目的：研究并探讨眼底荧光血管造影(FFA)在糖尿病视网膜病变(DR)诊疗中的应用价值。

方法：选择2014-01/2018-02期间在我院住院且疑似发生视网膜病变的糖尿病患者130例，所有患者均接受眼底照相和FFA检查。以临床确诊结果为参照，计算眼底照相和FFA检查对DR的诊断灵敏度、特异度、准确性，并比较二者对不同程度DR的诊断符合率，分析DR的FFA检查特征，采用Kappa一致性检验对两种诊断方法与临床确诊结果之间的一致性进行分析。

结果：FFA检查对DR的诊断灵敏度、特异度、准确性分别为96.8%、97.1%、96.9%，均高于眼底照相(P<0.05)。FFA检查对DR轻度、中度、重度的诊断符合率分别为97.1%、97.0%、96.4%，均高于眼底照相，但差异均无统计学意义(P>0.05)。经Kappa一致性检验分析，FFA检查诊断结果与临床确诊结果之间的一致性良好，而眼底照相与临床确诊结果之间的一致性仅为中等。FFA检查结果显示，DR多发生于鼻侧象限，在距视盘中周部分布较多，可见视网膜内微循环异常，视网膜微血管瘤、出血点、静脉串珠、视网膜毛细血管无灌注区的数量和分布位置各有不同； 部分患者在出现视网膜微血管瘤、出血点之前，出现黄斑中心凹厚度增加、局灶性棉绒斑、局灶性视网膜毛细血管无灌注区等表现。

结论：FFA检查对DR的诊断灵敏度、特异度、准确性高，与临床确诊结果之间的一致性较强，对于眼底照相检查中的疑似病变诊断准确。

METHODS: We selected 130 hospitalized diabetic patients suspected with diabetic retinopathy from January 2014 to February 2018 in our hospital. All patients underwent fundus photography and FFA examination. We analyzed the detected retinopathy. The reference was the clinical diagnosis, to calculate the sensitivity, specificity and accuracy of fundus photography and FFA in diagnosis of diabetic retinopathy and to compare the diagnostic accuracy of fundus photography and FFA for different degrees of diabetic retinopathy. The FFA characteristics of diabetic retinopathy was analyzed. Kappa consistency test was used to analyze the consistency between the two diagnostic methods and the clinical diagnosis results.

RESULTS: The sensitivity, specificity and accuracy of FFA on diabetic retinopathy were 96.8%, 97.1%, 96.9%, all of which were above the fundus photography(P<0.05). The diagnostic accuracy of FFA in mild, moderate, severe diabetic retinopathy were 97.1%, 97.0%, 96.4%, all above the fundus photography without significance(P>0.05). The Kappa consistency test showed the consistency between the diagnosis results of FFA and clinical was good; and the consistency between the results of the clinical and fundus photography was only moderate. FFA test results showed that diabetic retinopathy were more visible in nasal retinal lesions and in the peripheral part from the optic disc, and intraretinal microvascular abnormalitie could be seen. In diabetic retinopathy, the number and distribution of retinal microangiomas, hemorrhagic spots, vein beads, and capillary non-perfusion zone were different. Some patients, before the formation of retinal microangiomas and hemorrhagic spots, had increased foveal thickness, focal cotton-wool spot and focal capillary non-perfusion zone.

CONCLUSION: FFA has high sensitivity, specificity and accuracy in the diagnosis of diabetic retinopathy. The consistency between FFA diagnosis and clinical diagnosis is strong. FFA has accurate diagnosis for suspected changes in fundus photography.