光学相干断层扫描血管成像技术观察糖尿病性视网膜病变及糖尿病性黄斑水肿患者视网膜血流变化

Detection of vessel density changes in eyes of patients with diabetic retinopathy and diabetic macular edema using optical coherence tomography angiography

目的·利用光学相干断层扫描(optical coherence tomography,OCT)和光学相干断层扫描血管成像(optical coherence tomography angiography,OCTA)技术观察不同分期的糖尿病性视网膜病变(diabetic retinopathy,DR)以及伴随/不伴随糖尿病性黄斑水肿(diabetic macular edema,DME)的DR的影像学特征,寻找相关危险因子及潜在OCTA影像学生物标志物。方法·于上海交通大学附属第一人民医院入组90例DR患者,根据糖尿病性视网膜病变早期治疗研究分级标准分为轻、中、重度非增殖性糖尿病性视网膜病组和增殖性糖尿病性视网膜病组,并根据OCT影像分为DME组和无DME组。对所有受试者的OCT影像以及OCTA参数包括视网膜浅层、深层血流密度和中心凹无血管区面积进行比较分析;采用Logistic回归排除混杂因素影响,寻找与DR严重程度相关、与DME发生相关的影像学改变,以及包括性别、年龄、基础疾病病史、抗高血压药使用情况和血液指标在内的其他因素。结果·糖尿病发病年龄(P=0.042,95%CI-0.057~-0.001)以及视网膜深层血流密度(P=0.040,95%CI-0.066~-0.002)与DR疾病严重程度呈负相关。无高血脂为DR疾病进展的保护因素(P=0.027,95%CI-3.001~-0.176)。DME的发生率随着DR的严重程度加重而升高(P=0.004),视网膜内层结构紊乱的出现与DME相关(P=0.000);但未发现与DME明显相关的视网膜血流密度改变。结论·DR的进展可能与视网膜深层血管的血流密度密切相关,该指标可能成为预测DR进展的影像学生物标志物。

Objective·To observe the features of diabetic retinopathy(DR)at different stages,which is accompanied/not accompanied by diabetic macular edema(DME),using optical coherence tomography(OCT)and optical coherence tomography angiography(OCTA),and to determine related risk factors and potential OCTA imaging biomarkers of DR progression.Methods·Ninety DR patients from Shanghai General Hospital,Shanghai Jiao Tong University were divided into four groups according to early treatment of diabetic retinopathy study(ETDRS)grading standard(mild,moderate,severe non-proliferative diabetic retinopathy and proliferative diabetic retinopathy groups),or two groups according to the presence of DME or not.OCTA metrics,including superficial vessel density,deep vessel density and foveal avascular zone area were compared.Logistic regression was used to exclude confounding factors.Imaging changes related to DR severity and DME occurrence,as well as other factors including gender,age,history of underlying diseases,use of antihypertensive drugs and blood indicators were searched.Results·Lower age of the onset of diabetes(P=0.042,95%CI-0.057--0.001)and lower deep vessel density(P=0.040,95%CI-0.066--0.002)were significantly associated with DR progression.The absence of hyperlipidemia was a protective factor for the progression of DR disease(P=0.027,95%CI-3.001--0.176).The incidence of DME increased with the severity of DR(P=0.004),and the occurrence of disorganization of retinal inner layers was significantly related to DME(P=0.000).No alteration in vessel density was observed between patients with DME and those without DME.Conclusion·The progression of DR may be closely related to the vessel density of deep retinal vessels,which may become an imaging biomarker to predict the development of DR.