糖尿病性黄斑水肿与肾小球滤过率的相关性

目的：观察2型糖尿病患者肾小球滤过率(eGFR)与糖尿病性黄斑水肿(DME)之间的关系。

方法：选取2015-05/2017-05抚顺市眼病医院糖尿病眼病专科门诊在社区筛查的2型糖尿病患者912例,进行眼底照相、空腹血糖、糖化血红蛋白、肾功能等检查,应用我国eGFR课题协作组改良的简化MDRD方程估算eGFR。

结果：选取的912例2型糖尿病患者中无DME、轻度DME、中度DME、重度DME患者分别为815例、29例、21例、47例,随着DME病情的加重,患者eGFR逐渐降低(F=8.87,P<0.001)。Logistic回归分析显示,eGFR降低是DME发生的危险因素,且eGFR每下降20.3mL/(min·1.73m²)(1个标准差),发生DME的风险增加1.84倍,肾功能受损及肾功能不全者发生DME的风险是肾功能正常者的1.60及2.46倍。

结论：eGFR为DME发生的危险因素,与DME严重程度相关,临床治疗中应关注DME患者肾功能情况。     

血清脂蛋白比值与糖尿病黄斑水肿发生及严重程度的相关性分析

目的 探讨血清脂蛋白比值（ApoB/ApoA-1）与糖尿病黄斑水肿（diabetic macular edema,DME）的发生及进展关系。设计 回顾性病例系列。研究对象 2016年3月至2018年3月重庆渝北区医院眼科和内科住院的糖尿病视网膜病变（diabetic retinopathy,DR）患者279例,其中DME患者82例。方法 对279例DR住院患者进行眼底检查和黄斑相干光断层扫描（optic coherence tomography,OCT）,发现DME患者82例设为病例组（DME组）, 其余197例设为阳性对照组（非DME组）,并设立健康对照组80例。82例DME患者再根据黄斑水肿程度,分为轻度（Ⅰ组）、中度（Ⅱ组）和重度组（Ⅲ组）。收集研究对象的身高、体重、糖化血红蛋白,及ApoB和ApoA-1等血脂指标,并计算体质指数、ApoB/ApoA-1比值。比较各组相关指标的差异。主要指标 体质指数,糖化血红蛋白浓度,ApoB/ApoA-1比值和黄斑水肿分级。结果 DME组、非DME组及健康对照组的体质指数、糖化血红蛋白、ApoB/ApoA-1比值的差异均有统计学意义（P均<0.001）;轻、中、重度DME患者的ApoB/ApoA-1比值分别为1.01±0.07、1.18±0.04和1.32±0.08（F=142.04,P<0.001）。偏相关性分析排除混杂因素影响后,DME的严重程度与ApoB/ApoA-1比值成正相关（r=0.725 ,P<0.001）。结论 血清脂蛋白比值增高是DME病情发生及进展的高危因素,合理控制血脂可能有利于降低DME的发病风险,ApoB/ApoA-1比值可以作为DME预测及治疗过程中的重要监控指标。     

糖尿病视网膜病变中黄斑水肿的临床研究

糖尿病视网膜病变（DR）是糖尿病的严重并发症之一，而糖尿病视网膜病变黄斑水肿（DME）是DR的组成部分，同时也是影响视力的重要原因，目前我国的糖尿病视网膜病变（DR）的分期标准，未将黄斑水肿进行分级。现就我院自2000—2005年在眼科门诊确诊为DR并进行荧光素眼底血管造影的500例病例资料进行回顾性分析，探讨DME与糖尿病分期的关系。     

糖尿病黄斑水肿患者病变程度与脉络膜厚度的关系

目的　利用频域光学相干断层扫描深度增强（enhanced depth imaging spectral domain optical coherence tomography，EDI SD-OCT）观察糖尿病黄斑水肿（diabetic macular edema，DME）患者脉络膜厚度（choroidal thickness，CT）的变化及结构特点，探讨DME病变程度与CT的关系。方法　纳入2型糖尿病患者共123例204眼，其中69眼诊断为DME（DME组），135眼无黄斑水肿为对照组。DME眼依据OCT形态学特点进一步分为视网膜弥漫性增厚（diffuse retinal thickness，DRT）型（34眼）、黄斑囊样水肿（cystoid macular edema，CME）型（19眼）和浆液性视网膜脱离（serous retinal detachment，SRD）型（16眼），利用EDI-OCT分别测量黄斑中心凹下CT和以黄斑为中心上、下、鼻、颞500 μm、1000 μm、1500 μm、2000 μm处CT。结果　DME组黄斑中心凹下CT为（326.72±90.15）μm，对照组为（320.17±106.46）μm，两组之间无统计学差异，但黄斑中心凹下CT与视网膜厚度间具有明显正相关关系（r=0.270，P=0.025）。DME亚型CT分别为:DRT型（303.94±81.47）μm、CME型（304.42±73.98）μm和SRD型（401.63±88.80）μm，SRD型CT明显高于其他亚型（P<0.05），此外，SRD型的周边CT同样呈现均匀一致的增厚；鼻侧CT从500 μm至2000 μm呈距离敏感性降低（P<0.05），但SRD型鼻侧CT降低幅度明显变缓（P=0.195）。结论　SRD型黄斑水肿患者CT在中心凹下及周边部均显著增厚，CT与DME病变程度之间有一定相关性。     

糖尿病视网膜病变黄斑水肿的临床分析

目的 探讨糖尿病视网膜病变黄斑水肿（diabetic macular edema ,DME）分型与糖尿病视网膜病变(diabetic retinopathy, DR)分期、糖尿病病程以及视力损害之间的关系。 方法 回顾分析1 521例荧光素眼底血管造影(fundus fluorescein angiography，FFA )检查确诊的DR患者的FFA检查结果、病程、视力等临床资料。根据我国现行的DR诊断、分期标准对DR进行分期，按美国糖尿病视网膜病变早期治疗研究小组制定的标准对DME进行分型，分析统计各期DR中DME的发生率以及DME与病程、视力的关系。 结果 1521例患者中，468例791只眼存在DME，占30.77%。DME主要发生在糖尿病病程10年的患者，在此期间，DME 的发生率以及严重程度有逐年上升和加重的趋势。DME中黄斑局限性水肿361只眼，占DME患 者的45.64%；黄斑弥漫性水肿430只眼，占DME患者的54.36%。DME在DR I期中占1.13%；III 期中占7.84%；III期中占41.98%；IV期中占48.93%。V、VI期中，由于视网膜增生、玻璃体积血或者其他并发症的出现使DME的发现率较低。黄斑局限性水肿在DRIII期中居多，占22.51 % ，黄斑弥漫性水肿在DRIV期居多，占31.48%。但有部分患眼在DRI期出现了黄斑弥漫性水肿，而部分患眼在DR IV～V 期仍仅有局限性黄斑水肿。黄斑弥漫性水肿较局限性水肿对视力的损害更重。 结论 DME是DR引起视力损害的重要原因之一，随着糖尿病病程的延长，DME 的发生率增加，程度加重。DME的发生和分型与DR的程度有一定关系，但在时序上与我国现行的DR分期标准之间没有严格对应一致的关系。 （中华眼底病杂志，2003，19：83-86）     

激光治疗糖尿病黄斑水肿的预后影响因素

目的:分析影响激光光凝治疗糖尿病黄斑水肿(DME)疗效的影响因素。方法:回顾分析本院80例80眼经532激光局部/格栅治疗的2型糖尿病并发糖尿病黄斑水肿患者的临床资料。结果:Logistic回归分析,有3个危险因素对糖尿病黄斑水肿激光治疗预后的影响有统计学意义(P<0.05),分别为糖化血红蛋白(HbA1c)、高血脂及DME分型。结论:糖尿病黄斑水肿激光治疗预后与糖化血红蛋白(HbA1c)水平、高血脂及DME分型有关。     

影响2型糖尿病患者黄斑水肿的全身相关危险因素分析

糖尿病视网膜病变（DR）是糖尿病的严重并发症之一。糖尿病黄斑水肿（DME）是引起糖尿病患者视力下降的重要原因。全身系统的物质代谢和功能异常将导致或加速DME的发生和发展Ⅲ。我们对359例2型糖尿病（T2DM）患者的临床资料进行了回顾性分析，以探讨影响DME的全身相关因素。     

玻璃体腔注射雷珠单抗治疗糖尿病黄斑水肿与视网膜静脉阻塞性黄斑水肿的疗效对比

目的观察对比玻璃体腔注射雷珠单抗治疗糖尿病黄斑水肿（DME）与视网膜静脉阻塞性黄斑水肿（RVO-ME）的疗效。方法2013年5月至2014年12月在安徽医科大学第一附属医院眼科门诊确诊为DME 及RVO-ME的患者,共26例（33只眼）,其中DME 17只眼,RVO-ME 16只眼。患眼接受玻璃体腔注射雷珠单抗（0．5 mg／0．05 ml）治疗,治疗前和治疗后1 d、2周、4周定期门诊回访观察最佳矫正视力（BCVA）及中央黄斑厚度（CST）。比较雷珠单抗治疗两组治疗前和治疗后的BCVA及CST改变情况。结果 DME组与RVO-ME组治疗后1 d、2周、4周的BCVA均较治疗前明显提高,差异均有统计学意义（P ＜0．05）。DME组与RVO-ME组治疗后4周的CST均较治疗前明显改善,差异均有统计学意义（P ＜0．05）。DME组与RVO-ME组之间在BCVA及CST方面比较,差异均无统计学意义（P ＞0．05）。结论玻璃体腔注射雷珠单抗治疗DME及RVO-ME均可减轻黄斑水肿和改善视力,两者治疗效果无明显差异。     

不同OCT分型糖尿病黄斑水肿发病的影响因素分析

目的 探讨2型糖尿病患者不同光学相干断层成像(OCT)分型糖尿病黄斑水肿(DME)发病的影响因素。方法 选取2019年1月至2021年12月天津市第三中心医院内分泌科确诊为2型糖尿病合并DME的患者117例117眼作为研究对象。由2位经验丰富的眼科医师依据患者OCT的黄斑区横断面图像对DME进行分型：弥漫性视网膜增厚(DRT)型、黄斑囊样水肿(CME)型、神经上皮脱离(NSD)型，如果患者双眼分型不一致，则取表现最为显著眼作为研究对象。收集患者年龄、病程(患者首次诊断糖尿病为起始时间)、体重指数(BMI)、入院后首次收缩压和舒张压、入院后首次空腹取外周血所得糖化血红蛋白(HbA1c)、随机尿白蛋白尿肌酐比值(UACR)、肾小球滤过率估算值(eGFR)、胱抑素C浓度(SCysC)等指标信息。分析不同DME分型与各指标的相关性并行无序多分类Logistic回归分析。结果 117例DME患者中DRT型患者53例，CME型和NSD型患者各32例。NSD并Spearman相关分析结果显示：不同DME分型与收缩压、舒张压、UACR、SCysC均呈正相关(r=0.377、0.297、0.670、0....     

房水中白细胞介素-6浓度与糖尿病黄斑水肿的相关性研究

目的本研究主要观察房水中白细胞介素-6（inter-leukin-6，IL-6）浓度与糖尿病黄斑水肿（diabetic macular edema，DME）严重程度的关系。方法对接受白内障超声乳化及人工晶状体植入术的非增生性糖尿病视网膜病变患者57例65眼行回顾性研究，术前获得房水样本，采用酶联免疫法检测房水中IL-6质量浓度，同时对可能影响DME的因素进行统计学分析。结果65眼房水中IL-6浓度为12．17-327．99 μg· L^-1（平均为62．44 μg· L^-1）。多因素Logistic回归分析发现，房水中IL-6浓度增高，糖尿病患者并发临床意义的黄斑水肿可能性增大。回归方程为Y=EXP（5．49—4．16×X6），P〈0．01。房水中IL-6浓度与DME严重程度显著相关（r=0．63，P〈0.01），并且随着房水中IL-6浓度增加。DME严重程度增加。结论房水中IL-6的浓度与DME的严重程度有关，并且随着IL-6浓度的增加。DME的严重程度也增加。[眼科新进展2007；27（3）：198-200]     

Plasma Homocysteine is Associated with Retinopathy in Type 1 Diabetic Patients in the Absence of Nephropathy

Introduction: Previous cross-sectional studies suggested that plasma total homocysteine (tHcy) is associated with retinopathy in patients with type 1 diabetes (T1DM) only in cases of impaired renal function. The objective of this study was to examine whether there is an independent relationship between tHcy and retinopathy in normoalbuminuric T1DM patients with normal estimated glomerular filtration rate (eGFR). Methods: The study included 163 normoalbuminuric patients with T1DM and normal renal function (eGFR >60?≤?125?ml?min^?1 1.73?m^?2). Urinary albumin excretion rate (UAE) was measured from at least two 24?h urine samples. Photodocumented retinopathy status was made according to the EURODIAB protocol. tHcy level was measured with the chemiluminescent immunoassay. Results: Retinopathy was present in 48% of normoalbuminuric patients. Patients with retinopathy were older (49 vs 42 years, p?=?0.001), had higher systolic blood pressure (130 vs 120?mmHg, p?=?0.001), triglycerides (0.89 vs 0.77?mmol/L, p?=?0.01), tHcy (9.8 vs 9.1?µmol/L, p?=?0.04), and lower eGFR (100 vs 106?ml?min^?1 1.73?m^?2, p?=?0.03). In multivariate logistic regression analysis, after adjustment for variables that reached statistical significance in the univariate analysis, only tHcy was significantly associated with a risk of retinopathy in our subjects (p?=?0.02), with odds ratios of 1.02 to 1.43. Conclusion: These data suggest that tHcy is independently associated with retinopathy in normoalbuminuric T1DM with normal eGFR. The mechanisms relating tHcy and retinopathy in T1DM are not clear. Prospectives studies are needed to confirm whether higher tHcy in normoalbuminuric T1DM patients has predictive value for development of retinopathy.     

总胆红素水平与糖尿病黄斑水肿发病及严重程度的相关性

目的 探讨总胆红素水平与糖尿病黄斑水肿(DME)发病及严重程度的相关性。方法 本研究共纳入82例2型糖尿病伴有糖尿病视网膜病变的患者。根据DME严重程度分级标准，将患者分为3组：无DME组22例(黄斑区中心凹厚度处于正常值范围)、早期DME组25例(黄斑区中心凹厚度高于正常上限值但等于或低于正常值上限130%)、晚期DME组35例(黄斑区中心凹厚度高于正常值上限130%以上)。患者眼底检查及荧光素眼底血管造影结果由2位经验丰富的眼底病专家独立进行分级。收集所有患者性别、年龄、糖尿病病程、体重指数(BMI)等基本参数，以及血液学指标——中性粒细胞数、系统免疫炎症指数[SII,(中性粒细胞数×血小板数)/淋巴细胞数]、空腹血糖、糖化血红蛋白(HbA1c)、总胆红素、尿酸等。使用Pearson相关分析探讨总胆红素水平与各种临床指标的相关性。采用多因素Logistic回归分析探索2型糖尿病患者DME的危险因素。建立受试者工作特征(ROC)曲线，计算曲线下面积(AUC),分析总胆红素对2型糖尿病患者DME的诊断效能。结果 无DME组、早期DME组及晚期DME组患者的糖尿病病程、BMI、中性粒细胞...     

Impact of estimated glomerular filtration rate on diabetic macular edema

Purpose

Diabetic macular edema (DME) is a major cause of visual impairment in patients with diabetes and is influenced by various systemic factors. This study evaluates the effect of renal status on DME using estimated glomerular filtration rate (eGFR) as a study marker.

Methods

This was a prospective observational cross-sectional study. One hundred and ninety-five patients of diabetic retinopathy (DR) were included. Group 1 had patients of DR without DME (n = 100), and group 2 had patients of DR with DME (n = 95). All patients were evaluated for DR/DME-related risk factors. eGFR was calculated in all patients. Spectral domain optical coherence tomography (SDOCT) was done to identify the various patterns and severity of DME.

Results

Group 2 patients had significantly higher comorbidities than those in group 1 (p < 0.001). Hba1c, total cholesterol, triglycerides, LDL/HDL ratio, systolic and diastolic blood pressures were significantly higher in group II (p < 0.001 in each). There was no significant difference between the groups in terms of blood urea, serum creatinine or eGFR. eGFR did not show a significant association with a specific SDOCT pattern or severity of DME.

Conclusion

Comorbidities are more common and more severe in patients with DME. However, eGFR as a marker was not useful in predicting either the severity or pattern of DME. eGFR, in its present form, may not be useful in the evaluation and management of patients with DME.

     

eGFR作为糖尿病视网膜病变预警因子的研究

目的　评价糖尿病患者中糖尿病视网膜病变（ｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ,ＤＲ）的患病率及其与肾小球滤过率（ｇｌｏｍｅｒｕｌａｒｆｉｌ-ｔｒａｔｉｏｎｒａｔｅ,ＧＦＲ）的相互关系,探讨ｅＧＦＲ（ｅｓｔｉｍａｔｅｄＧＦＲ）作为ＤＲ预警因子的可行性。方法　１６１３例２型糖尿病（ｔｙｐｅ２ｄｉａｂｅ-ｔｅｓｍｅｌｌｉｔｕｓ,Ｔ２ＤＭ）患者参与本研究。所有研究对象均自愿接受生物化学和眼部检查。ＤＲ由眼科医师通过眼底镜检查和眼底照相确诊。通过易尔统计分析软件评估ＤＲ与ｅＧＦＲ之间的关系。结果　１６１３例糖尿病患者中,ＤＲ患病率为３４．１０％（５５０例）。将有无ＤＲ的患者分组比较,ＤＲ组与ＮＤＲ组差异有统计学意义的变量有:年龄、ＤＭ病程、ＤＭ家族史、空腹及餐后２ｈ血糖、糖化血红蛋白、总胆固醇、收缩压、ｅＧＦＲ、血清肌酐及高、低密度脂蛋白胆固醇。Ｌｏｇｉｓｔｉｃ回归分析结果显示,年龄、ＤＭ病程、血浆糖化血红蛋白、收缩压、舒张压、ｅＧＦＲ以及高密度脂蛋白胆固醇为ＤＲ的独立危险因素,其中ｅＧＦＲ与ＤＲ呈负相关。经调整后的饱和效应分析结果表明当ｅＧＦＲ＜９９．４ｍＬ?ｍｉｎ－１时,糖尿病患者患ＤＲ的风险明显增加。结论　ｅＧＦＲ与ＤＲ负相关,ｅＧＦＲ为９９．４ｍＬ?ｍｉｎ－１是预测ＤＲ发生的关键点。检测和评价这一因素对于ＤＲ的早期发现具有极其重要的临床意义。     

2型糖尿病患者肾功能相关指标与发生视网膜病变的相关性

目的:研究2型糖尿病患者肾功能相关指标与视网膜病变发生的相关性,指导糖尿病视网膜病变早期诊断及治疗.方法:选取2014-03/2015-12间就诊的明确诊断为2型糖尿病的295例患者.根据眼底表现情况,分为DR组和非DR组,对比分析两组患者一般资料、肾功能相关指标,基于差异性分析探讨肾功能相关指标与糖尿病患者发生视网膜病变发生相关性.结果:与非DR组相比,DR组24h尿蛋白定量、尿微量白蛋白/血肌酐比值、血肌酐、血尿素氮、血尿酸明显高于非DR组,差异具有统计学意义;两组内生肌酐清除率、肾小球滤过率差异不具有统计学意义.结论:24h尿蛋白定量、尿微量白蛋白/血肌酐比值、血肌酐、血尿素氮、血尿酸与DM患者发生DR具有相关性,而内生肌酐清除率、肾小球滤过率与DM患者发生DR无相关性.     

Relationship Between Retinal Capillary Nonperfusion Area and Renal Function in Patients With Type 2 Diabetes

PurposeWe sought to assess the relationship between retinal nonperfusion area (NPA) on ultra-widefield fluorescein angiography (UWFA) and renal function in type 2 diabetes mellitus (DM) patients with diabetic retinopathy (DR) and nephropathy.MethodsUWFA was performed in 248 eyes (124 patients) with DR, comprising 94 eyes from patients with chronic kidney disease (CKD) caused by diabetes and 154 eyes without CKD (non-CKD). Serum creatinine level (Cr), estimated glomerular filtration rate (eGFR), urine albumin/creatinine ratio (UACR), and urine protein/creatinine ratio (UPCR) were collected. On UWFA, retinal NPA was measured in an automated manner. The correlation between NPA and renal function was analyzed.ResultsThe mean NPA value of the total eye was 33.11 ± 45.77-disc diameter (DA) in non-CKD and 100.57 ± 69.52 in CKD (P < 0.001). NPA of posterior pole was 1.21 ± 3.28 DA in non-CKD and 7.99 ± 6.75 in CKD group (P < 0.001). The NPA values of both the total eye and posterior pole were significantly correlated with Cr (r = 0.585 and 0.483), eGFR (r = −0.572 and −0.524), UACR (r = 0.541 and 0.482), and UPCR (r = 0.509 and 0.529, respectively) (all P ≤ 0.001). Linear modeling encompassing all clinical factors and relative clinical factors suggested eGFR as the most important predictor for NPAs of the total eye and posterior pole.ConclusionsLarger retinal NPA on UWFA is associated with worse renal function in DM patients. Renal function can be used to predict retinal NPA in type 2 DM patients with nephropathy and DR.     

Prevalence of and risk factors for diabetic macular edema in a northeastern Chinese population

AIM:To estimate the prevalence of diabetic macular edema(DME) and clinically significant macular edema(CSME),and to assess their risk factors in a population with type 2 diabetic mellitus(T2DM) located in northeast China.METHODS:Patients were included from the Fushun Diabetic Retinopathy Cohort Study(FS-DIRECT),a community-based study conducted in northeast China.The presence of DME and CSME was determined by the Early Treatment Diabetic Retinopathy Study(ETDRS) retinopathy scale of fundus photographs.The age-standardized prevalence of DME and CSME was estimated.The association between DME/CSME and risk factors was analyzed in a multivariate Logistical analysis.RESULTS:A total of 292(15.4%) and 166(8.8%) patients were diagnosed as DME and CSME,yielding the age and sex standardized prevalence of 13.5%(95%CI:11.9%-15.0%),and 7.1%(95%CI:5.9%-8.3%),respectively.Female patients had a higher prevalence of DME compared to their male counterparts(15.7% vs 10.4%,P=0.03).Multivariable Logistic regression analysis showed that younger age,insulin use,proteinuria,longer duration of diabetes,and higher glycosylated hemoglobin A1c,were associated with the prevalence of DME and CSME.Patients with higher fasting plasma glucose,systolic blood pressure,and blood urea nitrogen were also found to be associated with DME.CONCLUSION:Early fundus screening in diabetic patients is invaluable and given the relatively high prevalence of DME and CSME in this study cohort,those with a high risk of sight threatening maculopathy would invariably benefit from earlier detection.     

2型糖尿病患者血清唾液酸浓度与糖尿病性黄斑水肿的相关性

目的:探讨2型糖尿病患者血清唾液酸浓度与糖尿病性黄斑水肿的相关性.方法:选取65例2型糖尿病患者,以及54例正常对照,采取外周静脉血后用比色法测量血清唾液酸浓度.对于糖尿病患者采用视网膜血管荧光造影方法判断黄斑区水肿程度.结果:糖尿病患者65例中黄斑水肿22例,无黄斑水肿43例,其中1级水肿10例,2级水肿5例,3级水肿7例.糖尿病患者血清唾液酸浓度为96.56±14.29mmol/L,对照组的血清唾液酸浓度为42.44±17.68mmol/L,两组比较有显著统计学差异(P＜0.05).在糖尿病患者组,无黄斑水肿的患者血清唾液酸浓度为86.53±13.39mmol/L,有黄斑水肿的患者中血清唾液酸浓度为110.09±18.81 mmol/L,两者差异具有统计学意义(P＜0.05).血清唾液酸浓度与黄斑水肿严重程度有显著正相关(r=0.62,P＜O.05).结论:血清唾液酸浓度在2型糖尿病患者并发黄斑水肿时明显升高,并且血清唾液酸浓度越高,黄斑水肿越严重.