糖尿病患者早期黄斑区微循环定量检测及其与视力的相关性

Quantification analysis of macular microcirculation in early diabetic patients and its correlation with visual acuity

目的分析糖尿病患者早期黄斑区微循环变化及其与视力的相关性。方法采用横断面研究方法,收集2019年12月至2020年9月于扬州大学附属苏北人民医院确诊的不合并糖尿病视网膜病变(NDR)患者75例75眼作为NDR组、非增生性糖尿病视网膜病变(NPDR)患者33例33眼作为NPDR组,另收集年龄匹配的健康体检者35人35眼作为对照组。采用RTVue XR光相干断层扫描血管仪扫描受检者黄斑区3 mm×3 mm的光相干断层扫描血管成像(OCTA)图像,采用Angio Vue软件系统对检测数据进行量化。分析并比较3个组患者黄斑中心凹无血管区(FAZ)面积及周长、非圆度指数(AI)、浅层和深层FAZ轮廓异常分级、浅层毛细血管网(SCP)和深层毛细血管网(DCP)血流密度和FAZ旁宽300μm区的毛细血管(FD300)血流密度,并分析各指标与视力的相关性。结果对照组、NDR组和NPDR组间黄斑区FAZ面积、FAZ周长、AI总体比较,差异均无统计学意义(F=1.948,P=0.146;F=2.632,P=0.075;H=5.582,P=0.061)。对照组、NDR组和NPDR组黄斑区浅层FAZ轮廓异常眼的比例分别为22.9%(8/35)、37.3%(28/75)和54.5%(18/33),深层FAZ轮廓异常眼的比例分别为42.9%(15/35),70.7%(53/75)和87.9%(29/33),其中NPDR组浅层及深层FAZ轮廓异常眼的比例明显高于对照组,差异均有统计学意义(均P<0.05)。且随着DR病情程度的加重,无论是浅层还是深层FAZ,轮廓异常眼的分级均呈现逐渐升高趋势(χ^(2)=9.827、9.030,均P<0.05)。对照组、NDR组和NPDR组旁中心凹DCP血流密度分别为[52.50(50.70,54.80)]%、[50.40(48.40,52.60)]%和[48.30(43.60,51.55)]%,DCP血流密度分别为[49.90(47.70,51.80)]%、[47.30(45.20,50.10)]%和[45.80(41.30,48.60)]%,总体比较差异均有统计学意义(H=21.719、21.652,均P<0.001),组间两两比较差异均有统计学意义(均P<0.05)。NPDR组中心凹SCP血流密度、中心凹DCP血流密度、FD300血流密度明显低于对照组,差异均有统计学意义(均P<0.05)。各组旁中心凹SCP血流密度、SCP血流密度总体比较,差异均无统计学意义(H=5.290、5.534,均P>0.05)。糖尿病患者的旁中心凹SCP血流密度及SCP血流密度与LogMAR最佳矫正视力(BCVA)均呈负相关(r_(s)=-0.305、-0.330,均P<0.05),浅层FAZ轮廓分级与LogMAR BCVA呈正相关(r_(s)=0.353,P<0.05)。结论糖尿病患者出现临床可见眼底病变前即可出现旁中心凹DCP血流密度、DCP血流密度及FAZ轮廓的异常,糖尿病患者旁中心凹SCP血流密度、SCP血流密度及浅层FAZ轮廓分级等微循环异常与视力存在相关性。OCTA在监测糖尿病患者视网膜病变进展和识别影响视功能的微循环参数方面有一定的作用。

Objective To analyze the change of macular microcirculation in early diabetic patients and its correlation with visual acuity.Methods A cross-sectional study was performed.Seventy-five eyes from 75 patients with non-diabetic retinopathy(NDR)and 33 eyes from 33 patients with non-proliferative diabetic retinopathy(NPDR)were included in Subei People's Hospital Affiliated to Yangzhou University from December 2019 to September 2020.The patients were divided into the NDR group and NPDR group according to their condition.Another 35 eyes from 35 healthy subjects served as the control group.Optical coherence tomography angiography(OCTA)images were acquired over 3 mm×3 mm regions centered on the fovea using RTVue XR OCTA device and the data were quantified with Angio Vue software.The area,perimeter and acircularity index(AI)of the macular foveal avascular zone(FAZ),the grading of abnormal superficial and deep FAZ contour,as well as the vessel density of superficial capillary plexuses(SCP),deep capillary plexuses(DCP)and a 300μm ring area beside FAZ(FD300)were analyzed and compared among the three groups.The correlations between these indexes and visual acuity were analyzed.This study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Subei People's Hospital affiliated to Yangzhou University(No.2018KY-167).Written informed consent was obtained from each subject prior to any medical examination.Results No statistically significant differences were found in the FAZ area,FAZ perimeter and AI among the three groups(F=1.948,P=0.146;F=2.632,P=0.075;H=5.582,P=0.061).The proportions of superficial and deep FAZ contour abnormality were 54.5%(18/33)and 87.9%(29/33)in the NPDR group,37.3%(28/75)and 70.7%(53/75)in the NDR group,22.9%(8/35)and 42.9%(15/35)in the control group,respectively,the proportions of superficial and deep FAZ contour abnormality in the NPDR group were significantly higher than those in the control group(both at P<0.05).With the aggravation of the condition,there were more eyes with high grades of abnormal superficial and deep FAZ contours(χ^(2)=9.827,9.030;all at P<0.05).The vessel density of parafoveal DCP was(52.50[50.70,54.80]),(50.40[48.40,52.60]),(48.30[43.60,51.55])%,and the vessel density of DCP was(49.90[47.70,51.80]),(47.30[45.20,50.10]),(45.80[41.30,48.60])%in the control group,NDR group and NPDR group respectively,and there were statistically significant differences among the three groups(H=21.719,21.652;both at P<0.001),and statistically significant differences were found in pairwise comparisons among the three groups(all at P<0.05).The vessel densities of foveal SCP,foveal DCP and FD300 in the NPDR group were significantly lower than those in the control group(all at P<0.05).There was no statistically significant difference in vessel densities of parafoveal SCP and SCP found in the overall comparison among the three groups(H=5.290,5.534;both at P>0.05).In diabetic mellitus patients,there were negative correlations between the vessel density of parafoveal SCP and LogMAR best corrected visual acuity(BCVA),and between the vessel density of SCP and LogMAR BCVA(r_(s)=-0.305,-0.330;both at P<0.05),and there was a positive correlation between the superficial FAZ contour grading and LogMAR BCVA(r_(s)=0.353,P<0.05).Conclusions Abnormal parafoveal DCP and DCP vessel density,as well as FAZ contour,appear in diabetic mellitus patients before the occurrence of visible fundus lesion,and the vessel density of parafoveal SCP and SCP,and superficial FAZ contour grading in diabetic mellitus patients are correlated with visual acuity.OCTA can help monitor disease progression and identify microcirculation parameters that affect visual function.