利用OCTA观察肾性高血压患者眼底微循环改变和视功能损伤关系的研究

Observation of the Relationship between Microcirculatory Changes in the Fundus and Visual Impairment in Patients with Renal Hypertension Using OCTA

目的 利用光学相干断层扫描血管成像(OCTA)观察肾性高血压患者眼底微循环改变和视功能损伤关系。方法 选择2020年7月至2022年12月期间我院收治的肾性高血压患者50例(50眼)作为研究对象作为病例组,收集同期年龄匹配的健康体检者50例(50眼)作为对照组。利用OCTA对所有研究对象视盘及黄斑区行OCTA模式扫描,定量分析视网膜神经纤维层(RNFL)、视盘旁血管密度(Peripapillary-VD,PVD)、黄斑区浅层血管密度(MSVD)、神经节细胞复合体厚度(GCC),以最佳矫正视力(BCVA)指标评估视功能,以BCVA为因变量构建回归模型,利用受试者工作特征曲线(ROC)评估PVD、GCC厚度衡量视功能损伤严重情况。结果 病例组RNFL厚度、GCC薄于对照组,PVD、MSVD低于对照组,BCVA劣于对照组,(P<0.05)。RNFL、PVD、MSVD、GCC与BCVA呈负相关(P<0.05),RNFL厚度、GCC越薄,PVD、MSVD越低,视力越差,视功能损伤越严重(P<0.05)。PVD联合GCC厚度预测视功能损伤的灵敏度、特异度、准确度分别为97.96%、93.88%、95.92%,显著高于单一PVD、单一GCC厚度指标预测效能(P<0.05)。结论 OCTA技术能够检测肾性高血压患者眼底微循环改变,能够反映视功能损伤。

Objective To observe the relationship between fundus microcirculatory alterations and visual function impairment in patients with renal hypertension using optical coherence tomography angiography(OCTA).Methods Fifty patients with renal hypertension admitted to our hospital between July 2020 and December 2022 were selected as the study subjects as the case group,and 50 healthy check-up patients who went to the physical examination center at the same period according to the principle of 1:1 matching(same sex,and mean age±3 years)as the control group(n=50).Microcirculatory changes in the fundus of the subjects[parapapillary retinal nerve fiber layer(RNFL),capillary density in the optic disc region(PVD),superficial macular vascular density(MSVD),and ganglion cell complex(GCC)]were detected using the OCTA technique,and visual function was assessed using the best corrected visual acuity(BCVA)index,and a regression model was constructed using BCVA as the dependent variable,using the subjects Working characteristic curve(ROC).Assessment of PVD,GCC thickness to measure the severity of visual function impairment.Results RNFL thickness and GCC were thinner in the case group than in the control group,PVD and MSVD were lower than in the control group,and BCVA was inferior to the control group,(P<0.05).RNFL,PVD,MSVD,and GCC were negatively correlated with BCVA(P<0.05),and the thinner the RNFL thickness,and GCC,the lower the PVD and MSVD were lower,the worse the visual acuity and the more severe the visual impairment(P<0.05).the sensitivity,specificity,and accuracy of PVD combined with GCC thickness in predicting visual impairment were 97.96%,93.88%,and 95.92%,respectively,which were significantly higher than the predictive efficacy of single PVD and single GCC thickness index(P<0.05).Conclusion OCTA technique can detect microcirculatory changes in the fundus of patients with renal hypertension and can reflect visual function impairment.