[目的]探讨糖尿病性视网膜病变(diabetic retinopathy,DR)程度和糖化血红蛋白(hemoglobin A1c,HbA1c)水平对糖尿病患者角膜内皮的影响.[方法]选取2023年2月至6月在烟台毓璜顶医院眼科诊治的167例(334眼)白内障患者,其中糖尿病患者117例(234眼)纳入观察组,非糖尿病患者50例(100眼)纳入对照组.观察组按照 DR 的临床分期分为无 DR(no diabetic retinopathy,NDR)组、DR 非增殖期(nonproliferative diabetic retinopathy,NPDR)组和 DR 增殖期(proliferative diabetic retinopathy,PDR)组;根据入院后 HbA1c 结果分为 A组(HbA1c＜7.5％)、B 组(7.5％≤HbA1c＜8.5％)、C 组(8.5％≤HbA1c＜9.5％)和 D 组(HbA1c≥9.5％).所有患者均采用内皮细胞显微镜检测角膜内皮细胞密度(endothelial corneal density,ECD)、细胞面积标准差(standard deviation,SD)、变异系数(variation coefficient,CV)、六角形细胞百分比(hexagonal cell percentage,HCR)、中央角膜厚度(central corneal thickness,CCT)并比较.[结果]与对照组相比,观察组ECD降低,SD、CV增加,差异有统计学意义(P＜0.05),但两组HCR、CCT比较,差异无统计学意义(P＞0.05).与NDR组、NPDR组比较,PDR组ECD明显降低,差异均有统计学意义(P＜0.05),但NDR组与NPDR组ECD比较,差异无统计学意义(P＞0.05);NPDR组、PDR组CV与NDR组比较,差异均有统计学意义(P＜0.05),SD与NDR组比较,差异无统计学意义(P＞0.05),且NPDR组与PDR组SD、CV比较,差异均无统计学意义(P＞0.05);NPDR组、PDR组、NDR组HCR、CCT比较,差异无统计学意义(P＞0.05).A组、B组、C组、D组ECD随着HbA1c水平升高而降低,且B组、C组、D组ECD、SD与A组比较,差异均有统计学意义(P＜0.05);但B组、C组、D组ECD、SD比较,差异无统计学意义(P＞0.05);A组和C组CV比较,差异有统计学意义(P＜0.05).A组CV与B组、D组比较,差异均无统计学意义(P＞0.05);A组、B组、C组、D组HCR、CCT比较,差异均无统计学意义(P＞0.05).年龄与CCT呈负相关(P＜0.05);糖尿病病程与ECD呈负相关(P＜0.05),与SD、CV呈正相关性(P＜0.05);HbA1c水平、DR严重程度与ECD呈负相关(P＜0.05).[结论]DR病变程度加重以及HbA1c水平升高均会导致ECD下降、CV升高,即随着糖尿病病程延长和血糖控制不稳定,角膜内皮细胞会发生数量和形态改变,并可导致角膜内皮细胞功能下降.
Effect of Diabetic Retinopathy Degree and Glycosylated Hemoglobin Level on Corneal Endothelium in Diabetic Patients
[Objective]To investigate the effect of diabetic retinopathy(DR)and glycosylated hemoglobin A1e(HbA1c)on corneal endothelium in diabetic patients.[Methods]A total of 167 patients(334 eyes)with cataract diag-nosed and treated in the Ophthalmology Department of Yuhuangding Hospital from February 2023 to June were selected in the study.Among them,117 patients with diabetes(234 eyes)were included in the observation group,and 50 patients without diabetes(100 eyes)were included in the control group.According to the clinical stage of DR,the observation group was divided into no DR group(NDR group),non-proliferative diabetic retinopathy group(NPDR group)and pro-liferative diabetic retinopathy group(PDR group).According to the HbA1c results after admission,the patients were fur-ther divided into group A(HbA1c＜7.5％),group B(7.5％≤HbA1c＜8.5％),group C(8.5％≤HbA1c＜9.5％)and group D(HbA1c≥9.5％).Endothelial cell microscopy was used to detect the corneal endothelial density(ECD),cell area standard deviation(SD),and variation coefficient(CV),hexagonal cell percentage(HCR)and central corneal thick-ness(CCT)in all patients for comparison.[Results]Compared with the control group,the ECD of the observation group decreased,while SD and CV increased;And the difference was statistically significant(P＜0.05)There was no statisti-cally significant differences in HCR and CCT between the two groups(P＞0.05).Compared with the NDR group and the NPDR group,ECD in the PDR group was significantly reduced,and the differences were statistically significant(P＜0.05),however,there was no statistically significant difference between ECD in the NDR group and the NPDR group(P＞0.05).There were statistically significant differences in CV of the NPDR group and the PDR group(P＜0.05),if compared to the NDR group;But there were no statistically significant differences in SD of the NPDR group and the PDR group with the NDR group(P＞0.05).There were no statistically significant differences in SD and CV between the NPDR group and the PDR group(P＞0.05).There were no significant differences in HCR and CCT among the NPDR group,the PDR group and the NDR group(P＞0.05).With the increase of HbA1c level,ECD in groups A,B,C and D decreased in order,and there were statistically significant differences in ECD and SD in groups B,C and D compared with group A(P＜0.05),though there were no statistically significant differences in ECD and SD among groups B,C and D(P＞0.05).There was statistical significance in CV between group A and group C(P＜0.05),but there was no statistical significance in CV of group A comparing with group B and D(P＞0.05).There were no significant differences in HCR and CCT among group A,group B,group C and group D(P＞0.05).Age was negatively correlated with CCT(P＜0.05).The duration of diabetes was negatively correlated with ECD(P＜0.05),and positively correlated with SD and CV(P＜0.05).The level of HbA1c and the severity of DR Were negatively correlated with ECD(P＜0.05).[Conclusion]The increase of the degree of DR lesions and the increase of HbA1c level can lead to the decrease of ECD and the increase of CV.The number and morphology of corneal endothelial cells will change with the prolonged course of dia-betes and unstable blood glucose control,which can lead to a decline in corneal endothelial cell function.
万方数据
维普
