不同分期糖尿病视网膜病变患者黄斑区结构和微血管改变定量分析
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Quantitative analysis of macular structure and microvascular changes in patients with diabetic retinopathy at different stages
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    摘要:

    目的:通过光相干断层扫描(OCT)和光相干断层扫描血管造影(OCTA)检查,观察不同分期糖尿病视网膜病变(DR)患者黄斑区神经节细胞-内丛状层(GCIPL)厚度及各象限视网膜浅层毛细血管密度特征并作定量分析。方法:回顾性病例对照研究。选取2019-12/2020-05我院确诊DR患者33例54眼,并根据眼底情况分为无糖尿病视网膜病变(NDR)组6例8眼、非增殖型糖尿病视网膜病变(NPDR)组18例28眼和增殖型糖尿病视网膜病变(PDR)组9例18眼。选取同期与患者年龄相匹配的健康志愿者18例26眼作为对照组。观察并定量分析不同分期DR患者黄斑区GCIPL厚度及各象限视网膜浅层毛细血管线性密度(VD)和血管灌注密度(PD)。结果:DR组患者黄斑区各象限视网膜浅层毛细血管VD、PD及GCIPL厚度最小值均小于对照组(P<0.05)。不同分期DR患者黄斑区GCIPL厚度最小值及各象限视网膜浅层毛细血管VD组间比较均有差异(P<0.05),下方视网膜浅层毛细血管VD对DR的诊断价值最高(AUC=0.807、最佳诊断界限值为18.60mm-1、灵敏度为0.923、特异度为0.648)。DR患者黄斑区GCIPL厚度最小值与各象限视网膜浅层毛细血管VD均呈正相关(r=0.342、0.480、0.384、0.342,均P<0.05)。结论:OCT结合OCTA检查为早期评估及定期随访DR的进展提供了可重复、可定量的检测方法和监测指标。

    Abstract:

    AIM: To observe and quantitatively analyze the thickness of macular ganglion cell inner plexiform layer(GCIPL)and the characteristics of superficial retinal capillaries vessel density in different stages of diabetic retinopathy(DR)by optical coherence tomography(OCT)and optical coherence tomography angiography(OCTA).METHODS: A retrospective case-control study. Thirty-three patients with diabetic(54 eyes)were selected as the DR group from December 2019 to May 2020. Among them, six patients(8 eyes)as non-diabetic retinopathy(NDR)group, eighteen patients(28 eyes)as non-proliferative diabetic retinopathy(NPDR)group and nine patients(18 eyes)as proliferative diabetic retinopathy(PDR)group according to fundus conditions. Eighteen healthy volunteers(26 eyes)without eye disease were selected as the normal group. The macular GCIPL thickness and the values of vascular linear density(vascular density, VD)and density of vascular perfusion(perfusion density, PD)in the superficial retinal capillaries vessels in each quadrant of macular region were observed and quantitatively analyzed in DR patients with different stages. RESULTS: The VD, PD and minimum thickness of GCIPL in each quadrant of DR group was lower than that of the healthy control group(P<0.05). The minimum thickness of GCIPL in macular area and the VD of superficial retinal capillaries in each quadrant decreased significantly in patients with different stages of diabetic retinopathy(P<0.01). The inferior VD of superficial retinal capillaries vessels had the highest diagnostic value for DR(AUC=0.807, optimal diagnostic threshold value of 18.60 mm-1, sensitivity of 0.923, specificity of 0.648). The minimum thickness of GCIPL in macular area of DR patients was positively correlated with VD of superficial retinal capillaries vessels in each quadrant(r=0.342, 0.480, 0.384, 0.342, all P<0.05). CONCLUSION: OCT combined with OCTA can provide repeatable and quantifiable detection methods and monitoring indicators for early assessment and regular follow-up of DR progress.

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刘长颖,李玲娜,张怀强,等.不同分期糖尿病视网膜病变患者黄斑区结构和微血管改变定量分析.国际眼科杂志, 2021,21(11):1948-1951.

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  • 收稿日期:2021-04-15
  • 最后修改日期:2021-10-11
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  • 在线发布日期: 2021-10-22
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