非增殖期糖尿病视网膜病变两种分期方法一致性的研究

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摘要目的观察非增殖期糖尿病视网膜病变两种分期方法的一致性。方法回顾性研究2014年1月～2016年6月于我院行FFA检查的非增殖期糖尿病视网膜病变患者共84例162眼。对每例患者每眼的眼底彩照以及FFA图像分别依据我国六期分期法以及国际分期法进行分期。统计两种方法各期的一致性。结果162眼中，按照六期分类法，以免散瞳下眼底彩照为标准，诊断为Ⅰ期DR患者为59眼，诊断为Ⅱ期DR患眼为37眼，诊断为Ⅲ期DR患眼为66眼；以50°眼底彩照为标准，Ⅰ期DR患者为52眼，Ⅱ期DR患者为38眼，Ⅲ期DR患者为72眼。按照国际分期法，轻度NPDR为34眼，中度NPDR患者为30眼，重度NPDR者为92眼，PDR为6眼。小瞳下眼底彩照以及散瞳下2张50°眼底彩照判断DR临床分期的一致性较好（Kappa=0.91）。六期分期法以及国际分期法两种分期方法的一致性一般（Kappa=0.634）。以轻度NPDR为筛查阈值，Ⅰ期病变的敏感度及特异度分别是100.0%、85.9%；以中度NPDR为筛查阈值，Ⅱ期病变的敏感度及特异度分别66.6%、86.3%；以重度NPDR为筛查阈值，Ⅲ期病变的敏感度及特异度分别71.0%、91.4%。结论FFA指导下的国际分期法更能够真实、客观地反映糖尿病性视网膜病变的微血管病变情况以及严重程度。对存在弥漫出血点以及微血管瘤的Ⅰ、Ⅱ、Ⅲ期糖尿病视网膜病变患者应及早进行FFA检查。

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	樊利敏
	杨波
	计青
	李乃洋

关键词 ：非增殖期, 糖尿病视网膜病变, 分期

Abstract：ObjectiveTo observe the consistency of the two staging method of non proliferative diabetic retinopathy.MethodsA retrospective study was performed on 162 eyes of 84 patients with non proliferative diabetic retinopathy who were examined by FFA in our hospital from January 2014 to June 2016.The fundus photograph of each eye in each patient and FFA images was confucted staging according to six classification method in our county and international classification method respectively.The consistency of the two methods in each period was examined.ResultsAmong 162 eyes,according to the six classification method,nonmydriaticfundus photograph was taken as the standard,DR with phase Ⅰdiagnosed were 59 eyes,phaseⅡdiagnosed were 37 eyes,and phaseⅢdiagnosed were 66 eyes.50°of fundus photograph was taken as the standard,DR with phaseⅠdiagnosed were 52 eyes,phaseⅡdiagnosed were 38 eyes,and phase Ⅲdiagnosed were 72 eyes.According to the international stage method,mild NPDR,moderate NPDR and severe NPDR patients was 34 eyes,30 eyes and 92 eyes respectively and 6 eyes were in PDR patients.The consistency of fundus photograph under hitomi and 50°of two fundus photographs under mydriasis judging the clinical staging of DR was better (Kappa=0.91).The consistency of six classification method and international classification method was general(Kappa= 0.634).Mild NPDR was seen as the screening threshold,the sensitivity and specificity for lesion at stage 1 was 100.0% and 85.9%respectively,and middle NPDR was seen as the screening threshold,the sensitivity and specificity for lesion at stageⅡ was 66.6%and 86.3%respectively,and severe NPDR was seen as the screening threshold,the sensitivity and specificity for lesion at stageⅢ was 71.0%and 91.4%respectively.ConclusionThe international staging under the guidance of FFA is more able to reflect the microvascular pathological changes and severity of diabetic retinopathy. Early FFA examination should be performed for patients at phaseⅠ,ⅡandⅢdiabetic retinopathy with diffuse hemorrhages and hemangioma.

Key words： Non proliferative phase Diabetic retinopathy Staging

基金资助:广东省深圳市宝安区科技计划项目（2013165）

引用本文:

樊利敏;杨波;计青;李乃洋. 非增殖期糖尿病视网膜病变两种分期方法一致性的研究[J]. 中国当代医药, 2017, 24(13): 115-117.
FAN Li-min;YANG Bo;JI Qing;LI Nai-yang. Study on the consistency of two staging method of non proliferative diabetic retinopathy. 中国当代医药, 2017, 24(13): 115-117.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2017/V24/I13/115

[1]	Solomon SD，Chew E，Duh EJ，et al.Diabetic retinopathy：a position statement by the American Diabetes Association[J]. Diabetes Care，2017，40（3）：412-418.
[2]	Roy S，Kern TS，Song B，et al.Mechanistic insights into pathological changes in the diabetic retina：implications for targeting diabetic retinopathy[J].Am J Pathol，2017，187（1）：9-19.
[3]	Ting DS，Tan KA，Phua V，et al.Biomarkers of diabetic retinopathy[J].Curr Diab Rep，2016，16（12）：125.
[4]	Fathy C，Patel S，Sternberg P Jr，et al.Disparities in adherence to Screening Guidelines for Diabetic Retinopathy in the United States：a comprehensive review and guide for future directions[J].Semin Ophthalmol，2016，31（4）：364-377.
[5]	第三届全国眼科学术会议.糖尿病视网膜病变分期标准[M].石家庄：河北人民出版社，1980：109-112.
[6]	中华医学会眼科学分会眼底病学组.糖尿病视网膜病变分期标准[J].中华眼科杂志，1985，21（2）：113.
[7]	李彬彬，曾敏，胡莉群，等.单视野免散瞳数码眼底照相筛查糖尿病视网膜病变的敏感性和特异性[J].国际眼科杂志，2013，13（7）：1334-1337.
[8]	夏伟，王利，李蓬秋，等.应用免散瞳眼底照相技术筛查糖尿病视网膜病变临床分析[J].国际眼科杂志，2013，13（11）：2267-2269.
[9]	毛彦琪，彭伟，刘贵锋，等.糖尿病视网膜病变不同筛查方法诊断效果的比较性研究[J].眼科新进展，2010，30（8）：781-783.
[10]	Wilkinson CP，Ferris FL，Klein RE，et al.Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales[J].Ophthalmology，2003，110 （9）：1677-1682.
[11]	高丽琴，张风，周海英.眼底彩色照像与荧光素眼底血管造影对判断糖尿病视网膜病变临床分期的一致性研究[J].中华眼科杂志，2008，44（1）：12-16.
[12]	周海英，焦璇.非增殖期糖尿病视网膜病变黄斑硬性渗出的临床观察[J].首都医科大学学报，2010，31（5）：645-648.
[13]	Das A.Diabetic Retinopathy：Battling the Global Epidemic[J]. Invest Ophthalmol Vis Sci，2016，57（15）：6669-6682.
[14]	美国眼科学会.糖尿病视网膜病变[A]//中华医学会眼科学分会.眼科学临床指南[M].七册.北京：人民卫生出版社，2006.
[15]	于强，刘万丽，闫宏，等.糖尿病视网膜病变筛查方法的比较研究[J].中华眼底病杂志，2006，22（1）：45-46.