光學相干斷層掃描在社區糖尿病視網膜病變篩查中的應用

李 冬，王瑞卿，劉學政

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·臨床研究·

光學相干斷層掃描在社區糖尿病視網膜病變篩查中的應用

李 冬1,2，王瑞卿3，劉學政1

?METHODS: Retrospective analysis. A total of 378 cases with type 2 diabetes mellitus in Fushun, 184 males (193 eyes) and 194 females (207 eyes), aged from 43 to 76 (averaged 59.0±9.7), were chosen in JiangJun community hospital. According to DR staging standard, 278 patients (300 eyes) with fundus changing were divided into 3 groups: DR1, DR2 and DR3. A total of 100 patients (100 eyes) with no fundus changing were as a control group. Spectralis OCT (Heidelberg, German) was used to scan retina of 3.4mm range around the optic disc with fast scanning mode and the thickness of retinal nerve fiber layer (RNFL) with different areas were recorded. Independent samplet-test and one-way ANOVA were used to compare the difference of RNFL thickness in each group.

?RESULTS: The averaged thickness of RNFL in control, DR1, DR2, and DR3 group were 109.52±7.13μm, 108.51±7.09μm, 99.37±8.92μm and 98.48±8.57μm, respectively. Significant differences were found in the RNFL thickness between control group and DR 1-3 group (P<0.05). Comparison of the RNFL thickness in different areas: the distributions of RNFL thickness in control and DR groups were similar, where the RNFL in nasal and temporal optic disc was thinnest and superior and inferior temporal RNFL was thickest. There was statistic difference between the thinnest and thickest RNFL (P<0.05). The differences of the nasal, superior temporal and inferior nasal RNFL were found between DR1 group and control group (P<0.05); the differences of the nasal, superior temporal and inferior nasal RNFL were found between DR2 group and control group (P<0.05); the differences of RNFL in each area were found between DR3 group and control group (P<0.05). No difference of RNFL in each area was found between DR1 and DR2 group (P>0.05); the differences of RNFL in each area were found between DR1 and DR3 group (P<0.05) except temporal RNFL; the differences of RNFL in each area were found between DR2 and DR3 group (P<0.05) except temporal RNFL.

?CONCLUSION: The RNFL thickness is one of the sensitive indexes for early diagnosis of DR. The application of OCT in community hospitals for DR screening is helpful to the early prediction and the assessment of DR progression.

目的：探討應用光學相干斷層掃描儀( optical coherence tomography, OCT) 在社區篩查糖尿病視網膜病變(diabetic retinopathy，DR)的可行性及意義。

方法：回顧性分析。選取在撫順市將軍社區醫院就診的2型糖尿病患者378例400眼，男184例193眼，女194例207眼，年齡43～76(平均59.0±9.7)歲。根據DR分期標準，將伴有眼底改變的DR患者278例300眼分為DR1、DR2和DR3 三組，無眼底改變的糖尿病患者100例100眼做對照組，共4組。應用頻域OCT快速掃描模式掃描4組患者視盤周圍3.4mm直徑范圍，按照不同區域記錄視神經纖維層(retinal nerve fiber layer thickness, RNFL)厚度。采用應用獨立樣本t檢驗和單因素方差分析比較各組RNFL厚度是否存在差異。

結果：對照組、DR1、DR2及DR3組的平均RNFL厚度分別為109.52±7.13、108.51±7.09、99.37±8.92、98.48±8.57μm；與對照組比較，DR各分期組的RNFL厚度差異有統計學意義(P<0. 05)。不同區域RNFL厚度的比較發現：對照組和DR組(1～3期)的RNFL厚度分布具有相似性，即鼻側和顳側RNFL最薄，顳上和顳下象限RNFL最厚。最薄與最厚處比較，差異有統計學意義(P<0.05)。與對照組相比，DR1期患者視盤鼻側、顳上、鼻下象限的RNFL厚度差異有統計學意義(P<0.05)；DR2期的鼻側、顳上、鼻下象限的RNFL厚度差異有統計學意義(P<0.05)；DR3期各個象限RNFL厚度差異均有統計學意義(P<0.05)。DR1期與DR2期相比，各個象限差異均無統計學意義(P>0.05)；DR1期與DR3期相比，除顳側象限外均有統計學意義(P<0.05)；DR2期與DR3期相比，除顳側象限外均有統計學意義(P<0.05)。

結論：視盤旁RNFL厚度是早期診斷DR的敏感指標之一，將OCT應用于社區DR的篩查有助于疾病的早期預測及病情進展評估。

光學相干斷層掃描儀；視盤旁神經纖維層厚度；糖尿病視網膜病變；疾病篩查；社區醫療

引用：李冬，王瑞卿，劉學政.光學相干斷層掃描在社區糖尿病視網膜病變篩查中的應用.國際眼科雜志2016;16(12):2276-2278

0引言

糖尿病性視網膜病變(diabetic retinopathy，DR)，是糖尿病性微血管病變中眼部的并發癥之一。據最新數據顯示我國人口中糖尿病的患病率現已接近11.6%，患病人數接近1.14億。DR是致盲的重要原因之一，其防治的關鍵在于早期診斷及有效治療[1]，而定期篩查對于早期診斷至關重要。……