAZ 面积与对照组比较,差异无统计学意义(P>0.05)。结论:糖尿病 无明显视力下降患者在其中心视力未受影响时,无论其眼底有无视网膜病变改变,其黄斑区血流密度及FAZ 面积都已出现有意义的改变,且随病情进展而加重;不同中医证型糖尿病无明显视力下降患者的黄斑区血流密 度及FAZ 面积具有差异性。

    Abstract:

    Abstract:Objective:To discuss the macular blood flow density of patients with no obvious sight loss caused by diabetes,the area changes of central foveal avascular zone (FAZ) and the change law of macular blood flow density of different traditional Chinese medicine (TCM) syndrome types. Methods: A total of 98 patients (192 eyes) with type II diabetes were collected and set as the diabetes group, which was further divided into two subgroups according to the results of fundus examination with VOLK lens + pre-set lens of 90D slit lamp, including the non- proliferative diabetic retinopathy (NPDR) group with 46 cases (91 eyes) with non-proliferative retinal microangiopathy,and the diabetes at stage 0 group with 52 cases (101 eyes) with no retinopathy;another 44 healthy persons were selected (84 eyes) as the control group. All enrolled subjects were given optical coherence tomography angiography (OCTA) examination to get the macular blood flow density of superficial retina and macular FAZ area. The macular blood flow density and FAZ area in each group were compared; the correlation of different gender, course of diabetes, glycosylated hemoglobin, fasting blood sugar, 2- hour postprandial blood glucose and TCM syndrome types with macular blood flow density and FAZ area of patients with diabetes was analyzed. Results:There was no significant difference being found in the comparisons of macular blood flow density and FAZ area between male and female patients with diabetes (P>0.05). Comparing the macular blood flow density of patients with diabetes of different courses, there was significant difference (P<0.05); in pairwise comparison, the blood flow density of patients with a course of ≥10 years was lower than that of those with a course<5 years (P<0.05); there was no significant difference being found in the comparison of blood flow density between patients with a course of 5-10 years and those with a course of<5 years and ≥ 10,respectively (P>0.05);there was no significant difference being found in the comparisons of average FAZ area between patients with different courses (P>0.05). There was significant difference being found in the comparisons of macular blood flow density and FAZ area between patients with diabetes of different levels of glycosylated hemoglobin (P<0.05);the pairwise comparison showed that the macular blood flow density of patients with levels of glycosylated hemoglobin of>9% was lower than that of patients with levels of glycosylated hemoglobin of<7% and 7%- 9% , respectively (P<0.05), and the FAZ area was bigger than that of patients with levels of glycosylated hemoglobin of<7% and 7%-9%,respectively (P< 0.05);the macular blood flow density of patients with levels of glycosylated hemoglobin of 7%- 9% was lower than that of patients with levels of glycosylated hemoglobin of<7% (P<0.05),and the FAZ area was bigger than that of patients with levels of glycosylated hemoglobin of<7%. There was significant difference in the comparisons of macular blood flow density and FAZ area between patients with diabetes of different TCM syndrome types (P<0.05);the pairwise comparison showed that the macular blood flow density of patients with syndrome of dual deficiency of qi and yin and syndrome of dual deficiency of yin and yang was lower than that of patients with syndrome of internal accumulation of phlegm- damp and syndrome of yin deficiency with internal heat (P<0.05);the FAZ area of patients with syndrome of dual deficiency of qi and yin and syndrome of dual deficiency of yin and yang was larger than that of patients with syndrome of internal accumulation of phlegm-damp and syndrome of yin deficiency with internal heat (P<0.05),and the FAZ area of patients with syndrome of dual deficiency of qi and yin was larger than that of patients with syndrome of dual deficiency of yin and yang (P<0.05). There was no correlation between the levels of fasting blood sugar and macular blood flow density and FAZ area of diabetic patients (P>0.05);there was a negative correlation between levels of 2hPBG and macular blood flow density (P<0.05) and a positive correlation with FAZ area (P<0.05). There was significant difference in the comparisons of macular blood flow density and FAZ area between the NPDR group, the diabetic at stage 0 group, and the control group (P<0.05); in the pairutse comparison, the macular blood flow density in the NPDR group and diabetes at stage 0 group was lower than that in the control group (P<0.05),and the macular blood flow density in the NPDR group was lower than that in the diabetes at stage 0 group (P<0.05);the FAZ area in the NPDR group was greater than that in the diabetes at stage 0 group and the control group (P<0.05),and there was no significant difference being found in the comparison of FAZ area between the diabetes at stage 0 group and the control group (P>0.05). Conclusion:Patients with no significant visual loss caused by diabetes had meaningful changes in macular blood flow density and FAZ area when their central vision was not affected, regardless of whether they had changes in retinopathy in the fundus, which worsens with disease progression; there was variability in macular blood flow density and detected FAZ area in patients without significant visual loss caused by diabetes of different TCM syndrome types.

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张梅珍,刘求红.糖尿病无明显视力下降患者黄斑区血流密度观察及中医证型研究[J].新中医,2023,55(18):54-60

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  • 在线发布日期: 2023-09-22
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