终末期糖尿病肾病患者围血液透析期眼部相关参数变化
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Changes of ocular related parameters in peri-hemodialysis in patients with end-stage diabetic nephropathy
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    摘要:

    目的:观察终末期糖尿病肾病(end-stage diabetic nephropathy,ESDN)患者围血液透析期眼压(intraocular pressure,IOP)、眼灌注压(ocular perfusion pressure,OPP)、中央前房深度(central anterior chamber depth,CACD)和黄斑中心凹下脉络膜厚度(subfoveal choroidal thickness,SFCT)变化的特点,评估血液透析(hemodialysis,HD)对ESDN患者眼部血供的可能影响。

    方法:病例前后对照研究。观察我院肾病科HD治疗的ESDN患者42例84眼,在HD开始前30min、开始后2h、结束后30min内,分别测量收缩压和舒张压,手持式回弹式眼压计测量眼压,经换算得出OPP(OPP=4/9舒张压+2/9收缩压-眼压)。HD开始前30min和结束后30min内,分别采用光学相干生物测量仪测量CACD,光学相干断层扫描(optical coherence tomography,OCT)测量SFCT。对HD前后各测量参数采用方差齐性检验、ANOVA分析、LSD-t组间比较和配对样本t检验进行统计学分析。

    结果:ESDN患者84眼中,HD开始前30min、开始后2h与结束后30min相比,收缩压差异无统计学意义(F=0.254,P=0.783); 舒张压差异无统计学意义(F=0.114,P=0.896); IOP差异有统计学意义(F=7.527,P=0.001); OPP差异有统计学意义(F=4.692,P=0.027)。HD开始前30min与开始后2h相比,IOP差异有统计学意义(t=-3.646,P=0.001),IOP较HD前升高; OPP差异有统计学意义(t=2.321,P=0.022),OPP较HD前降低。HD开始前30min与结束后30min相比,IOP差异有统计学意义(t=-2.977,P=0.003),IOP较HD前升高; OPP差异无统计学意义(t=0.219,P=0.872); CACD差异有统计学意义(t=6.291,P<0.05),CACD较HD前变浅; SFCT差异有统计学意义(t=5.736,P<0.05),SFCT较HD前变薄。

    结论:HD后可致ESDN患者IOP不同程度升高,OPP一过性降低,前房变浅,脉络膜血供减少。HD前应评估ESDN患者的眼部状况,采取有效的监测和预防措施,降低HD引起眼部血供状态变化对视功能的可能影响。

    Abstract:

    AIM: To observe the changes of intraocular pressure(IOP), ocular perfusion pressure(OPP), central anterior chamber depth(CACD)and subfoveal choroidal thickness(SFCT)in peri-hemodialysis in patients with end-stage diabetic nephropathy(ESDN), for evaluating the influences of hemodialysis(HD)on ocular blood supply of the ESDN patients.

    METHODS: Totally 42 cases(84 eyes)of ESDN patients treated with HD in the Department of Nephrology were observed. Systolic and diastolic blood pressure, IOP with the hand-held rebound tonometer were measured at 30min before HD, 2h after HD duration and 30min after HD completion. OPP was calculated(OPP= 4/9 diastolic pressure + 2/9 systolic pressure - IOP). CACD measured by optical coherence measuring instrument(IOL-Master)and SFCT measured by optical coherence tomography(OCT)were observed at 30min before HD and 30min after HD completion. The outcomes were assessed by analysis of homogeneity test of variance, one-way ANOVA, LSD-t test and t-test, to look for differences of the parameters in various time of HD.

    RESULTS: Totally 84 eyes of ESDN patients: in 30min before HD, 2h after HD duration and 30min after HD completion, systolic blood pressure was no statistically significant(F=0.254, P=0.783), and diastolic blood pressure was no statistically significant(F=0.114, P=0.896), and IOP was statistically significant(F=7.527, P=0.001), and OPP was statistically significant(F=4.692, P=0.027). In 2h after HD duration and 30min after HD completion, IOP was statistically significant(t=-3.646, P=0.001), and OPP was statistically significant(t=2.321, P=0.022). In 30min before HD and 30min after HD completion, increase of IOP was statistically significant(t=-2.977, P=0.003), and OPP was no statistically significant(t=0.219, P=0.872), and decrease of CACD was statistically significant(t=6.291, P<0.05), and decrease of SFCT was statistically significant(t=5.736, P<0.05).

    CONCLUSION: IOP increasing, OPP transiently decreasing, CACD shallow and SFCT thin were presented in peri-hemodialysis. It is important to evaluate eye conditions of ESDN patients before HD, and to take effective preventive measures to reduce the possible risk factors in peri-hemodialysis.

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伊恩晖,杜兆江,贺金刚,等.终末期糖尿病肾病患者围血液透析期眼部相关参数变化.国际眼科杂志, 2018,18(10):1940-1942.

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  • 收稿日期:2018-05-14
  • 最后修改日期:2018-08-23
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  • 在线发布日期: 2018-09-14
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