<
class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-pagination: widow-orphan" align=left><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"> 糖尿病性视网膜病变<SPAN lang=EN-US><?xml:namespace prefix = o ns = "urn:schemas-microsoft-com
ffice
ffice" /><o:p></o:p></SPAN></SPAN></P>
<
class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-pagination: widow-orphan" align=left><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">糖尿病性视网膜病变的发病率及致盲率有明显增高趋势。据统计，有<SPAN lang=EN-US>10</SPAN>年糖尿病史者，<SPAN lang=EN-US>7%</SPAN>有视网膜病变，<SPAN lang=EN-US>15</SPAN>年者约<SPAN lang=EN-US>25%</SPAN>，<SPAN lang=EN-US>15</SPAN>年以上者达<SPAN lang=EN-US>63%</SPAN>。糖尿病是糖代谢紊乱为主的多系统疾病，易导致视网膜组织代谢紊乱，致使视网膜血管功能及结构异常。临床上，糖尿病视网膜病变可分为两型：<SPAN lang=EN-US><o:p></o:p></SPAN></SPAN></P>
<
class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-pagination: widow-orphan" align=left><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">（一）单纯性糖尿病性视网膜病变<SPAN lang=EN-US><o:p></o:p></SPAN></SPAN></P>
<
class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-pagination: widow-orphan" align=left><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">此型较多见，进展缓慢。主要改变有小动脉缺血和血管的渗透性改变。在视网膜后极部首先出现微动脉瘤、出血、渗出物和静脉扩张。这些病变多发生在糖尿病未能控制而病程较久的病例。微动脉瘤数目不等，常位于后极部视网膜深层，呈紫红色小球状，是由于视网膜循环障碍血液淤滞，组织缺氧使毛细血管变薄、扩张所致。出血可为圆形或不规则的小出血斑，位于视网膜外网状层，棉絮状渗出物是由于视网膜小动脉末梢闭塞导致局部视网膜缺血所致。淡黄色硬性渗出物边缘清楚，有时混杂有发亮的胆固醇结晶，围绕黄斑区呈环状排列。视网膜静脉扩张，甚至可呈腊肠状。荧光血管造影时，微动脉瘤在静脉早期充盈，通常表现为边界清晰的小圆形荧光点，大小约<SPAN lang=EN-US>20</SPAN>～<SPAN lang=EN-US>30</SPAN>微米、间或可见微动脉瘤与微动脉瘤相连，常在小的毛细血管闭塞区周围出现，由扩张的毛细血管将微动脉瘤连接形成串珠状外观。毛细血管扩张可显示荧光渗漏。毛细血管无灌注区是较严重的视网膜病变，荧光造影表现为视网膜上呈斑点状或片状无荧光暗区。当动、静脉相互交通和短路时，有轻度的荧光素渗漏。硬性渗出物边缘有荧光素渗漏。黄斑囊样小肿则表现为围绕中心凹排列的花辨状或图案。<SPAN lang=EN-US><o:p></o:p></SPAN></SPAN></P>
<
class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-pagination: widow-orphan" align=left><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">（二）增殖性糖尿病性视网膜病变<SPAN lang=EN-US><o:p></o:p></SPAN></SPAN></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-pagination: widow-orphan" align=left><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">此型特征是在单纯性糖尿病性视网膜病变的基础上，出现新生血管及增殖性病变。脆弱的新生血管易引起反复出血，伴有视网膜纤维组织增殖。新生血管形成是从血管内皮细胞芽开始，可通过内界膜伸展到视网膜表面。视盘前新生血管纤维增殖，通常呈扇形或辐射状伸长，常粘附在玻璃体后面，甚至突入玻璃体中，可导致玻璃体出血和牵拉性视网膜脱离。（表<SPAN lang=EN-US>12</SPAN>－<SPAN lang=EN-US>2</SPAN>）（图<SPAN lang=EN-US>12</SPAN>－<SPAN lang=EN-US>11</SPAN>）<SPAN lang=EN-US><o:p></o:p></SPAN></SPAN></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-pagination: widow-orphan" align=left><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">表<SPAN lang=EN-US>12</SPAN>－<SPAN lang=EN-US>2 </SPAN>糖尿病性视网膜病变分期标准<SPAN lang=EN-US><o:p></o:p></SPAN></SPAN></P>
<DIV align=center>
<TABLE class=MsoNormalTable style="WIDTH: 360pt; mso-cellspacing: .7pt; mso-padding-alt: 5.25pt 5.25pt 5.25pt 5.25pt" cellSpacing=1 cellPadding=0 width=480 border=1>
<TBODY>
<TR style="mso-yfti-irow: 0; mso-yfti-firstrow: yes">
<TD style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 5.25pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 5.25pt; PADDING-BOTTOM: 5.25pt; BORDER-LEFT: #ece9d8; PADDING-TOP: 5.25pt; BORDER-BOTTOM: #ece9d8; BACKGROUND-COLOR: transparent" colSpan=3>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-pagination: widow-orphan" align=left><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">型 期<SPAN lang=EN-US> </SPAN>视 网 膜 病 变</SPAN><SPAN lang=EN-US style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"><o:p></o:p></SPAN></P></TD></TR>
<TR style="mso-yfti-irow: 1">
<TD style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 5.25pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 5.25pt; PADDING-BOTTOM: 5.25pt; BORDER-LEFT: #ece9d8; WIDTH: 10%; PADDING-TOP: 5.25pt; BORDER-BOTTOM: #ece9d8; BACKGROUND-COLOR: transparent" width="10%">
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-pagination: widow-orphan" align=left><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"> </SPAN><SPAN lang=EN-US style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"><o:p></o:p></SPAN></P></TD>
<TD style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 5.25pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 5.25pt; PADDING-BOTTOM: 5.25pt; BORDER-LEFT: #ece9d8; WIDTH: 7%; PADDING-TOP: 5.25pt; BORDER-BOTTOM: #ece9d8; BACKGROUND-COLOR: transparent" width="7%">
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-pagination: widow-orphan" align=left><SPAN lang=EN-US style="FONT-SIZE: 10pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">Ⅰ</SPAN><SPAN lang=EN-US style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"><o:p></o:p></SPAN></P></TD>
<TD style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 5.25pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 5.25pt; PADDING-BOTTOM: 5.25pt; BORDER-LEFT: #ece9d8; WIDTH: 84%; PADDING-TOP: 5.25pt; BORDER-BOTTOM: #ece9d8; BACKGROUND-COLOR: transparent" width="84%">
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-pagination: widow-orphan" align=left><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">有微动脉瘤或并有小出血点：<SPAN lang=EN-US>(+)</SPAN>较少<SPAN lang=EN-US>,</SPAN>易数；<SPAN lang=EN-US>(++)</SPAN>较多不易数；荧光造影时血点不显影</SPAN><SPAN lang=EN-US style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"><o:p></o:p></SPAN></P></TD></TR>
<TR style="mso-yfti-irow: 2">
<TD style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 5.25pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 5.25pt; PADDING-BOTTOM: 5.25pt; BORDER-LEFT: #ece9d8; WIDTH: 10%; PADDING-TOP: 5.25pt; BORDER-BOTTOM: #ece9d8; BACKGROUND-COLOR: transparent" width="10%">
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-pagination: widow-orphan" align=left><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">单纯型</SPAN><SPAN lang=EN-US style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"><o:p></o:p></SPAN></P></TD>
<TD style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 5.25pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 5.25pt; PADDING-BOTTOM: 5.25pt; BORDER-LEFT: #ece9d8; WIDTH: 7%; PADDING-TOP: 5.25pt; BORDER-BOTTOM: #ece9d8; BACKGROUND-COLOR: transparent" width="7%">
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-pagination: widow-orphan" align=left><SPAN lang=EN-US style="FONT-SIZE: 10pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">Ⅱ</SPAN><SPAN lang=EN-US style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"><o:p></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-pagination: widow-orphan" align=left><SPAN lang=EN-US style="FONT-SIZE: 10pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">Ⅲ</SPAN><SPAN lang=EN-US style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"><o:p></o:p></SPAN></P></TD>
<TD style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 5.25pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 5.25pt; PADDING-BOTTOM: 5.25pt; BORDER-LEFT: #ece9d8; WIDTH: 84%; PADDING-TOP: 5.25pt; BORDER-BOTTOM: #ece9d8; BACKGROUND-COLOR: transparent" width="84%">
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-pagination: widow-orphan" align=left><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">有黄白色<SPAN lang=EN-US>"</SPAN>硬性渗出<SPAN lang=EN-US>"</SPAN>或并有出血斑：<SPAN lang=EN-US>(+)</SPAN>较少，易数；（<SPAN lang=EN-US>++</SPAN>）较多，不易数</SPAN><SPAN lang=EN-US style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"><o:p></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-pagination: widow-orphan" align=left><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">有白色<SPAN lang=EN-US>“</SPAN>软性渗出<SPAN lang=EN-US>”</SPAN>或并有出血斑：（<SPAN lang=EN-US>+</SPAN>）较少，易数；（<SPAN lang=EN-US>++</SPAN>）较多，不易数</SPAN><SPAN lang=EN-US style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"><o:p></o:p></SPAN></P></TD></TR>
<TR style="mso-yfti-irow: 3; mso-yfti-lastrow: yes">
<TD style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 5.25pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 5.25pt; PADDING-BOTTOM: 5.25pt; BORDER-LEFT: #ece9d8; WIDTH: 10%; PADDING-TOP: 5.25pt; BORDER-BOTTOM: #ece9d8; BACKGROUND-COLOR: transparent" width="10%">
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-pagination: widow-orphan" align=left><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">增殖型</SPAN><SPAN lang=EN-US style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"><o:p></o:p></SPAN></P></TD>
<TD style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 5.25pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 5.25pt; PADDING-BOTTOM: 5.25pt; BORDER-LEFT: #ece9d8; WIDTH: 7%; PADDING-TOP: 5.25pt; BORDER-BOTTOM: #ece9d8; BACKGROUND-COLOR: transparent" width="7%">
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-pagination: widow-orphan" align=left><SPAN lang=EN-US style="FONT-SIZE: 10pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">Ⅳ</SPAN><SPAN lang=EN-US style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"><o:p></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-pagination: widow-orphan" align=left><SPAN lang=EN-US style="FONT-SIZE: 10pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">Ⅴ</SPAN><SPAN lang=EN-US style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"><o:p></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-pagination: widow-orphan" align=left><SPAN lang=EN-US style="FONT-SIZE: 10pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">Ⅵ</SPAN><SPAN lang=EN-US style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"><o:p></o:p></SPAN></P></TD>
<TD style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 5.25pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 5.25pt; PADDING-BOTTOM: 5.25pt; BORDER-LEFT: #ece9d8; WIDTH: 84%; PADDING-TOP: 5.25pt; BORDER-BOTTOM: #ece9d8; BACKGROUND-COLOR: transparent" width="84%">
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-pagination: widow-orphan" align=left><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">眼底有新生血管或并有玻璃体出血</SPAN><SPAN lang=EN-US style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"><o:p></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-pagination: widow-orphan" align=left><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">眼底有新生血管和纤维增殖<SPAN lang=EN-US>(</SPAN>后者更易发生于高血压病人<SPAN lang=EN-US>)</SPAN></SPAN><SPAN lang=EN-US style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"><o:p></o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-pagination: widow-orphan" align=left><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">眼底有新生血管和纤维增殖<SPAN lang=EN-US>,</SPAN>并发视网膜脱离</SPAN><SPAN lang=EN-US style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"><o:p></o:p></SPAN></P></TD></TR></TBODY></TABLE></DIV>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: center; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-pagination: widow-orphan" align=center><SPAN lang=EN-US style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"><o:p> </o:p></SPAN></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-pagination: widow-orphan" align=left><SPAN lang=EN-US style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt"><SPAN style="mso-spacerun: yes"> </SPAN>(</SPAN><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">三<SPAN lang=EN-US>)</SPAN>治疗<SPAN lang=EN-US><o:p></o:p></SPAN></SPAN></P>
<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-pagination: widow-orphan" align=left><SPAN style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt">早期用饮食及药物控制糖尿病<SPAN lang=EN-US>.</SPAN>每年定期作眼底荧光血管造影，对增殖型早期应采用激光凝固术治疗病变区，或采用广泛视网膜光凝术。对玻璃体出血引起混浊和机化，可试行玻璃体切割术。<SPAN lang=EN-US><o:p></o:p></SPAN></SPAN></P>
