摘要
目的探讨2型糖尿病患者不同视网膜病变阶段对应的角膜病变表现。方法病例对照研究。选择2015年5月至2019年12月青岛眼科医院就诊的90例(90只眼)2型糖尿病患者,根据糖尿病视网膜病变临床分期分为非增生性糖尿病视网膜病变(NPDR)组(30例)、增生性糖尿病视网膜病变(PDR)早期组(30例)和PDR中晚期组(30例),对照组纳入年龄性别匹配的健康人30名。采用活体共聚焦显微镜(IVCM)观察角膜中央区各层次角膜图像,比较角膜神经纤维长度、神经纤维密度、神经纤维分支密度和神经纤维弯曲度,并比较角膜免疫细胞、上皮基底细胞、前基质细胞及内皮细胞计数。各组均数间比较采用单因素方差分析,多个样本均数之间两两比较采用SNK-q检验;各组构成比的比较采用χ^2检验。结果IVCM观察可见对照组神经纤维数量和分支较多,走行平缓,而糖尿病各组角膜上皮下神经纤维疏松,走行弯曲。对照组、NPDR组、PDR早期组、PDR中晚期组的神经纤维长度分别为(21.55±2.57)、(14.73±1.56)、(11.23±1.40)、(8.02±1.33)mm/mm^2,组间比较差异均有统计学意义(F=316.17,P=0.00)。各组间神经纤维密度、分支密度、弯曲度的组间比较差异均有统计学意义(F=345.72,479.46,167.00;P<0.01)。对照组、NPDR组、PDR早期组、PDR中晚期组的上皮基底细胞密度分别为(5761±303)、(5336±367)、(4146±379)、(3658±365)个/mm^2,各组间比较差异均有统计学意义(F=234.94,P=0.00)。对照组、NPDR组、PDR早期组、PDR中晚期组角膜前基质细胞密度分别为(836±30)、(727±57)、(544±59)、(360±47)个/mm^2,各组间比较差异均有统计学意义(F=535.08,P=0.00)。对照组、NPDR组、PDR早期组、PDR中晚期组各组角膜内皮细胞六边形细胞比例为62.0%±5.5%、51.1%±3.7%、40.2%±4.0%、27.8%±3.9%,朗格汉斯细胞数量为(1.5±0.6)、(4.2±1.3)、(6.8±2.1)、(10.9±2.1)个/mm^2,组间比较差异均有统计学意义(F=342
Objective To study the diabetic keratopathy in type 2 diabetes patients with retinopathy by in vivo laser confocal microscopy.Methods This was a case-control study.Ninety type 2 diabetes patients were involved in this study from May 2015 to December 2019 in Qingdao Eye Hospital.According to the diabetic retinopathy clinical stage,these patients were divided into the non-proliferative diabetic retinopathy(NPDR)group(30 cases),early stage proliferative diabetic retinopathy(PDR)group(30 cases)and intermediate to late stage PDR group(30 cases).Thirty non-diabetic healthy volunteers were included in the control group.The central cornea was observed with an in vivo laser confocal microscope.The corneal nerve fiber density,nerve fiber length,nerve branch density,and nerve fiber tortuosity were compared between groups.The corneal Langerhans cells,epithelial cells,stromal cells and endothelial cells were also compared.Results There were more nerve fibers and branches in the control group than the other three diabetic groups.The nerve fiber length in the control group,NPDR group,early stage PDR group and intermediate to late stage PDR group was(21.55±2.57),(14.73±1.56),(11.23±1.40)and(8.02±1.33)mm/mm2,respectively,and there were statistically significant differences between the groups(F=316.17,P=0.00).In the nerve fiber density,nerve branch density and curvature,there were statistically significant differences between the groups(F=345.72,479.46,167.00,all P=0.00).The basal cell density in the control group,NPDR group,and two PDR groups was(5761±303),(5336±367),(4146±379)and(3658±365)cells/mm^2,respectively,and there were statistically significant differences between the groups(F=234.94,P=0.00).The anterior stromal cell density in the four groups was(836±30),(727±57),(544±59)and(360±47)cells/mm^2,respectively,and there were statistically significant differences between the groups(F=535.08,P=0.00).The hexagonal endothelium cell rate in the four groups was 62.0%±5.5%,51.1%±3.7%,40.2%±4.0%and 27.8%±3.9%,respect
作者
刘廷
孙大鹏
李东芳
毕文娇
谢立信
Liu Ting;Sun Dapeng;Li Dongfang;Bi Wenjiao;Xie Lixin(Qingdao Eye Hospital Affiliated to Shandong First Medical University,State Key Laboratory Cultivation Base,Shandong Provincial Key Laboratory of Ophthalmology,Shandong Eye Institute,Shandong First Medical University&Shandong Academy of Medical Sciences,Qingdao 266071,China)
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2020年第10期754-760,共7页
Chinese Journal of Ophthalmology
基金
国家重点基础研究发展计划(973计划)课题(2012CB722409)
国家自然科学基金(81500703)
山东第一医科大学学术提升计划(2019ZL001)
青岛市南区科技发展资金项目(2018-4-030-YY)。
关键词
糖尿病
2型
角膜疾病
显微镜检查
共焦
活体显微镜检查
Diabetes mellitus,type 2
Corneal diseases
Microscopy,confocal
Intravital microscopy
