【作者】 李科军；

【导师】 李素芬； 张彤迪；

【作者基本信息】 河北医科大学 ， 眼科学， 2004， 硕士

【摘要】 目的：糖尿病是一种累及全身的血管性疾病，有关糖尿病视网膜病变（diabetic retinopathy,DR）已有诸多研究，而对占眼球血流90%的脉络膜循环改变观察甚少。本研究旨在对糖尿病患者的脉络膜循环及其供血血管进行系统性研究，探讨糖尿病患者脉络膜循环的改变及其与DR发生发展的关系，为临床上预防及早期治疗DR提供有价值的理论依据。方法1 将所有受试对象（包括糖尿病患者及正常对照组）进行常规内科及眼科检查，并详细询问其病史，患有其他系统性疾病及眼病者被排除此项研究。2 根据1984年第一届全国眼底病会议制定的“糖尿病视网膜病变分期标准”，同时结合眼底荧光血管造影(fundus fluorescein angiography,FFA）检查结果，将糖尿病患者的视网膜病变分为无糖尿病视网膜病变期（no diabetic retinopathy,NDR）、非增殖性糖尿病视网膜病变期（nonproliferative diabetic retinopathy,NPDR）、增殖性糖尿病视网膜病变期（proliferative diabetic retinopathy,PDR）三期。3 采用德国海德堡共焦激光眼底扫描系统（heidelberg retina angiograph, HRA）对所有糖尿病患者45例90眼及正常对照组20例40眼同步进行FFA及吲哚青绿血管造影<WP=4>(indocyanine green angiography,ICGA)，对比观察两种影像形态特征及视网膜脉络膜动脉充盈时间，从血流动力学角度阐述糖尿病患者脉络膜循环病变特点。4 采用彩色多普勒显像技术（color Doppler flow imaging,CDFI）检测糖尿病患者45例90眼及对照组15例30眼的眼动脉（ophthalmic artery,OA）颞侧睫状后动脉（posterior ciliary artery, PCA1）及鼻侧睫状后动脉(PCA2)，记录所有动脉的收缩期峰值血流速度（peak systolic velocities,PSV）舒张末期血流速度（end diastolic velocities,EDV）及阻力指数（resistive index,RI），利用统计学分析不同时期的糖尿病患者与对照组间球后血管血流动力学参数差异。5 将糖尿病患者吲哚青绿血管造影特征（脉络膜动脉充盈时间）与彩色多普勒血流参数联合分析，探讨糖尿病患者脉络膜病变特征。结果1 NDR、NPDR、PDR组患者视网膜中央动脉充盈时间分别为13.66±2.63s；13.58±2.75s；14.05±1.91s，与正常组（12.52±1.05s）相比无显著差异；各组脉络膜动脉充盈时间分别为：14.10±2.70s；14.78±3.39s；15.38±1.82s均较正常对照组（11.62±1.01s）减慢,且有显著性差异（p<0.05）。2 NDR组54%眼脉络膜动脉充盈时间较视网膜中央动脉（central retinal artery,CRA）充盈时间延长，即发生充盈倒置现象；23%眼脉络膜动脉与CRA几乎同时充盈；23%眼脉络膜动脉充盈时间较CRA充盈时间短。NPDR组74%<WP=5>眼发生充盈倒置；21%眼脉络膜动脉与CRA同时充盈；5%眼脉络膜动脉充盈时间早于CRA。PDR组中有85%眼发生充盈倒置；15%眼脉络膜动脉与CRA同时充盈。3 NDR组85%眼于造影早期出现脉络膜充盈不良，且持续至22.80±3.84s充盈完全，并且有54%眼在ICGA晚期（30min后）出现斑点状的强荧光渗漏；NPDR组95%眼出现造影早期脉络膜充盈不良，持续至31.74±4.80s完全充盈，并有84%眼在造影晚期出现斑点状强荧光；PDR组所有眼在造影早期出现脉络膜充盈不良，持续至36.56±4.62s完全充盈，且有92%眼出现晚期斑点状强荧光。4 OA：NDR组PSV为27.96±6.34cm/s，EDV为6.91±2.20cm/s，比对照组（PSV为31.12±8.28cm/s，EDV为9.18±3.62cm/s）降低，但PSV相比于对照组无显著差异(P=0.11)，而EDV明显降低(P﹤0.05)，其RI为0.75±0.04，较对照组0.71±0.04明显升高(P<0.01)。NPDR组PSV为25.62±6.85cm/s，EDV为6.73±2.81cm/s, RI为0.76±0.06，与正常对照组相比均有显著差异（P均小于0.05），而与NDR相比无明显变化。PDR组的PSV为21.96±5.71cm/s，EDV为5.09±2.80cm/s，较正常对照组NDR、NPDR组均明显降低（P﹤0.01），RI为0.79±0.06，均较其它组明显升高（P﹤0.01）。5 PCA1：NDR组的PSV为11.66±4.50cm/s，EDV为3.18±1.55cm/s，RI为0.73±0.05，较正常对照组（PSV：13.59±2.81cm/s，EDV：4.53±1.56cm/s ，RI：0.67±0.07）均有显著差异（P﹤0.05）。NPDR组PSV为11.50±3.87cm/s，EDV为3.42±1.24cm/s，RI为0.71±0.05，较正常对照组有<WP=6>明显差异（P﹤0.05），而与NDR组相比显著变化。PDR组PSV为9.23±2.07cm/s，EDV为2.22±0.48cm/s，较正常对照组、NDR、NPDR组均降低，且具有显著差异（P均小于0.01），而RI为0.77±0.05，较其它各组都明显升高（P均小于0.01）。6 PCA2：NDR组PSV为11.37±3.44cm/s，EDV为3.4±1.11cm/s，RI为0.70±0.05，较正常对照组（PSV为13.57±4.33cm/s，EDV为4.77±1.56cm/s，RI为0.66±0.07），较正常对照组均有明显差异（P<0.05）。NPDR组PSV为10.99±4.17cm/s，EDV为3.31±1.20cm/s，RI为0.69±0.06，较正常对照组有显著差异（P﹤0.05），而与NDR组相比无显著差异。PDR组PSV为8.72±2.24cm/s，EDV为2.29±0.60cm/s，较正常NDR、NPDR组均显著下降（P均﹤0.05），RI为0.74±0.06，较其它各组明显升高（P﹤0.05）。7 臂-脉络膜动脉循环时间与PCA血流动力学相关因素分析:臂-脉络膜动脉充盈时间更多还原

【Abstract】 Purpose: Diabetes mellitus (DM) is a sort of vascular disease affect general body. Diabetic Retinopathy (DR) was studied by many researchers, but the choroids were also influenced. This study was designed to investigate Diabetic choroidopathy and the relationship of diabetic choroidopathy with DR, in order to provide valuable theories for preventing and treating DR and make compensation for the ocular disease of DM.Method1 All subjects (DMs and controls ) were examined by physicists and oculists, some are excluded for their general disease and other ocular disease.2 According to the “the deviation standard of DR” and the results of FFA , Diabetes patients were divided into no diabetic retinopathy (NDR), nonproliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR).3 All subjects were examined by fundus fluorecein angiography(FFA), indocyaine green angiography(ICGA) technique at the same time ,observe two type of angiography results and analysis the images of patients in 3 groups ,in order to evaluate the diabetic choroidapathy. <WP=9>4 Color doppler flow imaging (CDFI) was use to quantitate peak systolic velocity (PSV), end diastolic velocity (EDV) and resistence index (RI) of the ophthalmic artery (OA), the temporal posterior ciliary artery (PCA1), and nasal posterior ciliary artery (PCA2), in the control group and DM patients; using statistic software to analysis the hemodynamic parameters.5 Combining the ICG images and hemodynamic parameters to investigate the progression of piapetic choroidapathy.Results1 The CRA filling time of NDR,NPDR,PDR were 13.66±2.63s,13.58±2.75s,14.05±1.91s and there were no significant difference between DR and control group. The choroid filling time of NDR,NPDR,PDR were 14.10±2.70s,14.78±3.39s,15.38±1.82s and there were significant increase in 3 group compared to the control group.2 Choroid filling time of 54% NDR eyes were longer than the CRA filling time, 23% eyes’ choroid filling time were similar to the CRA filling time, and the other 23% eyes’ choroid filling time were shorter than the CRA filling time. Choroid filling time of 74% NDR eyes were longer than the CRA filling time, 21% eyes’choroid filling time were similar to the CRA filling time, and the other 5% eyes’ choroid filling time were shorter than the CRA filling time. Choroid filling time of 85% NDR eyes were longer than the CRA filling time, <WP=10>2% eyes’ choroid filling time were similar to the CRA filling time.3 Lobular delayed choroidal perfusion were observed in 85% NDR eyes at early angiographic sign, and the lobular perfusion were disappeared at 22.80±3.84s; 54% eyes had the appearance of lobular spotty hyperfluorescent and hypofluorescent areas(“salt and pepper” appearance) in late phase. Lobular delayed choroidal perfusion were observed in 95% NPDR eyes at early angiographic sign, and the lobular perfusion were disappeared at 31.74±4.80s; 54% eyes had the appearance of lobular spotty hyperfluorescent and hypofluorescent areas(“salt and pepper” appearance) in late phase. Lobular delayed choroidal perfusion were observed in all the PDR eyes at early angiographic sign, and the lobular perfusion were disappeared at 22.80±3.84s; 92% eyes had the appearance of lobular spotty hyperfluorescent and hypofluorescent areas(“salt and pepper” appearance) in late phase.4 OA: There was a significant decrease of EDV (6.91±2.20cm/s) in the NDR group compared to the control group(EDV:9.18±3.62cm/s)(p<0.05),but there was no significant decrease in PSV(27.96±6.34cm/s) in the NDR group compared to the control group (PSV:31.12±8.28cm/s). (p=0.11).There was a significant decrease in both PSV (25.62±6.85cm/s) and EDV (6.73±2.81cm/s) in the NPDR group compared to the control group (PSV:31.12±8.28cm/s, <WP=11>EDV:9.18±3.62cm/s) (P<0.05),and there was no significant decease in NPDR group compared to NDR group. There was a significant decrease in both PSV(21.96±5.71cm/s) and EDV(5.09±2.80cm/s) in the PDR group compared to the control group, NDR group,更多还原