OCTA在NPDR患者黄斑区微循环改变中的临床效果及应用价值

Clinical effect and application value of OCTA on macular microcirculation changes of NPDR patients

目的:利用光学相干断层扫描血管成像(OCTA)观察非增殖型糖尿病视网膜病变(NPDR)患者黄斑区微循环改变情况,探讨OCTA的临床应用价值。方法:选择经FFA检查确诊为NPDR的患者70例118只眼为实验组,同期年龄、性别与患者相匹配、眼底无其他异常的健康人70例98只眼为对照组。实验组分为轻、中、重度NPDR,分别为19例26只眼、23例39只眼、28例53只眼。利用OCTA测量黄斑中心凹无血管区(FAZ)面积、黄斑区3 mm×3 mm血流密度,选用视网膜浅层(SRL)和视网膜深层(DRL)血流图像进行分析。结果:实验组中、重度NPDR组黄斑区视网膜毛细血管较正常对照组改变明显;无论是SRL还是DRL,4组的FAZ面积依次增大,血流密度依次减小,差异均有统计学意义(P<0.05)。结论:FAZ面积、黄斑区血流密度可作为检测NPDR病变程度的敏感指标,OCTA在诊断糖尿病视病变患者黄斑区微循环改变中具有重要临床应用价值,值得推广。

Objective:To observe the changes of microcirculation in the macular area of patients with non-proliferative diabetic retinopathy(NPDR)through optical coherence tomography angiography(OCTA),and investigate the clinical application value of OCTA.Methods:118 eyes of 70 patients diagnosed with NPDR by fluorescein fundus angiography(FFA)were selected as the experimental group;while in the same period,98 eyes of 70 healthy people without any abnormal fundus whose age and sex matched with the diabetic patients were selected as the control group.Meanwhile,the experimental group was divided into the mild,moderate and severe NPDR patients,with 26 eyes in 19 cases,39 eyes in 23 cases,and 53 eyes in 28 cases,respectively.OCTA was used to measure the area of the macular foveal avascular zone(FAZ)and the blood flow density of the macular area(size:3 mm×3 mm),then superficial retinal(SRL)and deep retinal(DRL)blood flow images were selected for analysis.Results:The experimental group,especially the moderate and severe NPDR group,macular retinal capillaries changed significantly compared with the normal control group.Whether it was SRL or DRL,the FAZ area among the 4 groups increased sequentially,and the blood flow density decreased sequentially,and the differences were statistically significant(P<0.05).Conclusion:FAZ area and macular blood flow density are sensitive indicators for detecting the degree of NPDR lesions,and OCTA has important clinical application value in diagnosing the changes of macular microcirculation in patients with diabetic visual lesions and is worthy of promotion.