中华眼底病杂志

中华眼底病杂志

糖尿病视网膜病变的激光多普勒视网膜血流分析

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目的 观察激光多普勒视网膜血流分析在糖尿病视网膜病变中的应用价值。 方法 采用海德堡视网膜血流分析仪(HRF)对糖尿病患者108例216只眼及正常对照组32例64只眼进行检查,检测视盘旁视网膜的血流量、血流速度、红细胞移动速率。将糖尿病患者分为无视网膜病变的糖尿病患者(NDR)组和非增生性糖尿病视网膜病变(NPDR)组,其中NDR组27例54只眼;NPDR组共 81例162只眼,NPDR组又分为轻度NPDR组26例52只眼、中度NPDR组24例48只眼、重度NPDR组31例62只眼。同时对糖尿病患者及对照组部分人员行荧光素眼底血管造影(FFA),检测黄斑中心凹无血管区(FAZ)面积。对各组数据进行统计学分析。 结果 NDR组、NPDR组患者颞侧及鼻侧视盘旁视网膜血流参数均低于正常对照组,差异有统计学意义(Plt;0.05)。随视网膜病变程度的加重,NDR组及轻度NPDR组鼻侧及颞侧视盘旁视网膜的血流速度及红细胞移动速率呈上升趋势,至中度NPDR组达顶峰,随后下降,这种变化趋势以视网膜的血流速度表现更明显。中度NPDR组的颞侧和鼻侧视盘旁视网膜的血流量均高于其他3组,差异有统计学意义(Plt;0.01);中度NPDR组的颞侧和鼻侧视盘旁视网膜的血流速度、红细胞移动速率高于轻度NPDR组、NDR组,差异有统计学意义(Plt;0.01);重度NPDR组的颞侧视盘旁视网膜的血流速度、红细胞移动速率均高于NDR组,差异有统计学意义(P<0.01)。血糖值与视网膜病变程度呈显著正相关关系(r=0.172,P=0.046)。糖尿病患者FAZ面积与颞侧视盘旁视网膜的血流速度及红细胞移动速率呈显著正相关关系(r=0.268, P=0.000;r=0.275, P=0.000)。糖尿病患者FAZ面积与黄斑病变程度呈显著正相关关系(r=0.559,P=0.000)。 结论 HRF作为非侵入性的血流测量技术,对于揭示病变的机制、病变的程度及治疗的选择具有重要的价值。 (中华眼底病杂志,2007,23:256-259)

Objective To observe the effect of laser-Doppler retinal blood flowmeter in diabetic retinopathy. Methods The blood flow volume (VOL), the blood flow velocity (FLW) and the erythrocyte flow velocity (VEL) of peri-papillary retina were measured with the non-invasive Heidelberg Retinal Flowmeter (HRF) in 108 patients (216 eyes) with diabetes and 32 patients (64 eyes) in normal control group. The patients with diabetes were divided into non-diabetic retinopathy (NDR) group (27 patients, 54 eyes) and non-proliferative diabetic retinopathy (NPDR) group (81 patients, 162 eyes). NPDR group were subdivided into 3 groups: 26 patients (52 eyes) in mild group, 24 patients (48 eyes) in moderate group, and 31 patients (62 eyes) in severe group. The foveal avascular zone area (FAZ) was measured by fundus flourescein angiography (FFA) in patients with diabetes and some in the control group. The data in each group were statistically analyzed. Results The parameter of retinal blood flow of temporal and nasal peri-papillary retina in NDR and NPDR group was significantly lower than that in the control group (Plt;0.05). With the degree of retinopathy becoming more severe, the FLW and VEL of temporal and nasal peri-papillary retina in NDR and mild NPDR group presented ascending tendency, reached the peak in moderate NPDR group, and then decreased. The change tendency of the FLW was more obviously. The VOL of temporal and nasal peri-papillary retina in moderate NPDR group was obviously higher than that in the other groups (Plt;0.01).The FLW and the VEL of temporal and nasal peri-papillary retina in moderate NPDR group were significantly higher than that in mild NPDR and NDR group (Plt;0.01). The FLW and the VEL of temporal peri-papillary retina in severe NPDR group were obviously higher than that in NDR group (Plt;0.01). Blood sugar value positively correlated with degree of diabetic retinopathy (r=0.172,P=0.046). The FLW and the VEL of temporal peri-papillary retina positively correlated with FAZ area in patients with diabetes (r=0.268, P=0.000;r=0.275, P=0.000). The FAZ area positively correlated with the degree of macular degeneration in patients with diabetes (r=0.559, P=0.000). Conclusion As a non-invasive method for measurement of retinal blood flow, HRF has important value in revealing the mechanism and degree of pathological changes and choice of treatment for diabetic retinopathy. (Chin J Ocul Fundus Dis,2007,23:256-259) 

关键词: 糖尿病视网膜病变/超声检查; 血液流变学; 激光多普勒流量测定/利用

Key words: Dabetic retinopathy/ultrasonography; Hemorheology; Laser-Doppler Flowmetry/utilization

引用本文: 韩梅,陈松,陈莉明等. 糖尿病视网膜病变的激光多普勒视网膜血流分析. 中华眼底病杂志, 2007, 23(4): 256-259. doi: 复制

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