摘要： 目的 探讨糖化血红蛋白（HbA1c）水平与糖尿病视网膜病变（DR）激光光凝术后黄斑水肿的相关性。方法 选取2017年2月至2019年6月本院眼科门诊确诊的重度非增殖型糖尿病视网膜病变（NPDR）或增殖型糖尿病视网膜病变（PDR）患者53例（98眼）。根据患者HbA1c水平分为4组：A组（HbA1c≤6.5%）、B组（HbA1c>6.5%~7%）、C组（HbA1c>7%~9%）、D组（HbA1c>9%）。患者均降糖治疗3个月，同时给予全视网膜激光光凝术（PRP）治疗。记录患者治疗前、治疗后1周、1个月、3个月黄斑中心厚度（CMT）、黄斑中心凹下脉络膜厚度（SFCT）。结果 PRP治疗后1周各组患者CMT及SFCT均较术前增厚（P<0.05），CMT及SFCT增厚程度与HbA1c水平正相关（P<0.05）；PRP术后1个月、3个月A、B、C组患者CMT及SFCT均较术前变薄（P<0.05），CMT及SFCT变薄程度与HbA1c水平负相关（P<0.05）；PRP术后1个月、3个月D组患者CMT及SFCT与术前比较均无统计学差异（P>0.05）。结论 HbA1c水平与DR患者PRP术后黄斑水肿消退程度密切相关，较高HbA1c水平下DR患者PRP术后黄斑水肿不易消退或有加重可能。HbA1c水平可作为DR患者PRP治疗时机选择的重要参考指标之一。

糖化血红蛋白水平与糖尿病视网膜病变激光光凝术后黄斑水肿的相关性

张聪, 徐丽

沈阳医学院附属沈阳第四人民医院眼科, 沈阳 110031

收稿日期:2020-03-22出版日期:2020-11-30发布日期:2020-10-31
通讯作者:徐丽E-mail:cong_zhang25@163.com
作者简介:张聪(1981-),女,副主任医师,博士.
基金资助:辽宁省自然科学基金（2018011263-301）


关键词: 糖化血红蛋白, 糖尿病视网膜病变, 全视网膜激光光凝术, 糖尿病黄斑水肿
Abstract: Objective To investigate the relationship between the level of glycated hemoglobin A1c(HbA1c)and changes in macular edema after laser photocoagulation in diabetic retinopathy(DR). Methods A total of 53 patients(98 eyes)diagnosed with nonproliferative diabetes mellitus(NPDR)or proliferative diabetes mellitus(PDR)from February,2017 to June,2019 were selected and divided into four groups according to HbA1c levels:Group A(HbA1c ≤ 6.5%),Group B(HbA1c > 6.5%-7%),Group C(HbA1c > 7%-9%),and Group D(HbA1c > 9%). All patients were treated with normal hypoglycemic therapy for 3 months,and also with pantinal photocoagulation(PRP)treatment. Changes in central macular thickness(CMT)and subfoveal choroidal thickness(SFCT)were recorded before treatment and at 1 week,1 month,and 3 month after treatment. Results CMT and SFCT increased in each group 1 week after PRP treatment(P<0.05). The increased degree of CMT and SFCT in each group was positively correlated with HbA1c level(P<0.05). The CMT and SFCT of groups A,B,and C at 1 month and 3 month after PRP treatment were decreased(P<0.05). There was a significant negative correlation between CMT and SFCT and HbA1c levels in each group(P<0.05). CMT and SFCT in Group D showed no significant differences at 1 month and 3 month after PRP treatment(P>0.05). Conclusion The level of HbA1c was closely related to the degree of macular edema in patients undergoing PRP treatment. Macular edema with higher HbA1c levels is not easily reduced or may be aggravated by PRP treatment. HBA1c level may be an important reference index for the treatment timing of DR patients using PRP.
Key words: glycated hemoglobin A1c, diabetic retinopathy, panretinal photocoagulation, diabetic macular edema
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