摘要目的 探讨糖尿病患者发生视网膜病变的眼部生物结构特征及其危险因素.方法 回顾性病例系列研究.收集118例病程超过10年的2型糖尿病患者临床资料进行回顾性分析,包括患者全身和实验室检查情况、眼底改变、糖尿病视网膜病变(DR)程度、相干光生物测量仪及屈光检测资料.同时以50例非糖尿病性白内障患者的临床资料进行对比.根据病变程度,将糖尿病患者分为3组:0组无DR,1组轻中度DR,2组威胁视力DR.采用广义估计方程模型控制来自同一患者双眼数据的关联性,将眼部生物结构指标包括眼轴长度、前房深度、角膜直径、角膜曲率及屈光度数等变量指标分别纳入Logistic回归分析.结果 除外全身因素,眼部各变量因素分析,显示118例糖尿病患者的眼轴长度为(23.22±1.46)mm,前房深度为(3.01 ±0.42)mm,角膜直径为(11.60 ±0.48)mm,角膜曲率为(44.84±1.44)D；与对照组眼轴长度(23.87±1.55)mm、前房深度(2.59 ±0.41)mm、角膜直径(11.59 ±0.41)mm及角膜曲率(44.54 ±1.71)D比较,其中眼轴长度和前房深度差异有统计学意义(OR=1.358,5.955；P＜0.05).糖尿病患者3组间比较,显示眼轴长度越短、前房深度越浅,DR发生和发展的危险性越大(OR=16.869,7.248,6.577;P＜0.05),其中DR分型和黄斑水肿类型的危险性尤为突出.远视眼发生严重DR病变的危险性显著增加(OR=1.301,95％ CI=1.044 ～1.621,P＜0.05).结论 病程10年以上的2型糖尿病患者中,眼部危险因素主要为眼轴长度和前房深度,其具有促使DR发生及病情进展的作用.

abstractsObjective To investigate the characteristics and risk factors of biological ocular structures in the development of diabetic retinopathy in diabetes mellitus (DM) patients.Methods Retrospective case series study.Systemic condition,results of laboratory examination,fundus examination,refractive status and ocular biometry measured by IOL Master,were collected from the DM group(118 type-Ⅱ diabetic patients with diabetes more than 10 years) and the control group (50 cataract subjects without diabetes).The DM group was classified to three subgroups:none diabetic retinopathy,minimal and moderate nonproliferative diabetic retinopathy (NPDR) and vision-threatening diabetic retinopathy.Chisquare and Kruskal-Wallis rank sum tests were used to compare the difference between the DM and control groups.Ocular biometry,including axial length (AL),anterior chamber depth (ACD),corneal diameter,corneal curvature and spherical equivalent refraction (SE) were analyzed with multivariate logistic regression.Results 1.There was no significant difference in systemic factors.2.Ocular factors:There were significant differences of AL and ACD between the DM and control groups.The risk for the development of DR and the severity of DR were increasing with shorter AL and ACD between the three DR subgroups,especially the risk of and the occurrence of macular edema (ME) (OR =16.869,7.248,6.577 ;P ＜0.05,respectively).3.The risk of advanced DR increased significantly in hyperopia (OR =1.301,95％ CI =1.044 to 1.621 ;P ＜ 0.05).Conclusions The ocular risk factors of type-Ⅱ DM patients with diabetes more than 10 years are the AL and ACD,which have significant relationship with the development and the progress of DR.