系统性红斑狼疮患者黄斑区视网膜微血管变化特征

Characteristics of Macular Microvascular Changes in Patients withSystemic Lupus Erythematosus

目的:利用高分辨率光学相干断层扫描血管成像技术(OCTA)探究系统性红斑狼疮(SLE)患者黄斑区视网膜微血管形态的早期变化特征。方法:系列病例研究。收集2018年5─11月在温州医科大学附属第二医院风湿免疫科门诊就诊的SLE患者31例(62眼),分为狼疮性视网膜病(LR)组10例(17眼)和非狼疮性视网膜病(NLR)组24例(45眼)。同时招募与疾病组年龄、性别匹配的正常成年人35例(35眼)作为正常对照组。应用OCTA对所有受检者黄斑区视网膜行3 mm×3 mm模式扫描,获得黄斑区浅层及深层视网膜微血管图像,并用本实验室自行编写的分析程序将视网膜血流灌注图进行骨架化分析,获得去除中央无血管区(FAZ,0.6 mm)的总环区域(TAZ)以及进一步4分区(S、T、I、N)的浅层及深层视网膜骨架化毛细血管密度(RCD)。此外,以系统性红斑狼疮疾病活动度评分(SLEDAI)对疾病组进行评分。采用独立样本t检验和方差分析等进行数据分析。结果:在浅层视网膜TAZ区域以及S、T、I、N各分区,NLR组和LR组的RCD值均低于正常对照组,且LR组相较于NLR组更低,这些差异均有统计学意义(P<0.05)。在深层视网膜,3组之间的差异不如浅层明显,仅发现LR组在N区域的RCD值较NLR组明显下降(P=0.022),且LR组在除T外其他3个分区的RCD值均较正常对照组明显下降(P<0.05)。此外,LR组的SLEDAI评分显著高于NLR组(P=0.006),且LR组的SLE并发症,如狼疮性肾炎和神经精神性狼疮的发生率均更高(分别为50%vs.25%,10%vs.4%)。结论:OCTA能有效检测SLE患者黄斑区视网膜微血管形态的早期改变。SLE患者无明显眼底及视力损伤时,浅层视网膜RCD即发生显著性改变,推测其可能可以作为监测SLE视网膜损害的早期生物学特征。

Objective:To observe the characteristics of early macular microvascular changes in patients with systemic lupus erythematosus using optical coherence tomography angiography(OCTA).Methods:This was a retrospective series of case study.Thirty-one patients(62 eyes)who were diagnosed with SLE by the Second Affiliated Hospital&Yuying Children's Hospital of Wenzhou Medical University from May to November 2018,were divided into a lupus retinopathy(LR)group of 10 patients(17 eyes)and a non-lupus retinopathy group of 24 patients(45 eyes).At the same time,35 healthy subjects(35 eyes)who were matched by age and sex with the disease groups were recruited as a control group.All subjects had a 3 mm×3 mm area of the macula scanned by OCTA to obtain superficial and deep retinal microvascular images of the macular area,and retinal blood flow density maps were skeletonized and analyzed by a custom automated algorithm.The total annular zone(TAZ),with a diameter of 2.5 mm,was obtained after excluding the foveal avascular zone(FAZ,0.6 mm),and the superficial and deep retinal skeletonized capillary densities(RCD)of the TAZ were further divided into 4 regions(S,T,I,N).In addition,disease activity of the patients was assessed using the SLE disease activity index(SLEDAI).Data analysis was performed using a t test and analysis of variance.Results:The RCD of the superficial retinal capillary plexus(SRCP)were found to be significantly lower in the NLR and LR groups than in the control group,and the LR group was even lower than the NLR group and the difference was significant(P<0.05).In the deep retinal capillary plexus(DRCP),the difference between the three groups was not as obvious as that in the superficial layer.Only the RCD of the LR group in the N region was significantly lower than that in the NLR group(P=0.022),which were also lower than those in the control group(P<0.05)except for the T region.In addition,the score of SLEDAI in the LR group was significantly higher than in the NLR group(P=0.006),and the incidence of SLE complications such as lupus nephritis and neuropsychiatric SLE were higher in the LR group(50%vs.25%,10%vs.4%respectively).Conclusions:OCTA can effectively detect early changes in macular microvascular morphology in the patients with SLE.In patients with SLE without significant fundus and visual impairment,the RCD of SRCP is significantly altered,suggesting that it may be used as an early biomarker for monitoring SLE retinal damage.