运用光学相干断层扫描血管成像技术分析无眼底病变的糖尿病患者黄斑区变化
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摘要
目的通过光学相干断层扫描血管成像技术(OCTA)分析正常人与无眼底病变的糖尿病(DM)黄斑区变化。方法共纳入患者85例(共144眼),其中无糖尿病视网膜病变(NDR)的DM患者41例(共74眼)为NDR组,慢性结膜炎等眼表疾病患者44例(共70眼)为对照组。所有受检者均需先行最佳矫正视力、裂隙灯及眼底检查,然后行OCTA检查,使用最新版分析软件,获取受检者的视网膜厚度、图像质量、中心凹无血管区(FAZ)面积、周长、非圆指数(AI)以及中心凹旁300μm血流密度(FD-300)、旁中心凹浅层及深层视网膜血流密度等一系列参数。结果 NDR组与对照组相比,视网膜的厚度和浅层视网膜血流密度两组间的差异无统计学意义(P均>0.05)。NDR组与对照组相比,FAZ面积及周长均增大,差异有统计学意义(P均<0.05);NDR组与对照组相比,AI增加,差异有统计学意义(P<0.05);而NDR组与对照组对比,FD-300及中心凹深层视网膜血流密度均下降,组间差异有统计学意义(P均<0.05)。结论通过OCTA分析,DM患者在出现眼底视网膜病变之前,FAZ面积、周长及AI增加,FD-300及旁中心凹深层视网膜血流密度下降,这为DM患者出现临床眼底改变之前提供新的监测指标。
Objective Using optical coherence tomography angiography(OCTA) to observe the changes of macular between normal people and no diabetic retinopathy person.Methods A total of 85 patients(144 eyes) were selected. 41 patients(74 eyes) no diabetic retinopathy(NDR) were selected as experimental group and 44 patients(70 eyes in total) with chronic conjunctivitis and other ocular surface diseases were selected as control group.All subject should measure the best vision, slit lamp and preset lens first. And then check the OCTA, and using the latest version of analysis software to measure the subject′s retinal thickness, image quality, the foveal avascular zone area(FAZ) area and circumferences, A-circularity index(AI), center recess 300 μm blood flow density, central fovea shallow layer and deep blood flow density.Results Compared with the control group, there was no statistically significant difference between the thickness of the retina and the blood flow density in the shallow layer(P>0.05). Between the two groups, FAZ′s area and circumference increases, the area of NDR group and control group were(0.315±0.100) mm~2 and(0.266±0.106) mm~2, it′s circumference were(2.267±0.375) mm and(1.982±0.398) mm, The difference between the two groups was statistically significant(P<0.05).Compared with the group, NDR group′s AI was increased, and the AI values of the NDR group and the control group were(1.153±0.049) and(1.106±0.035), respectively. The difference between the two groups was statistically significant(P<0.05). NDR group and control group in the center recess 300 μm blood flow density were reduced, two groups respectively were(47.372±3.734),(49.035±4.750), and the difference between the two group displayed a statistical significance(P<0.05). It was found that that deep blood flow density of NDR group and control group were reduced by(49.511±4.673),(52.139±4.038), respectively, and there was statistical difference between the two group(P<0.05).Conclusion Through the quantitative analysis of OCTA, patients with diabetes before the emergence of retinopathy, FAZ area and the circumference and AI increased, the FD-300 and the density of the blood flow in the central fovea concave depression were decreased, which provided before the new monitoring method for patients with diabetes clinical fundus changes.
Objective Using optical coherence tomography angiography(OCTA) to observe the changes of macular between normal people and no diabetic retinopathy person.Methods A total of 85 patients(144 eyes) were selected. 41 patients(74 eyes) no diabetic retinopathy(NDR) were selected as experimental group and 44 patients(70 eyes in total) with chronic conjunctivitis and other ocular surface diseases were selected as control group.All subject should measure the best vision, slit lamp and preset lens first. And then check the OCTA, and using the latest version of analysis software to measure the subject′s retinal thickness, image quality, the foveal avascular zone area(FAZ) area and circumferences, A-circularity index(AI), center recess 300 μm blood flow density, central fovea shallow layer and deep blood flow density.Results Compared with the control group, there was no statistically significant difference between the thickness of the retina and the blood flow density in the shallow layer(P>0.05). Between the two groups, FAZ′s area and circumference increases, the area of NDR group and control group were(0.315±0.100) mm~2 and(0.266±0.106) mm~2, it′s circumference were(2.267±0.375) mm and(1.982±0.398) mm, The difference between the two groups was statistically significant(P<0.05).Compared with the group, NDR group′s AI was increased, and the AI values of the NDR group and the control group were(1.153±0.049) and(1.106±0.035), respectively. The difference between the two groups was statistically significant(P<0.05). NDR group and control group in the center recess 300 μm blood flow density were reduced, two groups respectively were(47.372±3.734),(49.035±4.750), and the difference between the two group displayed a statistical significance(P<0.05). It was found that that deep blood flow density of NDR group and control group were reduced by(49.511±4.673),(52.139±4.038), respectively, and there was statistical difference between the two group(P<0.05).Conclusion Through the quantitative analysis of OCTA, patients with diabetes before the emergence of retinopathy, FAZ area and the circumference and AI increased, the FD-300 and the density of the blood flow in the central fovea concave depression were decreased, which provided before the new monitoring method for patients with diabetes clinical fundus changes.
引文
[1] Cao D,Yang D,Yu H,et al.Optic nerve head perfusion changes preceding peripapillary retinal nerve fiber layer thinning in preclinical diabetic retinopathy[J].Clin Exp Ophthalmol,2018,doi:10.1111/ceo.13390.
[2] Bain S C,Klufa M A,Ho A,et al.Worsening diabetic retinopathy with rapid improvement in systemic glucose control:a review[J].Diabetes Obes Metab,2019,21(3):454-66.
[3] Spaide R F,Klancnik J M,Cooney M J.Retinal vascular layers imaged by fluorescein angiography and optical coherence tomography angiography[J].JAMA Ophthalmol,2015,133(1):45-50.
[4] Kim K,Kim E S,Yu S Y.Optical coherence tomography angiography analysis of foveal microvascular changes and inner retinal layer thinning in patients with diabetes[J].Br J Ophthalmol,2017,102(9):1226-31.
[5] 刘青,艾明.光学相干断层扫描血管成像(OCTA)和荧光素血管造影(FFA)对比观察增生型糖尿病视网膜病变(PDR)[J].眼科新进展,2017(1):52-5.
[6] Miyamoto K,Khosrof S,Bursell S E,et al.Prevention of leukostasis and vascular leakage in streptozotocin-induced diabetic retinopathy via intercellular adhesion molecule-1 inhibition[J].Proc Natl AcadSci USA,1999,96(19):10836-41.
[7] Freiberg F J,Pfau M,Wons J,et al.Optical coherence tomography angiography of the foveal avascular zone in diabetic retinopathy[J].Graefes Arch Clin Exp Ophthalmol,2016,254(6):1051-8.
[8] Mansour A M,Schachat A,Bodiford G,et al.Foveal avascular zone in diabetes mellitus[J].Retina,1993,13(2):125-8.
[9] Di G,Weihong Y,Xiao Z,et al.A morphological study of the foveal avascular zone in patients with diabetes mellitus using optical coherence tomography angiography[J].Graefes Arch Clin Exp Ophthalmol,2016,254(5):873-9.
[10] 向湘,马红婕,唐仕波.OCTA在DR患者黄斑血流密度观察中的应用[J].国际眼科杂志,2017,17(7):1344-7.
[11] 王健,陈松,何广辉,等.无明显糖尿病视网膜病变的2型糖尿病患者黄斑区微血管改变的光相干断层扫描血管成像观察[J].中华眼底病杂志,2017,33(1):15-8.
[12] Hwang T S,Jia Y,Gao S S,et al.Optical coherence tomography angiography features of diabetic retinopathy[J].Retina,2015,35(11):2371-6.
[13] Li Z,Alzogool M,Xiao J,et al.Optical coherence tomography angiography findings of neurovascular changes in type 2 diabetes mellitus patients without clinical diabetic retinopathy[J].Acta Diabetol,2018,55(10):1075-82.
[14] 黄江,徐国旭,魏晓红,等.无明显糖尿病视网膜病变的2型糖尿病患者多焦视网膜电图特征分析[J].中华眼底病杂志,2013,29(5):487-9.
[2] Bain S C,Klufa M A,Ho A,et al.Worsening diabetic retinopathy with rapid improvement in systemic glucose control:a review[J].Diabetes Obes Metab,2019,21(3):454-66.
[3] Spaide R F,Klancnik J M,Cooney M J.Retinal vascular layers imaged by fluorescein angiography and optical coherence tomography angiography[J].JAMA Ophthalmol,2015,133(1):45-50.
[4] Kim K,Kim E S,Yu S Y.Optical coherence tomography angiography analysis of foveal microvascular changes and inner retinal layer thinning in patients with diabetes[J].Br J Ophthalmol,2017,102(9):1226-31.
[5] 刘青,艾明.光学相干断层扫描血管成像(OCTA)和荧光素血管造影(FFA)对比观察增生型糖尿病视网膜病变(PDR)[J].眼科新进展,2017(1):52-5.
[6] Miyamoto K,Khosrof S,Bursell S E,et al.Prevention of leukostasis and vascular leakage in streptozotocin-induced diabetic retinopathy via intercellular adhesion molecule-1 inhibition[J].Proc Natl AcadSci USA,1999,96(19):10836-41.
[7] Freiberg F J,Pfau M,Wons J,et al.Optical coherence tomography angiography of the foveal avascular zone in diabetic retinopathy[J].Graefes Arch Clin Exp Ophthalmol,2016,254(6):1051-8.
[8] Mansour A M,Schachat A,Bodiford G,et al.Foveal avascular zone in diabetes mellitus[J].Retina,1993,13(2):125-8.
[9] Di G,Weihong Y,Xiao Z,et al.A morphological study of the foveal avascular zone in patients with diabetes mellitus using optical coherence tomography angiography[J].Graefes Arch Clin Exp Ophthalmol,2016,254(5):873-9.
[10] 向湘,马红婕,唐仕波.OCTA在DR患者黄斑血流密度观察中的应用[J].国际眼科杂志,2017,17(7):1344-7.
[11] 王健,陈松,何广辉,等.无明显糖尿病视网膜病变的2型糖尿病患者黄斑区微血管改变的光相干断层扫描血管成像观察[J].中华眼底病杂志,2017,33(1):15-8.
[12] Hwang T S,Jia Y,Gao S S,et al.Optical coherence tomography angiography features of diabetic retinopathy[J].Retina,2015,35(11):2371-6.
[13] Li Z,Alzogool M,Xiao J,et al.Optical coherence tomography angiography findings of neurovascular changes in type 2 diabetes mellitus patients without clinical diabetic retinopathy[J].Acta Diabetol,2018,55(10):1075-82.
[14] 黄江,徐国旭,魏晓红,等.无明显糖尿病视网膜病变的2型糖尿病患者多焦视网膜电图特征分析[J].中华眼底病杂志,2013,29(5):487-9.