早期阿尔茨海默病患者黄斑区视网膜血管密度及厚度变化——基于OCTA的测量

Changes of retinal blood vessel density and thickness in macular area of patients with early Alzheimer’s disease by OCTA detection

目的利用光学相干断层扫描血管成像(OCTA)评估早期阿尔茨海默病(AD)患者黄斑区视网膜血管密度和视网膜厚度变化。方法临床检查确诊的轻度AD患者16例32眼(AD组)纳入本研究,正常对照组选取性别、年龄相匹配16例32眼。两组受检者性别构成比、年龄、眼压差异均无统计学意义(均为P>0.05)。所有受检眼均行高清OCTA检查,以黄斑中心为圆心,直径为3.0 mm的快速扫描,获取黄斑区视网膜上方、下方、颞侧、鼻侧4个象限血管密度及其厚度。比较两组受检眼之间不同眼别的黄斑区视网膜厚度及视网膜血管密度变化。结果两组受检者智力状况检查法(mini-mental state examination,MMSE)评分及视力差异均有统计学意义(均为P<0.05)。与正常对照组相比,AD组患者双眼黄斑区厚度、中心凹视网膜厚度变薄,差异均有统计学意义(均为P<0.05);AD组患者黄斑区视网膜血管密度在整体、中心凹、旁中心凹、颞侧及上方均显著降低(均为P<0.05),且左右眼具有一致性。AD组患者黄斑区鼻侧及下方平均血管密度较正常对照组降低,但差异均无统计学意义(均为P>0.05)。AD组、正常对照组受检者两眼之间黄斑区视网膜血管密度差异均无统计学意义(均为P>0.05)。结论早期AD患者可发生黄斑区视网膜厚度变薄、黄斑区血管密度降低的退行性视网膜病变,而OCTA可为AD早期诊断、随访、评估疗效提供一定的参考价值。

Objective To evaluate changes in macular retinal blood vessel density and retinal thickness macular area for patients with early Alzheimer’s disease(AD)by optical coherence tomography(OCTA).Methods Sixteen patients(32 eyes)with mild AD confirmed by clinical examination were included in the study(AD group).In the normal control group,16 patients with 32 eyes were selected who were matched in gender and age.There was no statistical significance in gender composition ratio,age or intraocular pressure of the subjects between the two groups(all P>0.05).All eyes were examined with high-definition OCTA.Rapid scanning with the macular center as the center and the diameter of 3.0 mm was used to obtain the blood vessel density and thickness in the four quadrants(above,below,temporal and nasal sides)of the macular area.The changes of retinal thickness and retinal blood vessel density in macular area were compared between the two groups.Results There was statistical significances in mini-mental state examination(MMSE)score and visual acuity in AD group and normal control group(both P<0.05).Compared with the normal control group,the average thickness of macular area and the thickness of fovea retina decreased in the AD group,with statistically significant differences(all P<0.05).In the AD group,the retinal blood density in macular area was significantly reduced in the whole,fovea,para-fovea,temporal side and upper part(all P<0.05),and the consistency was found in the left and right eyes.In addition,the average blood flow density on the nasal side and the lower part of the macular area in the AD group was lower than that in the normal control group,but the difference was not statistically significant(all P>0.05).There was no statistically significant difference in retinal blood vessel density density between both eyes of subjects in AD group and normal control group(both P>0.05).Conclusion Patients with early AD may develop degenerative retinopathy with thinning retinal thickness in macular area and decreased blood vessel density in macular area.OCTA technology can provide reference value for early diagnosis,follow-up and evaluation of the efficacy of AD.