摘要: 目的：探讨微信辅助真彩广角眼底照相联合光学相干断层扫描(OCT)在糖尿病视网膜病变(DR)患者管理中的作用。方法：选取在我院确诊并参加治疗的98例DR患者，随机分为微信组和非微信组，每组49例。对比两组患者在按时回院随访依从性、对自身疾病及DR危险因素认知度、最佳矫正视力、治疗后DR出血、渗出、水肿情况以及黄斑厚度等观察指标上的差异。结果：首先使用卡方检验、t检验比较两组患者性别、年龄的差异性无统计学差异，具有可比性。在此基础上使用卡方检验比较两组患者按时回院随访依从性的差异性，观察组患者按时回院随访的比例93.88%，显著高于常规组患者73.47%，差异具有统计学意义，
χ2 = 7.470，P = 0.006 < 0.05。使用Mann Whitney检验比较两组患者自身疾病认知度得分的差异性，观察组患者的自身疾病认知度得分(91.00)，显著高于常规组患者(78.00)，差异具有统计学意义，U值 = 132.000，z = −7.707，P < 0.001。使用Mann Whitney检验比较两组患者糖尿病视网膜病危险因素认知度得分的差异性，观察组患者的糖尿病视网膜病危险因素认知度得分(85.00)，显著高于常规组患者(64.00)，差异具有统计学意义，U值 = 105.000，z = −7.788，P < 0.001。使用Mann Whitney检验、配对样本Wilcoxon检验比较两组患者治疗前后最佳矫正视力的差异性，结果显示：组间比较时，治疗前，两组的最佳矫正视力无统计学差异，U值 = 1155.000，z = −0.330，P = 0.742 > 0.05。治疗后，观察组的最佳矫正视力高于常规组，差异具有统计学意义，U值 = 736.000，z = −3.339，P = 0.001 < 0.05。组内比较时，治疗后，观察组与常规组的最佳矫正视力均显著提高，差异具有统计学意义，中位数差值 = −0.200，z = 5.691，P < 0.001；中位数差值 = −0.100，z = 3.491，P < 0.001。可知观察组患者的最佳矫正视力效果优于常规组患者。使用卡方检验比较两组患者治疗后UWFSLO改善情况，结果显示：观察组患者治疗后的SLO改善率83.67%，见图1~3显著高于常规组患者的SLO改善率61.22%，差异具有统计学意义，
χ2 = 6.186，P = 0.013 < 0.05。使用Mann Whitney检验、配对样本Wilcoxon检验比较两组患者治疗前后黄斑厚度的差异性，结果显示：组间比较时，治疗前，两组的黄斑厚度无统计学差异，U值 = 1092.000，z = −0.771，P = 0.441 > 0.05。治疗后，常规组的黄斑厚度高于观察组，差异具有统计学意义，U值 = 710.000，z = −3.486，P < 0.001。组内比较时，治疗后，观察组与常规组的黄斑厚度均显著降低，差异具有统计学意义，中位数差值 = 303.000，z = 5.877，P < 0.001；中位数差值 = 170.000，z = 4.660，P < 0.001。可知观察组患者的黄斑厚度降低效果优于常规组患者。结论：以微信平台辅助DR疾病慢病管理，可有效提升患者依从性、对疾病认知性、自我护理管理能力，从而确保本病治疗效果，值得临床推广。
Abstract: Objective: To explore the role of wechat-assisted true color wide angle fundus photography combined with Optical coherence tomography (Oct) in the management of patients with diabetic retinopathy retinopathy (DR). Methods: 98 patients with DR, who were diagnosed and treated in our hospital, were randomly divided into wechat group and non-wechat group with 49 cases in each group. To compare the difference between the two groups in compliance, cognition of self-disease and DR risk factors, best corrected visual acuity, DR hemorrhage, exudation, edema and macular thickness after treatment. Results: first, chi-square test and t-test were used to compare the difference of sex and age between the two groups. On this basis, the chi-square test was used to compare the compliance of the two groups. The proportion of the patients in the observation group returning to hospital on time was 93.88%, which was significantly higher than that in the routine group (73.47%), χ2 = 7.470, P = 0.006 < 0.05. Using Mann Whitney test to compare the difference of self-disease cognition score between the two groups, the self-disease cognition score of the Observation Group (91.00) was significantly higher than that of the routine group (78.00), the difference was statistically significant, U value = 132.000, z = −7.707, P < 0.001. Mann Whitney test was used to compare the difference of diabetic retinopathy risk factor cognition score between the two groups, and the diabetic retinopathy risk factor awareness scores of the patients in the observation group (85.00) were significantly higher than those of the patients in the conventional group (64.00), which was a statistically significant difference (U = 105.000, z = −7.788, P < 0.001). Mann Whitney test and paired sample Wilcoxon test were used to compare the difference of the best corrected visual acuity before and after treatment between the two groups, U value = 1155.000, z = −0.330, P = 0.742 > 0.05. After treatment, the best corrected visual acuity in the observation group was higher than that in the routine group, the difference was statistically significant (U = 736.000, z = −3.339, P = 0.001 < 0.05). After treatment, the best corrected visual acuity of the observation group and the routine group were significantly improved, the difference was statistically significant (median difference = −0.200, z = 5.691, P < 0.001; median difference = −0.100, z = 3.491, P < 0.001). The best corrected visual acuity in the observation group was better than that in the routine group. Chi-square test was used to compare the improvement of UWFSLO between the two groups. The results showed that the SLO improvement rate of the observation group was 83.67% as seen in Figures 1~3, which was significantly higher than that of the conventional group (61.22%), the difference was statistically significant (χ2 = 6.186, P = 0.013 < 0.05). The differences of macular thickness between the two groups before and after treatment were compared by Mann Whitney test and paired sample Wilcoxon test. The results showed that there was no significant difference in macular thickness between the two groups before treatment, U = 1092.000, z = −0.771, P = 0.441 > 0.05. After treatment, the macular thickness in the routine group was significantly higher than that in the observation group (U = 710.000, Z = −3.486, P < 0.001). After treatment, the macular thickness was significantly decreased in both groups (median difference = 303.000, z = 5.877, P < 0.001; median difference = 170.000, z = 4.660, P < 0.001). The effect of macular thickness reduction in the observation group was better than that in the routine group. Conclusion: Using Wechat platform to assist the management of chronic disease of DR can effectively improve the patients’ compliance, cognition to the disease and self-care management ability, thus ensuring the therapeutic effect of this disease, which is worthy of clinical promotion.