糖尿病性视网膜病变图像黄斑水肿等级自动分析方法

糖尿病性黄斑水肿（DME）可以出现在糖尿病性视网膜病变（DR）的任何阶段,是导致糖尿病患者视力损伤的主要原因,因此DME自动分析是DR筛查的关键内容。依据DME国际临床分级标准,通过检测并判断硬性渗出（HEs）是否接近或涉及黄斑中心,可对眼底图像进行DME等级的自动分析。HEs检测选择基于现有的数学形态学方法的综合改进;黄斑中心定位则引入定向局部对比度滤波结合局部血管密度的新方法,可同步确定并去除视盘区域,以消除对HEs检测的影响,其中血管密度仅需提取粗血管网络。经开放的HEI MED数据集中169幅眼底图像的测试,HEs检测在图像水平上获得100%敏感性和922%特异性;黄斑中心定位正确率982%;各DME等级评价正确率均在88%以上,具有重要的临床参考和应用价值。     

糖尿病视网膜病变图像数据库建立及应用

目的评价基于糖尿病视网膜病变(DR)图像数据库的临床应用技术,探讨其在临床DR早期诊断中的作用。方法采集1100例DR患者的眼底图像,经过初选和归纳分析后选择300只眼,建立微型DR图像数据库及应用软件技术。对100例糖尿病患者的眼底照相和荧光素眼底血管造影(FFA)检查图像进行人工直接诊断,并进行基于DR图像数据库技术的虚拟FFA诊断,对两者各层诊断符合情况进行统计分析,确定其诊断一致性。结果在DR患者不同分期的层次中,FFA检查诊断相符程度均大于80%,人工直接诊断和虚拟FFA诊断的总符合率为90%。结论虚拟FFA诊断与DR眼底照相诊断有较高的一致性,该图像数据库的建立和应用技术可指导和规范临床DR的早期诊疗,也为有创性FFA检查在DR诊治中合理应用提供依据和参考。     

初探糖尿病视网膜病变与糖尿病肾病的相关性

目的:分析糖尿病视网膜病变(DR)与糖尿病肾病(DN)之间的关系。方法:对236例二型糖尿病患者进行荧光素眼底血管造影(FFA)和12小时尿白蛋白排泄率(AER)的检查,根据眼底改变将病人分为三组,计算各组患者并发糖尿病肾病的比例,并做尿白蛋白排泄率与DR眼底改变的相关性分析。结果:DR临床前期组的病人中有5%并发DN,DR非增殖期组的病人中有42%并发DN,DR增殖期组的病人中有71%并发DN;AER与DR的眼底改变呈显著的正相关性。结论:糖尿病视网膜病变和糖尿病肾病临床表现密切相关,呈平行发展关系。     

糖尿病视网膜病变相关基因多态性的研究进展

糖尿病视网膜病变是目前国际上最主要的致盲性眼病之一,患病率日渐升高.其发生和发展与血糖水平、糖尿病病程、环境及遗传等多种因素有关.近些年来,随着基因多态性与糖尿病视网膜病变关系的研究不断深入和进展,已经筛选出了可能与之相关的数十 种基因,其中几种基因多态性已经被证实为糖尿病视网膜病变发生的独立危险因素.现将与糖尿病视网膜病变密切相关的基因多态性研究进展作一综述.     

IL-18与糖尿病及糖尿病视网膜病变的研究进展

IL-18是近年发现的一种新型的白介素家族成员,它是生物活性最强、作用最持久的细胞因子,参与机体免疫调节的许多方面。IL-18作为一种前炎症细胞因子,导致Th1/Th2细胞因子失平衡及胰岛β细胞凋亡而与糖尿病（DM）的发生、发展相联系,并且通过多种机制影响糖尿病的大血管病变和微血管病变的发生。糖尿病视网膜病变（DR）是糖尿病微血管病变的严重并发症,其发生、发展受多种因素如细胞因子的影响。现有的研究表明DR是一个多基因多步骤疾病,目前其发病的分子机理不清。IL-18在糖尿病和糖尿病视网膜病变发生和发展中的作用被广泛关注并成为研究的热点。本文就IL-18的生物学特性和其在DM和DR的发生、发展中所起作用的研究进展进行综述。     

糖尿病视网膜病变患者瘦素水平的变化

目的 :探讨糖尿病视网膜病变患者血清瘦素水平变化规律。方法 :受试对象 12 0例 ,分为对照组 30例 (男 18,女 12 )、糖尿病无视网膜病变组 30例 (男 18,女 12 ) ,非增殖性视网膜病变组 30例 (男 18,女 12 )及增殖性视网膜病变组 30例 (男 18,女 12 ) ,检测血清瘦素、胰岛素、Ⅳ型胶原及血糖浓度 ,分析瘦素水平与其它指标的相关性。结果 :对照组、无视网膜病变组、NPDR组及PDR组血清瘦素浓度分别为 6 91± 1 87μg/L ,7 83± 2 11μg/L ,9 5 6± 2 4 3μg/L和 11 6 9± 2 5 7μg/L ,经协方差分析排除体重指数的影响 ,PDR组血清瘦素浓度高于NPDR组 (t=2 15 ,p<0 0 5 )、无视网膜病变组 (t=2 71,p <0 0 1)及对照组 (t =3 5 0 ,p <0 0 0 1) ;NPDR组高于无视网膜病变组 (t=2 2 3,p <0 0 5 )及对照组 (t=2 75 ,p<0 0 1)。血清瘦素浓度与体重指数、胰岛素呈正相关 (r=0 2 2 ,p <0 0 5 ;r=0 2 8,p<0 0 1)。结论 :糖尿病视网膜病变患者血清瘦素浓度升高 ,且增高的幅度与病情的严重程度正相关     

糖尿病视网膜病变的血液流变学改变

糖尿病是一种内分泌代谢紊乱性疾病 ,视网膜病变（ＤＲ）是其严重的并发症之一。ＤＲ可导致视力减退甚至失明 ,故临床定期眼底检查是极其必要的。从临床病例研究发现 ,糖尿病患者的血液流变学的改变直接影响了ＤＲ的发生及发展。１材料与方法１．１研究对象 :自１９９５年１月起我院对１２１例Ⅱ型糖尿病患者分三个时期进行眼底检查和血液流变学检测（ＤＲ的分期标准遵照１９８５年全国眼科学术会议通过的《糖尿病视网膜病变分期标准草案》） ,发现有５８例发生ＤＲ ,我们从中选出血液流变学呈进行性改变的ＤＲ患者４０例为ＤＲ组 ,其中男２…     

糖尿病性视网膜病变的发病机制

糖尿病性视网膜病变（ＤＲ）是糖尿病的主要微血管病变之一，是糖尿病微血管病变在眼底独特环境中的表现，受全身代谢、内分泌、血液因素、眼部情况及新生血管生长因子等影响，由于激光光凝疗法和玻璃体切割等手术方法的改进使增殖性视网膜病变致盲的危险性明显减少，但这些疗法均可使视网膜受到严重损害或带来其它方面的危险，因此早期治疗和预防糖尿病视网膜病变的意义重大，为此本文从防患于未然的角度探讨ＤＲ的发病机制。     

Early diagnosis of diabetic retinopathy in primary care

Objective:

To evaluate the impact of a strategy for early detection of diabetic retinopathy in patients with type 2 diabetes mellitus (DMT2) in Quintana Roo, México.

Methods:

Study transversal, observational, prospective, analytical, eight primary care units from Mexican Social Security Institute in the northern delegation of the State of Quintana Roo, Mexico were included. A program for early detection of diabetic retinopathy (DR) in adult 376,169 was designed. Were diagnosed 683 cases of type 2 diabetes, in 105 patients randomized was conducted to direct ophthalmoscopy were subjected to a secondary hospital were assigned. Will determine the degree of diabetic retinopathy and macular edema was performed.

Results:

In population were 55.2% female, mean age 48+11.1 years, 23.8 % had some degree of DR, 28.0% with mild non- proliferative diabetic retinopathy 48.0 % moderate 16.0% and severe and 8.0% showed proliferative diabetic retinopathy. Those over age 30 are 2.8 times more risk of developing DR, OR= 2.8; 95%CI: 0.42-18.0, and OR= 1.7; 95%CI: 1.02-2.95 women.

Conclusions:

The implementation of programs aimed at the early detection of debilitating conditions such as diabetic retinopathy health impact beneficiaries, effective links between primary care systems and provide second level positive health outcomes for patient diseases.     

1526名广州市公务员体检糖尿病视网膜病变的现况

目的对体检公务员患糖尿病视网膜病变的情况进行分析,为临床防治提供依据。方法以2012年1-6月在广东省人民医院进行体检的1526名公务员为研究对象,调查内容包括基本情况、相关病史资料、相关实验室检查,并进行常规眼科检查等。结果研究对象的糖尿病患病率为15.66%（239/1526）,并发糖尿病视网膜病变的患病率为32.64%（78/239）。糖尿病视网膜病变的患病率在不同性别和不同年龄段之间差异无统计学意义（P〉0.05）。糖尿病视网膜病变组与非糖尿病视网膜病变的糖尿病组的身高、体重、空腹血糖、糖化血红蛋白、甘油三脂、高密度脂蛋白、低密度脂蛋白比较差异无统计学意义（P〉0.05）,而两组间的病程、收缩压、舒张压、餐后2h血糖、总胆固醇、血肌酐、尿素氮比较差异具有统计学意义（P〈0.05）。结论该研究人群糖尿病视网膜病变患病率高,糖尿病视网膜病变患者同时患高血压、高胆固醇、肾功能异常等全身异常的几率大。     

Increased protein carbonylation of red blood cell membrane in diabetic retinopathy

We investigated the protein carbonylation of red blood cell (RBC) membrane in type 2 diabetic patients and the potential implication of carbonyl/oxidative stress in reflecting disease severity. Sixty-four diabetic patients with or without retinopathy of variable clinical severity (Groups DR and DM, respectively) and 20 healthy controls were included in the study. Protein carbonyls were determined in RBC membranes by immunoblotting. Compared to healthy volunteers, the RBC membranes of diabetic patients were characterized by significantly increased levels of carbonylated proteins. The carbonylation of Group DR was higher compared to that of Group DM. The subgroup of patients with proliferative retinopathy exhibited a trend towards a significant increase in protein carbonyls, compared to both free-of-retinopathy diabetic cases and non-proliferative diabetic retinopathy cases. The correlation between the chemical modifications of the erythrocyte membrane proteins and the clinical severity of diabetic retinopathy suggests a potential utility of membrane carbonylation as a marker and risk factor in the development of retinopathy.     

糖尿病视网膜病变黄斑拱环形态改变的临床研究

目的客观评价糖尿病视网膜病变（DR）患者黄斑拱环结构改变的形态特征,总结黄斑拱环形态变化、荧光渗漏及黄斑区视网膜厚度对视力的影响因素。方法患者按有无眼底改变分为3组,糖尿病视网膜病变组（DR组）38例65只眼,2型糖尿病无DR眼底改变组（非DR组）16例29只眼,正常组17例33眼。三组病例均先行眼底荧光素血管造影（FFA）检查,后行光学相干断层扫描（OCT）眼底黄斑部放射状扫描检查。结果三组之间黄斑拱环形态变化比较,有显著差异（P=0．0003）,黄斑中心1mm直径视网膜厚度有显著差异（P=0．0007）。DR组患者拱环形态与荧光渗漏程度显著相关（P=0．0003）,黄斑拱环形态与黄斑中心1mm直径视网膜厚度显著相关（P=0．0063）,荧光渗漏程度与黄斑中心1mm直径视网膜厚度显著相关（P=0．0046）。DR组患者黄斑拱环形态、荧光渗漏和黄斑中心1mm直径视网膜厚度变化与最佳矫正视力无相关性（P=0．076,P=0．067,P=0．128）。结论DR患者黄斑拱环形态改变、渗漏程度及黄斑中心视网膜厚度是相互影响和互为因果,黄斑拱环形态变化特征为进一步选择和调整治疗手段提供了准确依据。     

Determination of foveal avascular zone in diabetic retinopathy digital fundus images

Monitoring FAZ area enlargement enables physicians to monitor progression of the DR. At present, it is difficult to discern the FAZ area and to measure its enlargement in an objective manner using digital fundus images. A semi-automated approach for determination of FAZ using color images has been developed. Here, a binary map of retinal blood vessels is computer generated from the digital fundus image to determine vessel ends and pathologies surrounding FAZ for area analysis. The proposed method is found to achieve accuracies from 66.67% to 98.69% compared to accuracies of 18.13-95.07% obtained by manual segmentation of FAZ regions from digital fundus images.     

Intraocular matrix metalloproteinase 2 and 9 in patients with diabetes mellitus with and without diabetic retinopathy

Introduction

We aimed to investigate activities of metalloproteinases 2 (MMP-2) and MMP-9 in aqueous humour of patients with diabetes mellitus with various stages of diabetic retinopathy.

Material and methods

We included 36 samples of aqueous humour of patients suffering from diabetes mellitus, undergoing routine cataract surgery. Seven of them suffered from proliferative diabetic retinopathy (PDR), 3 had diabetic maculopathy and the remaining 26 had background or minimal background retinopathy only. Metalloproteinases 2 and MMP-9 activities in aqueous humour were measured by gelatin zymography combined with the densitometric imaging system. Total protein content in aqueous humour samples was also assessed.

Results

Metalloproteinases 2 activities were present in almost all samples of aqueous humour (32 of 36) and were 2.6-fold higher in patients who suffered from diabetic ocular complications (p < 0.0001). Activities of MMP-2 correlated well with the duration of the disease (correlation = 0.37, p = 0.03) and tended to correlate with total protein levels in aqueous humour (correlation = 0.43, p = 0.06). Metalloproteinases 9 activities were observed only in 2 of 7 patients with proliferative diabetic disease and the enzyme was absent from aqueous humour samples of patients without proliferative retinopathy.

Conclusions

Increased activities of MMP-2 in aqueous humour of patients with PDR may be related to the disease process and support the hypothesis that MMP-2 may be of particular importance in diabetic retinal neovascularization. MMP-9 may be activated at a certain disease stage only.     

Progress towards automated diabetic ocular screening: A review of image analysis and intelligent systems for diabetic retinopathy

Patients with diabetes require annual screening for effective timing of sight-saving treatment. However, the lack of screening and the shortage of ophthalmologists limit the ocular health care available. This is stimulating research into automated analysis of the reflectance images of the ocular fundus. Publications applicable to the automated screening of diabetic retinopathy are summarised. The review has been structured to mimic some of the processes that an ophthalmologist performs when examining the retina. Thus image processing tasks, such as vessel and lesion location, are reviewed before any intelligent or automated systems. Most research has been undertaken in identification of the retinal vasculature and analysis of early pathological changes. Progress has been made in the identification of the retinal vasculature and the more common pathological features, such as small aneurysms and exudates. Ancillary research into image preprocessing has also been identified. In summary, the advent of digital data sets has made image analysis more accessible, although questions regarding the assessment of individual algorithms and whole systems are only just being addressed.     

基于Gabor滤波器的糖尿病视网膜新生血管检测

目的:采用Gabor滤波器实现眼底图像中新生血管检测,帮助医生准确确定糖尿病视网膜病变的分期。 方法:对眼底图像进行预处理,并使用不同尺度参数和方向参数Gabor滤波器作用于预处理图像,并在尺度参数确定的情况下取各方向输出结果的最大值作为最后Gabor滤波器的输出。 结果:对比分析不同尺度参数的Gabor滤波器的结果,发现小尺度参数的Gabor滤波器在新生血管部分具有较强的输出。 结论:本研究提出的Gabor滤波器可以很好地区分眼底图像中正常血管与新生血管结构。     

Regional analysis of diabetic retinopathy and co-existing social and demographic factors in the overall population of Poland

IntroductionThe aim of our study was to analyse the regional differences in diabetic retinopathy (DR) prevalence and its co-existing social and demographic factors in the overall population of Poland in the year 2017.Material and methodsData from all levels of healthcare services at public and private institutions recorded in the National Health Fund database were evaluated. International Classification of Diseases codes were used to identify patients with type 1 and type 2 diabetes mellitus (DM) and with DR. Moran’s I statistics and Spatial Autoregressive (SAR) model allowed us to understand the distribution of DR prevalence and its possible association with environmental and demographic exposures.ResultsIn total, 310,815 individuals with diabetic retinopathy (DR) were diagnosed in the year 2017 in Poland. Of them, 174,384 (56.11%) were women, 221,144 (71.15%) lived in urban areas, and 40,231 (12.94%) and 270,584 (87.06%) had type 1 and type 2 DM, respectively. The analysis of the SAR model showed that the significant factors for the occurrence of DR in particular counties were a higher level of average income and a higher number of ophthalmologic consultations per 10,000 adults.ConclusionsThe analyses of social, demographic, and systemic factors co-existing with DR revealed that level of income and access to ophthalmologic and diabetic services are crucial in DR prevalence in Poland.