儿童葡萄膜炎患者黄斑区微血管结构变化

Changes of microvascular structure in the macular region of pediatric uveitis

目的观察并分析单侧儿童葡萄膜炎(PU)患眼及对侧健康眼黄斑区微血管结构变化。方法横断面病例对照研究。2019年1月至2021年7月于北京协和医院眼科检查确诊的单侧炎症安静期PU患者21例21只眼(PU组)纳入研究。将PU患者未受累对侧眼作为对侧眼组;选取同期年龄匹配的健康志愿者21名21只眼作为正常对照组(NC组)。采用光相干断层扫描血管成像仪对受检眼黄斑区6 mm×6 mm范围进行扫描,测量视网膜浅层毛细血管丛(SCP)、深层毛细血管丛(DCP)血管密度以及黄斑中心凹无血管区(FAZ)面积、中心凹下脉络膜厚度(SFCT)、中心凹视网膜厚度(CRT)。采用设备自带软件测量以黄斑中心凹为中心,直径分别为1.0、1.5、3.0 mm环形区域的脉络膜毛细血管密度(CCD),分别记录为CCD-1.0、CCD-1.5、CCD-3.0。三组间计量资料比较采用方差分析;若三组数据方差不齐则采用Kruskal-Wallis检验。多元线性回归分析评估CCD的潜在相关因素。结果与对侧眼组、NC组比较,PU组SCP(H=-13.857、-25.500,P=0.043、P<0.001)、DCP(H=-15.333、-31.595、P=0.007、P<0.001)血管密度和CCD-1.0(H=-14.000、-16.214,P=0.040、0.012)均显著降低,差异有统计学意义。PU组、NC组CRT、FAZ面积比较,差异无统计学意义(F=0.955,P=1.000、0.661)。与NC组比较,对侧眼组SCP、DCP血管密度均降低,其中DCP血管密度的差异有统计学意义(H=-16.262,P=0.004);两组受检眼CCD比较,差异无统计学意义(P=1.000)。与NC组比较,PU组SFCT更厚,差异有统计学意义(F=5.552,P=0.004);与对侧眼组比较,差异无统计学意义(F=5.552,P=0.270)。多元线性回归分析结果显示,CCD-1.0、CCD-1.5、CCD-3.0与FAZ面积(β=-0.494、-0.527、-0.566,P=0.015、0.009、0.010)、CRT(β=-0.322、-0.466、-0.342,P=0.026、0.002、0.028)呈线性相关;CCD-1.0、CCD-1.5与DCP血管密度(β=0.277、0.275,P=0.047、0.045)呈线性相关。结论安静期PU患眼的视网膜和脉络膜微血管结构均存在异常;未受累对侧眼可能存在黄斑循环障碍。

Objective To observe and analyze the macular microvascular system changes in unilateral pediatric uveitis(PU)and healthy contralateral eyes.Methods A cross-sectional case-control study.From January 2019 to July 2021,21 eyes of 21 patients with PU diagnosed in one eye(PU group),21 unaffected contralateral eyes(contralateral eye group),and 21 age-matched volunteers with 21 eyes(NC group)during the same period were examined in Peking Union Medical College Hospital.Optical coherence tomography angiography was used to scan the 6 mm×6 mm fundus macular area in the three groups of selected eyes to measure the vessel density of the superficial capillary plexus(SCP)and deep capillary plexus(DCP)of the retina,the area of the avascular zone(FAZ)in the fovea of the macula,the choroidal thickness under the fovea(SFCT),and the retinal thickness in the fovea of the macula(CRT).The device comes with a software choriocapillary flow measurement tool,which can obtain the macula's choriocapillary density(CCD)with the fovea as the center and the diameter of the annular area of 1.0 mm,1.5 mm,and 3.0 mm,respectively.They were recorded as CCD-1.0,CCD-1.5,and CCD-3.0.The measurement data of multiple groups were compared by analysis of variance;if the variance of the three groups of data was not uniform,the Kruskal-Wallis test was used.Multiple linear regression analysis was used to evaluate the potentially related factors of CCD.Results Compared with the contralateral eye group and the NC group,the vessel density of SCP(H=-13.857,-25.500;P=0.043,P<0.001),DCP(H=-15.333,-31.595;P=0.007,P<0.001)and CCD-1.0(H=-14.000,-16.214;P=0.040,0.012)of the clinically quiescent PU group were significantly decreased.CRT and FAZ were not statistically different between PU and NC groups(F=0.955;P=1.000,0.661).Compared with the NC group,the mean vessel density of SCP and DCP in the contralateral eye group decreased,and the difference in DCP vessel density was statistically significant(H=-16.262,P=0.004).There was no statistically significant difference between the CCD of two groups(P=1.000).The SFCT of the PU group was significantly thicker than that of the NC group(F=5.552,P=0.004),however,difference was not statistically significant from the fellow eye group(F=5.552,P=0.270).The results of multiple linear regression analysis revealed that the CCD-1.0,CCD-1.5,and CCD-3.0 showed a linear correlation with the area of FAZ(β=-0.494,-0.527,-0.566;P=0.015,0.009,0.010)and CRT(β=-0.322,-0.466,-0.342;P=0.026,0.002,0.028).CCD-1.0 and CCD-1.5 showed a linear correlation with the vessel density of DCP(β=0.277,0.275;P=0.047,0.045).Conclusion Both retinal and choroidal microvasculature are abnormal in resting eyes with PU,and macular circulation disorders may be present in the unaffected fellow eye.