简介:目的探讨玻璃体腔注射雷珠单抗辅助23G玻璃体切割治疗增殖期糖尿病视网膜病变的优质护理。方法通过对28例28眼采用玻璃体腔注射雷珠单抗辅助玻璃体切割治疗糖尿病患者并发视网膜增殖期病变存在的主要护理问题,针对患者治疗各阶段,责任护士提供全程、连续、系统的优质护理服务,加强护患沟通,提高护理质量,缩短手术时间,减少并发症的发生。结果24眼一次性手术复位成功(85.7%)术后三个月取出硅油,其中有4例伴有晶状体混浊的同时行晶状体超声乳化联合人工晶体植入术;4例硅油填充下仍然存在下方局限性视网膜增殖,术后三个月取出硅油再次切割增殖膜然后注入C3F8气体填充,随访至气体完全吸收,视网膜复位。结论对玻璃体腔注射雷珠单抗辅助23G玻璃体切割治疗增殖期糖尿病视网膜病变的患者提供优质护理,可缩短手术时间,减少并发症的发生,提高病人及家属的满意度,提升患者的康复效果,是手术取得成功的关键因素。
简介:目的:通过测定糖尿病性白内障患者血清中糖代谢指标、胰岛素抵抗与房水和血清中炎症因子的水平,探讨其相关性。方法:随机选取我院2017-02/2018-01糖尿病性白内障患者69例(观察组)和白内障患者65例(对照组),检测两组患者血清中糖化血红蛋白(HbA1c)、空腹血糖(FPG)、空腹胰岛素(FINS)的水平,计算胰岛素抵抗指数(HOMA-IR);同时检测房水和血清中的胰岛素样生长因子-1(IGF-1)、白细胞介素-6(IL-6)含量,对HbA1c、HOMA-IR与房水和血清中IGF-1、IL-6含量进行相关性分析。结果:对照组血清中的FPG、HbA1c、HOMA-IR,以及房水和血清中IGF-1、IL-6含量显著低于观察组,差异有统计学意义(均P<0.05)。HbA1c与房水及血清中的IGF-1和IL-6均呈正相关(P<0.05)。HOMA-IR与房水及血清中的IGF-1和IL-6均呈正相关(P<0.05)。结论:糖尿病性白内障患者HbA1c、HOMA-IR与房水及血清中的IGF-1、IL-6含量具有相关性,通过对上述指标的测定可以辅助判断病情。
简介:目的:对影响糖尿病患者视网膜血管形态变化的相关因素进行分析。方法:选取2012-01/2016-09期间于本院就诊的2型糖尿病患者312例为研究对象。对患者进行、眼底摄片及相关实验室检查。以患者年龄、性别、病程、是否吸烟、饮酒,是否合并高血压、高血脂或糖尿病肾病等作为分组因素,比较不同组间患者出现视网膜血管形态变化的发生率,将有意义的因素再次引入Logistic回归方程,筛选出糖尿病患者视网膜血管形态变化的独立危险因素。结果:所选的312例2型糖尿病患者中,伴视网膜血管形态异常组169例,不伴视网膜血管形态异常组143例。单因素分析结果显示,年龄、病程、合并高血压、高血脂或糖尿病肾病与视网膜血管形态变化显著相关(P〈0.05),性别、是否吸烟、饮酒等与视网膜血管形态异常的发生无显著相关性(P〉0.05)。将发生视网膜血管形态异常作为因变量,上述具有统计学意义的分组因素作为自变量,经Logistic逐步回归分析结果显示,病程、患者合并高血压或糖尿病肾病是发生视网膜血管形态异常的独立危险因素(P〈0.05)。结论:病程增加、患者合并高血压或糖尿病肾病是糖尿病患者发生视网膜血管形态变化的独立危险因素。早期诊断与干预,采取措施控制血压稳定,减少肾脏损害可降低视网膜血管病变的发生率,同时减少糖尿病所引发的大血管病变,减少心脑血管不良事件的发生。
简介:AIM:Toassesstheawarenessofeyecomplicationsandtheprevalenceofretinopathy,inthefirstvisittoeyeclinic,amongtype2diabeticpatientsattendingatertiarymedicalcentreinKualaLumpur,Malaysia.METHODS:Aninvestigator-administeredquestionnairewasgivento137patientswithdiabetesundergoingfirsttimeeyescreeningintheeyeclinic.Thiswasfollowedbyadetailedfundusexaminationbyaseniorophthalmologisttoassessforpresenceofretinopathy.RESULTS:Almost86%ofrespondentswereawareofdiabeticeyecomplications,especiallyinpatientswhohadachievedtertiaryeducationallevel(96.3%).Themajorityofthepatients(78.8%)werereferredbytheirphysiciansandonly20.4%cameontheirowninitiative.Manyofthepatients(43.8%)didnotknowhowfrequenttheyshouldgoforaneyecheck-upand72.3%didnotknowwhattreatmentswereavailable.Lackofunderstandingondiabeticeyediseases(68.6%)wasthemainbarrierformostpatientsfornotcomingforeyescreeningearlier.Despiteahighlevelofawareness,only21.9%hadrecordedHbA1clevelof<6.5%while31.4%wereundertheerroneousassumptionofhavingagoodbloodsugarcontrol.Atotalof29.2%haddiabeticretinopathyintheirfirstvisiteyetesting.CONCLUSION:Inthepresentstudy,29.2%oftype2diabeticpatientshadretinopathyintheirfirsttimeeyetesting.Althoughtheawarenessofdiabeticeyecomplicationswashighamongfirsttimeeyescreeningpatients,theappropriateeyecare-seekingbehaviorwascomparativelylessandshouldberectifiedtopreventtheriseofthissightthreateningeyedisease.
简介:AIM:Tofindouttheoutcomeoflaserphotocoagulationinclinicallysignificantmacularedema(CSME)byopticalcoherencetomography(OCT).·METHODS:Itwasaprospective,non-controlled,caseseriesstudyenrolling81eyesof64patientswithCSMEbetweenAugust2008andJanuary2010.AllpatientsreceivedmodifiedgridphotocoagulationwithfrequencydoubledNd:YAGlaser.Eachpatientwasevaluatedintermsofbest-correctedvisualacuity(BCVA)andregressionorprogressionofmaculopathyafterlasertherapyat1,3and6months.Spearman’scorrelationtestwasusedtoshowthecorrelationbetweenBCVAandtotalmacularvolume(TMV).Analysisofvariance(ANOVA)wasusedtocompareamonggroupsandindependentt-testwasusedtocompareineachgroup.·RESULTS:ThereishighcorrelationbetweenBCVAandTMV(P≤0.001).BCVAimprovedin50.6%,remainedstaticin39.5%anddeterioratedin9.9%patientsafter6monthoftreatment.TheBaselineTMV(meanandSD)were9.26±1.83,10.4±2.38,11.5±3.05,8.89±0.75and9.47±1.98mm3fordifferentOCTpatterns,ST(spongelikethickening),CMO(cystoidmacularedema),SFD(subfovealdetachment),VMIA(Vitreomacularinterfaceabnormality)andaverageTMVrespectively(P=0.04).After6monthsoflasertreatment,themeanTMVdecreasedfrom9.47±1.98mm3to8.77±1.31mm3(P=0.01).InSTtherewassignificantdecreaseinTMV,P=0.01,Furtherwithinthesegroupsat6months,theyweresignificantlydifferent,P=0.01.·CONCLUSION:OCTshowedthedifferentmorphologicalvariantofCSMEwhiletheresponseoftreatmentisdifferent.TMVdecreasedthemostandhenceshowedtheimprovementinvisionafter6monthsoflasertreatment.IntheeraofAntivascularendothelialgrowthfactors(VEGFs),efficacyoflaserseemstobeinshadowbutitisstillfirstlineoftreatmentindevelopingnationlikeNepalwhereantiVEGFsmaynotbeeasilyavailableandaffordable.
简介:AIM:Toinvestigatethelevelsofserumsolubleintercellularadhesionmolecules-1(sICAM-1)andneutrophilicexpressionofCD18inpatientswithvariousstagesofdiabeticretinopathyandtodeterminetheirdifferentexpressionpatterninthedevelopmentofdiabeticretinopathy(DR).·METHODS:LevelsofserumsICAM-1andCD18onthesurfaceofneutrophileweremeasuredin41DRpatients,theywereclassifiedinthreesubgroupsaccordingtothestageofretinopathyasdeterminedbyfund’sophthalmoscopy;10controlsubjectswerealsostudied.sICAM-1weremeasuredbyenzyme-linkedimmunosorbentassayandCD18byflowcytometry.·RESULTS:TheneutrophilicCD18expressionandserumsICAM-1levelwereallsignificantlyelevatedinalldiabeticsubgroupscomparedtocontrolsubjects(P<0.01).ThedifferencesofCD18andsICAM-1amongthediabeticsubgroupsweresignificantinCD18butnotinsICAM-1.TheprogressionofretinopathywasassociatedwithanincreasebothinCD18andinsICAM-1levelsbysimplecorrelationanalysis(β=0.74,P<0.001;β=0.38,P<0.01,respectively).ButstepwisemultipleregressionanalysisrevealedthatonlyCD18wasindependentdeterminantofretinopathy(β=1.04,P<0.01).·CONCLUSION:OurresultsconfirmthecontributionofendothelialandneutrophilicactivationinthedevelopmentofDRasindicatedbyincreasedlevelsofCD18andsICAM-1.However,adirectimplicationofCD18andICAM-1intheprogressionofDRcanbesupportedonlyintheCD18butnotICAM-1.CD18andICAM-1mayplaydifferentroleinthedevelopmentofdiabeticretinopathy.
简介:3型Stargardt病(STGD3,MIM600110)是一种常染色体显性遗传的早发性黄斑营养不良性疾病,是一种单基因遗传性疾病。目前为止,已知的STGD3致病基因为极长链脂肪酸延长酶4基因(ELOVL4)。ELOVIA是位于内质网上的一种调节极长链饱和及多不饱和脂肪酸生物合成的限速缩合反应中不可或缺的膜蛋白。作为一种遗传性疾病,STGD3目前仍无有效治疗方法。然而,饮食补充极长链多不饱和脂肪酸可能是治疗STGD3的一种可行疗法。对STGD3基因及致病机制的研究可能将有助于发现STGD3的有效治疗方法及进一步了解其他遗传性视网膜变性疾病和更复杂的年龄相关性黄斑变性。
简介:AIM:Topresenttheoutcomeofmodifiedgridlaserphotocoagulation(GLP)indiffusediabeticmacularedema(DDME)ineyeswithoutextrafovealand/orvitreofovealtraction.METHODS:InclusioncriteriafortheretrospectivestudywereDDMEeyesofpatientswithtypeⅡdiabetesmellitusthathad≥4monthsoffollow-upfollowingGLP.Onlyoneeyeperpatientwasanalyzed.Using3-Dspectral-domainopticalcoherencetomography(3-DSDOCT),eyesthathadeitherextrafovealorvitreofovealtraction,orhadbeenpreviouslytreatedbyanintravitrealmedication(s)wereexcluded.TreatedDDMEeyesweredividedinto4groups:A)'Classic'DDMEthatinvolvedthecentralmacula;B)edemadidnotinvolvethemacularcenter;C)eyesassociatedwithcentralepiretinalmembrane(ERM);D)DDMEthatwasassociatedwithmacularcapillarydropout≥2disc-diameter(DD).RESULTS:GLPoutcomein35DDMEeyesafter4-24(mean,13.1±6.9)monthswasasfollows:GroupA)18eyeswith'classic'DDME.Followingoneor2(mean,1.2)GLPtreatments,best-correctedvisualacuity(BCVA)improvedby1-2Snellenlinesin44.4%(8/18)ofeyes,andworsenedby1linein11.1%(2/18).Centralmacularthickness(CMT)improvedby7%-49%(mean,26.6%)in77.8%(14/18)ofeyes.CausesofCMTworsening(n=4)werecommonlyexplainable,predominantly(n=3)associatedwithemergenceofextrafovealtraction,5-9monthspost-GLP.GroupB)GLP(s)inDDMEthatdidnotinvolvethemacularcenter(n=6)resultedinimprovedBCVAby1-2linesin2eyes.However,thecentralmaculabecameinvolvedintheedemaprocessaftertheGLPin3(50%)eyes,associatedwithanemergenceofextrafovealtractioninoneoftheseeyes4monthsfollowingtheGLP.GroupC)GLPfailedinall5eyesassociatedwithcentralERM.GroupD)GLPwasofpartialbenefitin2of6treatedeyeswithmacularcapillarydropout≥2DD.CONCLUSION:EyeswithDDMEthatinvolvedthemacularcenterwerefoundtoachievefavourableoutcomesafterGLP(s)duringmid-termfollow-up,unlesscomplicatedpre-GLPorpost-GLPbyvltreoretinalinterfaceabnormalities,oftenextrafovealtra
简介:目的:探讨糖尿病患者黄斑中心凹下脉络膜厚度(SFCT)与脉络膜血流动力学指数及糖化血红蛋白之间的关系。方法:选择在我院眼科及内分泌科住院治疗的2型糖尿病患者78例156眼作为研究对象。其中男39例,女39例,平均(59.8±6.2)岁。根据ETDRS糖尿病视网膜病变分级方法,将患者分为无视网膜病变组、轻中度NPDR组、重度NPDR组、PDR组。采用EDI-OCT与超声多普勒对四组患者进行脉络膜厚度测量与脉络膜血流动力学指数测量。并记录所有患者的血糖化血红蛋白含量。采用多元线性回归分析SFCT与血流动力学指数与糖化血红蛋白的相关性。结果:NDR患者组舒张末期血流速度(EDV)明显高于其它患者组,SFCT较其它各组偏薄,差异有统计学意义。四组患者收缩期峰值血流速度(PSV)无统计学差异;重度NPDR组血管阻力指数(RI)高于NDR组及轻中度NPDR组;PDR组RI进一步增高,差异有统计学意义。SFCT与糖化血红蛋白有显著正相关性(b=0.540,P〈0.001);SFCT与DR分级(P=0.341)、PSV(P=0.770)、EDV(P=0.131)及RI(P=0.084)无显著相关性。结论:糖尿病患者SFCT与血流动力学各指数无相关性。糖化血红蛋白是糖尿病患者SFCT的影响因素之一。
简介:目的:探讨雷珠单抗(ranibizumab)治疗特发性脉络膜新生血管(idiopathicchoroidalneovascularization,ICNV)的有效性,分析在光学相干断层扫描(opticalcoherencetomography,OCT)下不同形态表现的特发性脉络膜新生血管(Ⅰ型和Ⅱ型)的疗效差异,进一步为雷珠单抗在治疗脉络膜新生血管的有效性提供±据,指导临床治疗。方法:对我院2013-10/2014-06的31例(Ⅰ型9例,Ⅱ型22例)诊断为"ICNV冶并接受玻璃体腔注射雷珠单抗的患者资料进行回顾性分析,比较分析最佳矫正视力(best-correctedvisualacuity,BCVA)和OCT测量病灶处视网膜最大厚度的变化趋势有无不同。结果:患者31例(其中Ⅰ型9例,Ⅱ型22例)经统计学分析,在术前与术后1,3moBCVA和病灶视网膜最大厚度的比较具有统计学意义,不同ICNV类型患者治疗前后的最佳矫正视力及病灶处视网膜最大厚度的变化趋势的差异无统计学意义,说明雷珠单抗玻璃体腔注射对于治疗特发性脉络膜新生血管疗效肯定,对于Ⅰ型和Ⅱ型ICNV的临床治疗效果不具显著性差异。结论:玻璃体腔注射雷珠单抗治疗特发性脉络膜新生血管疗效肯定,对于Ⅰ型和Ⅱ型ICNV本组研究中尚未发现存在疗效差异。其安全性和远期并发症需进一步研究证实。
简介:目的研究转录因子扭曲基因(Twist)在喉鳞癌(LSCC)中的表达及其通过对上皮型钙黏附蛋白(E-cadherin)、神经型钙黏附蛋白(N-cadherin)的作用在判断肿瘤的生物学行为方面的意义。方法采用免疫组织化学SP法及反转录聚合酶链反应(RT-PCR)方法检测49例喉鳞癌及20例癌旁组织中Twist、E-cadherin和N-cadherin基因的表达情况。结果Twist在喉癌组织中的阳性表达率(61.22%)明显高于癌旁组织(25%)(P〈0.01);Twist在喉癌组织中的mRNA相对表达量(0.93±0.39)明显高于癌旁组织(0.57±0.24)(P〈0.01);Twist在喉癌中蛋白及mRNA表达均与淋巴结转移、临床分期相关,而与肿瘤病理学分级、临床分型及年龄无关。在mRNA及蛋白水平,Twist与E-cadherin,N-cadherin与E-cadherin的表达均呈负相关;Twist与N-cadherin均呈正相关。结论Twist在喉鳞癌中过度表达,可能通过分别上调N-cadherin和下调E-cadherin的表达,进而在喉鳞癌的浸润、转移过程中发挥重要作用。