全程化血糖管理在改善无明显视网膜病变的2型糖尿病性白内障患者术后视力的效果分析：基于视觉电生理和OCTA研究

doi:10.3969/j.issn.1006-5725.2024.20.012

Abstract

Abstract:

Objective Visual electrophysiology and optical correlation tomography angiography （OCTA） were used to investigate differences in preoperative retinal function in patients with type 2 diabetic cataract （DC） without obvious retinopathy （NDR） and to determine the clinical application of whole-process blood glucose management （WBGM） for improving postoperative vision in DC patients. Methods This study investigated the preoperative and postoperative visual electrophysiology （N75， P100， photopic FERG， and scotopic FERG）， peripapillary retinal nerve fiber layer （pRNFL） and peripapillary capillary vessel density （ppVD） data， as well as trends in these data changes during blood glucose management intervention. Results As the course of T2DM progressed， FBG and HbA1c increased， the N75 and P100 lategraduancy periods of patients gradually lengthened， and the photopic FERG， scotopic FERG， pRNFL， and ppVD values decreased at each postoperative time point. At the same time， the best corrected visual acuity （BCVA） of patients after surgery gradually decreased （P < 0.05）. Compared with that at 1 week after surgery， the BCVA of Group A （without whole-process blood glucose management） gradually increased at 1 month and 3 months after surgery but showed a downward trend at 1 year after surgery. The BCVA of Group B （with whole-process blood glucose management） gradually stabilized at 1 month after surgery， and at all time points after surgery， the BCVA of Group B was better than that of Group A. The results showed that N75 and P100 in Group A were greater than those in Group B， while the photopic and scotopic FERG， pRNFL， and ppVD （%） in Group A were lower than those in Group B. In addition， N75 and P100 in Group A showed a gradual prolongation trend at various time points after surgery， while photopic FERG， scotopic FERG， pRNFL， and ppVD （%） showed a gradually decreasing trend. However， the above data in Group B gradually stabilized at 3 months after DC surgery， approaching the preoperative level of the group （P < 0.05）. In the state of whole blood glucose management， although N75 and P100 both reached their longest durations at 1 week after surgery， N75， P100， photopic FERG， scotopic FERG， and pRNFL showed a gradually decreasing trend at 1 month and 3 months after surgery， while ppVD （%） gradually increased （P < 0.05）. At various time points from 3 months to 1 year after surgery， the overall trend of the above indicators remained stable and close to the preoperative values （P > 0.05）. Conclusion According to the results of the quantitative analysis of visual electrophysiology and OCTA， in DC patients without obvious retinopathy and with the worsening of diabetes， retinal function decreased， but whole-process blood glucose management effectively restored retinal function and improved visual quality after surgery.

Key words: type 2 diabetes, visual electrophysiology, OCTA, whole-process blood glucose management, retinal function

CLC Number:

R771

Juan TANG,Fen LAN,Linxia MENG,Qinqin ZHANG,Chuanqiang DAI,Zheng LEI,Qilin FANG,Ying LI,Xiaoli WU,Tao. LI. The clinical effect of the whole process blood glucose management on improving postoperative vision in T2DM cataract patients with non-diabetic retinopathy based on visual electrophysiology and OCTA study[J]. The Journal of Practical Medicine, 2024, 40(20): 2888-2899.

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变量	OR（95%CI）	P值
性别（男/女）	1.36（0.92 ~ 1.67）	0.375
年龄/岁	0.97（0.72 ~ 1.38）	0.261
T2DM持续时间/年	1.77（1.43 ~ 2.12）	0.003
吸烟	1.62（1.31 ~ 1.96）	0.001
喝酒	1.04（0.93 ~ 1.31）	0.481
SBP ≥ 130 mmHg	1.21（0.86 ~ 1.71）	0.183
HbA1c	1.96（1.15 ~ 2.79）	0.001
FBG	2.27（1.39 ~ 3.82）	0.007
TC	1.72（0.92 ~ 2.63）	0.001
TG	1.59（1.21 ~ 1.83）	0.031
HDL-C	1.63（1.13 ~ 2.15）	0.047
LDL-C	1.47（1.15 ~ 1.74）	0.386
N75	1.74（1.31 ~ 2.43）	0.003
P100	1.54（0.97 ~ 2.13）	0.037
pRNFL	2.27（1.14 ~ 3.07）	0.007
ppVD	2.57（1.83 ~ 3.67）	0.003
明视FERG	2.17（1.46 ~ 2.83）	0.001
暗视FERG	2.06（1.37 ~ 2.87）	0.043

项目	1 ~ 5年	5 ~ 10年	10 ~ 15年	15 ~ 20年	> 20年	F值	P值
N75/ms	74.23 ± 4.34	78.67 ± 5.03	83.67 ± 4.52	90.45 ± 3.94	96.73 ± 3.49	67.82	0.037
P100/ms	107.34 ± 5.83	113.29 ± 4.91	120.78 ± 5.39	127.82 ± 6.32	137.32 ± 4.89	72.38	0.003
暗视FERG/μV	89.34 ± 5.47	83.45 ± 5.03	78.93 ± 4.38	72.38 ± 4.83	67.23 ± 5.17	68.32	0.001
明视FERG/μV	68.45 ± 4.98	62.34 ± 4.48	57.34 ± 3.91	52.37 ± 4.38	43.89 ± 4.12	69.25	0.028
pRNFL/μm	138.34 ± 12.45	134.47 ± 10.35	129.34 ± 11.88	122.39 ± 9.34	110.23 ± 10.75	67.81	0.001
ppVD/%	57.23 ± 3.92	54.39 ± 3.82	50.02 ± 2.78	45.39 ± 3.37	39.34 ± 3.39	59.03	0.002

项目	3.9 ~ 6.1 mmol/L	6.1 ~ 7.5 mmol/L	7.5 ~ 9.0 mmol/L	9.0 ~ 10.5 mmol/L	≥ 10.50 mmol/L	F值	P值
N75/ms	67.92 ± 5.29	74.37 ± 4.56	79.02 ± 3.93	89.34 ± 4.58	94.38 ± 4.78	73.18	0.038
P100/ms	102.45 ± 3.95	110.23 ± 3.43	18.54 ± 5.04	129.07 ± 5.79	141.49 ± 3.07	69.04	0.001
暗视FERG/μV	94.23 ± 6.83	87.34 ± 4.93	79.32 ± 3.92	70.72 ± 4.04	61.92 ± 4.39	78.92	0.003
明视FERG/μV	73.39 ± 5.19	67.38 ± 4.07	61.75 ± 3.86	53.49 ± 5.82	42.13 ± 3.78	65.38	0.017
pRNFL/μm	145.89 ± 10.48	137.89 ± 9.78	132.78 ± 10.57	127.47 ± 8.94	115.78 ± 9.38	59.02	0.001
ppVD/%	58.34 ± 3.02	55.49 ± 3.48	51.34 ± 3.58	43.92 ± 2.83	38.43 ± 3.49	67.32	0.029

项目	4% ~ 6%	6% ~ 8%	8% ~ 10%	10% ~ 12%	> 12%	F值	P值
N75/ms	72.94 ± 5.29	77.82 ± 4.82	84.02 ± 3.82	91.82 ± 4.17	98.38 ± 4.28	72.93	0.007
P100/ms	105.48 ± 6.72	110.38 ± 3.03	117.42 ± 4.72	125.92 ± 4.82	133.58 ± 3.72	70.48	0.002
明视FERG/μV	87.38 ± 5.82	84.53 ± 4.78	76.32 ± 4.54	69.03 ± 5.63	60.77 ± 4.43	64.38	0.003
暗视FERG/μV	69.12 ± 4.53	65.67 ± 3.92	62.02 ± 4.27	55.83 ± 4.03	46.32 ± 5.32	72.37	0.048
pRNFL/μm	141.34 ± 9.38	138.48 ± 10.82	132.49 ± 12.01	123.87 ± 10.25	111.38 ± 9.78	65.92	0.013
ppVD/%	60.49 ± 3.92	54.76 ± 4.37	48.39 ± 3.48	42.18 ± 2.94	36.54 ± 2.78	62.37	0.001

T2DM病程	术后1周	术后1个月	术后3个月	术后6个月	术后1年	F值	P值
1 ~ 5年	0.73 ± 0.23	0.76 ± 0.17	0.83 ± 0.12	0.82 ± 0.17	0.81 ± 0.15	63.15	0.031
5 ~ 10年	0.65 ± 0.15	0.69 ± 0.16	0.73 ± 0.13	0.71 ± 0.21	0.72 ± 0.14	67.34	0.015
10 ~ 15年	0.52 ± 0.17	0.58 ± 0.15	0.61 ± 0.19	0.62 ± 0.22	0.63 ± 0.18	54.78	0.001
15 ~ 20年	0.43 ± 0.18	0.49 ± 0.21	0.52 ± 0.14	0.51 ± 0.15	0.53 ± 0.17	53.17	0.001
> 20年	0.35 ± 0.12	0.42 ± 0.15	0.48 ± 0.16	0.47 ± 0.12	0.47 ± 0.13	49.03	0.017
F值	67.82	71.23	69.03	72.01	65.38
P值	0.001	0.042	0.037	0.007	0.014

The clinical effect of the whole process blood glucose management on improving postoperative vision in T2DM cataract patients with non-diabetic retinopathy based on visual electrophysiology and OCTA study

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FBG	术后1周	术后1个月	术后3个月	术后6个月	术后1年	F值	P值
3.9 ~ 6.1 mmol/L	0.74 ± 0.08	0.79 ± 0.12	0.87 ± 0.14	0.86 ± 0.11	0.84 ± 0.09	67.34	0.042
6.1 ~ 7.5 mmol/L	0.71 ± 0.18	0.74 ± 0.13	0.81 ± 0.14	0.81 ± 0.13	0.82 ± 0.13	61.34	0.001
7.5 ~ 9.0 mmol/L	0.61 ± 0.14	0.64 ± 0.12	0.71 ± 0.15	0.69 ± 0.12	0.71 ± 0.13	59.03	0.001
9.0 ~ 10.5 mmol/L	0.45 ± 0.15	0.49 ± 0.13	0.53 ± 0.15	0.54 ± 0.11	0.52 ± 0.09	62.19	0.037
≥ 10.5 mmol/L	0.35 ± 0.14	0.39 ± 0.17	0.43 ± 0.15	0.42 ± 0.13	0.43 ± 0.12	58.38	0.003
F值	64.87	67.82	72.01	68.92	69.04
P值	0.001	0.024	0.007	0.019	0.041

HbA1c	术后1周	术后1个月	术后3个月	术后6个月	术后1年	F值	P值
4% ~ 6%	0.72 ± 0.11	0.75 ± 0.13	0.84 ± 0.11	0.85 ± 0.09	0.84 ± 0.15	68.34	0.001
6% ~ 8%	0.67 ± 0.15	0.71 ± 0.15	0.79 ± 0.13	0.81 ± 0.17	0.81 ± 0.15	72.34	0.007
8% ~ 10%	0.58 ± 0.14	0.61 ± 0.13	0.65 ± 0.13	0.64 ± 0.15	0.65 ± 0.14	69.42	0.003
10% ~ 12%	0.43 ± 0.16	0.46 ± 0.12	0.49 ± 0.12	0.48 ± 0.08	0.49 ± 0.09	67.81	0.013
> 12%	0.33 ± 0.12	0.37 ± 0.13	0.42 ± 0.09	0.43 ± 0.11	0.42 ± 0.13	64.39	0.028
F值	61.39	63.48	67.32	69.02	65.19
P值	0.002	0.031	0.001	0.043	0.012

分组	术后1周	术后1个月	术后3个月	术后6个月	术后1年	F值	P值
A组视力	0.45 ± 0.13	0.53 ± 0.15	0.62 ± 0.14	0.60 ± 0.13	0.54 ± 0.13	57.86	0.002
B组视力	0.47 ± 0.18	0.72 ± 0.17	0.73 ± 0.12	0.72 ± 0.14	0.71 ± 0.11	63.64	0.001
P₁值	0.073	0.019	0.032	0.001	0.001	-	-
A组N75/ms	85.89 ± 9.34	87.45 ± 10.23	90.67 ± 8.93	92.54 ± 9.34	95.45 ± 10.23	67.38	0.001
B组N75/ms	84.34 ± 7.83	76.54 ± 6.78	75.48 ± 7.03	77.46 ± 6.93	76.94 ± 6.58	49.38	0.003
F值	0.254	0.003	0.012	0.037	0.041	-	-
A组P100/ms	118.84 ± 9.23	120.34 ± 12.31	123.43 ± 11.73	127.72 ± 9.45	130.32 ± 10.39	67.34	0.019
B组P100/ms	116.34 ± 8.84	102.37 ± 9.34	100.73 ± 8.59	101.63 ± 9.45	102.65 ± 7.48	30.45	0.031
P₂值	0.147	0.015	0.42	0.039	0.014	-	-
A组明视FERG/μV	67.45 ± 8.39	75.34 ± 9.83	73.35 ± 8.45	72.34 ± 7.93	70.54 ± 10.28	69.03	0.038
B组明视FERG/μV	68.45 ± 7.94	79.56 ± 8.48	83.45 ± 9.17	82.86 ± 8.46	84.78 ± 9.37	71.27	0.001
P₃值	0.527	0.032	0.029	0.001	0.001	-	-
A组暗视FERG/μV	53.85 ± 7.83	58.65 ± 6.94	58.67 ± 7.34	56.45 ± 7.28	52.47 ± 6.73	59.03	0.003
B组暗视FERG/μV	52.54 ± 7.04	61.35 ± 6.73	62.36 ± 8.18	63.96 ± 7.04	63.45 ± 6.94	63.45	0.001
P₄值	0.382	0.001	0.013	0.021	0.001	-	-
A组pRNFL/μm	168 ± 12.23	160 ± 12.48	141 ± 11.79	137 ± 12.32	134 ± 11.34	68.45	0.007
B组pRNFL/μm	165 ± 10.34	148 ± 11.45	142 ± 10.92	140 ± 11.37	141 ± 11.78	70.34	0.001
P₅值	0.482	0.001	0.038	0.021	0.008	-	-
A组ppVD/%	49.53 ± 3.45	52.78 ± 5.43	53.19 ± 4.78	52.46 ± 3.97	48.79 ± 4.32	58.93	0.002
B组ppVD/%	52.38 ± 3.57	58.82 ± 4.82	57.49 ± 4.57	58.05 ± 4.27	57.58 ± 4.63	61.32	0.001
P₆值	0.389	0.042	0.039	0.001	0.001	-	-

糖尿病病程	术后1周	术后1个月	术后3个月	术后6个月	术后1年	F值	P值
1 ~ 5年	156.38 ± 8.95	137.67 ± 6.89	134.58 ± 8.73	135.62 ± 9.37	134.89 ± 8.97	68.94	0.001
5 ~ 10年	158.57 ± 10.43	143.43 ± 7.47	127.43 ± 8.64	126.85 ± 7.97	128.56 ± 9.43	67.34	0.003
10 ~ 15年	161.68 ± 11.67	153.25 ± 7.88	125.74 ± 7.45	127.45 ± 9.03	124.24 ± 7.89	64.57	0.015
15 ~ 20年	164.87 ± 9.75	158.77 ± 8.65	130.54 ± 8.65	122.67 ± 7.31	119.83 ± 6.94	65.87	0.028
> 20年	169.75 ± 10.45	163.64 ± 9.47	140.54 ± 6.96	125.45 ± 6.71	112.78 ± 8.54	70.06	0.001
F值	72.45	69.06	71.38	68.48	72.87
P值	0.003	0.027	0.001	0.007	0.001

FBG	术后1周	术后1个月	术后3个月	术后6个月	术后1年	F值	P值
3.9 ~ 6.1 mmol/L	153.36 ± 8.95	145.78 ± 7.99	140.07 ± 8.04	141.68 ± 7.63	139.54 ± 8.34	54.78	0.001
6.1 ~ 7.5 mmol/L	155.75 ± 10.23	149.64 ± 9.45	137.84 ± 8.48	136.53 ± 9.17	135.63 ± 7.83	57.32	0.003
7.5 ~ 9.0 mmol/L	159.42 ± 10.47	152.56 ± 10.54	132.67 ± 9.26	128.45 ± 9.84	127.35 ± 8.48	55.84	0.047
9.0 ~ 10.5 mmol/L	163.87 ± 11.39	154.36 ± 10.48	135.67 ± 11.18	124.65 ± 9.48	120.53 ± 9.73	58.39	0.029
≥ 10.5 mmol/L	168.94 ± 11.21	164.34 ± 10.53	152.67 ± 11.02	132.53 ± 8.72	112.64 ± 8.67	59.05	0.001
F值	69.05	62.75	68.57	65.89	68.06
P值	0.001	0.025	0.031	0.017	0.019

HbA1c	术后1周	术后1个月	术后3个月	术后6个月	术后1年	F值	P值
4% ~ 6%	155.88 ± 0.11	136.87 ± 0.13	131.84 ± 0.11	132.45 ± 0.09	131.65 ± 0.15	70.64	0.019
6% ~ 8%	158.53 ± 0.15	148.42 ± 0.15	132.75 ± 0.13	128.93 ± 0.17	126.45 ± 0.15	68.45	0.024
8% ~ 10%	162.46 ± 0.14	153.34 ± 0.13	140.54 ± 0.13	126.57 ± 0.15	121.34 ± 0.14	72.43	0.001
10% ~ 12%	167.13 ± 0.16	160.65 ± 0.12	142.65 ± 0.12	123.34 ± 0.08	115.53 ± 0.09	69.06	0.001
> 12%	175.79 ± 0.12	162.53 ± 0.13	147.53 ± 0.09	124.54 ± 0.11	110.75 ± 0.13	70.64	0.007
F值	58.94	56.35	59.34	55.39	57.85
P值	0.001	0.008	0.024	0.001	0.001

糖尿病病程	术后1周	术后1个月	术后3个月	术后6个月	术后1年	F值	P值
1 ~ 5年	48.75 ± 7.93	54.49 ± 6.82	55.76 ± 8.03	55.54 ± 6.28	56.78 ± 6.79	58.32	0.007
5 ~ 10年	46.39 ± 6.74	48.96 ± 6.83	52.38 ± 6.92	53.56 ± 5.64	53.69 ± 6.73	62.76	0.001
10 ~ 15年	43.92 ± 7.38	45.76 ± 7.88	47.82 ± 7.02	48.94 ± 6.38	48.34 ± 7.32	55.34	0.019
15 ~ 20年	38.67 ± 6.72	39.43 ± 8.65	42.35 ± 8.02	43.05 ± 6.93	42.53 ± 6.83	57.38	0.002
> 20年	32.48 ± 7.01	33.89 ± 9.47	36.75 ± 6.83	36.35 ± 6.57	36.98 ± 7.26	58.83	0.001
t值	57.83	55.48	52.31	53.81	54.39
P值	0.001	0.037	0.001	0.029	0.001

FBG	术后1周	术后1个月	术后3个月	术后6个月	术后1年	F值	P值
3.9 ~ 6.1 mmol/L	47.83 ± 5.83	57.54 ± 5.97	58.43 ± 6.79	57.48 ± 6.26	58.54 ± 5.98	64.56	0.001
6.1 ~ 7.5 mmol/L	45.57 ± 5.57	50.45 ± 6.27	53.47 ± 6.92	54.38 ± 6.93	55.84 ± 5.87	67.85	0.036
7.5 ~ 9.0 mmol/L	43.47 ± 6.02	45.88 ± 6.34	48.71 ± 6.38	49.05 ± 6.19	49.49 ± 5.69	63.54	0.027
9.0 ~ 10.5 mmol/L	39.59 ± 6.27	41.27 ± 5.38	43.01 ± 6.24	42.96 ± 5.78	43.17 ± 6.04	61.96	0.031
≥ 10.5 mmol/L	33.76 ± 6.18	35.47 ± 5.86	37.24 ± 5.43	36.87 ± 6.05	37.05 ± 7.12	69.05	0.001
F值	59.45	60.34	57.83	59.04	60.46
P值	0.013	0.001	0.003	0.015	0.018

HbA1c	术后1周	术后1个月	术后3个月	术后6个月	术后1年	F值	P值
4% ~ 6%	49.45 ± 5.43	54.86 ± 5.87	55.43 ± 6.15	55.48 ± 5.67	55.94 ± 5.95	70.54	0.002
6% ~ 8%	47.39 ± 6.74	49.65 ± 6.26	52.94 ± 6.31	53.97 ± 5.63	53.86 ± 6.46	68.87	0.001
8% ~ 10%	44.58 ± 5.38	46.86 ± 4.85	49.53 ± 5.85	48.75 ± 5.47	49.65 ± 6.36	69.63	0.007
10% ~ 12%	39.37 ± 6.72	41.43 ± 4.65	44.27 ± 3.76	44.53 ± 4.87	44.73 ± 5.36	65.36	0.001
> 12%	32.94 ± 5.01	34.74 ± 5.43	36.64 ± 5.54	37.45 ± 5.04	37.84 ± 4.59	71.64	0.001
F值	60.44	59.67	64.53	63.25	60.74
P值	0.003	0.001	0.016	0.037	0.001

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