视网膜动脉阻塞伴发急性黄斑旁中心中层视网膜病变患者脉络膜厚度变化与眼部血供及功能的关系

The relationship between choroidal thickness changes and ocular blood supply and function in patients with retinal artery occlusion accompanied by acute paramacular central medial retinopathy

目的探讨视网膜动脉阻塞(RAO)伴发急性黄斑旁中心中层视网膜病变(PAMM)患者脉络膜厚度变化与眼部血供及功能的关系。方法回顾性病例研究。选择90例于2016年1月至2021年1月在我院就诊的RAO患者作为研究对象,根据患者是否确诊为PAMM将其分为PAMM组(n=21)和非PAMM组(n=69),对受试者行黄斑区相干光层析成像术(OCT)检查,并检测视网膜血流动力学参数,通过Pearson分析黄斑中心凹下脉络膜厚度(SFCT)变化与眼部供血及视功能的相关性。通过拟合曲线和阈值效应分析患者SFCT与PAMM发生的关系,采用多因素Logistics回归模型分析发生PAMM的独立危险因素,构建列线图模型。结果与非PAMM组比较,PAMM组患者SFCT、黄斑区脉络膜总面积(TCA)、血管区面积(LA)、脉络膜血管指数(CVI)及平均光敏感度(MS)水平均显著降低(P<0.05);PAMM组收缩期峰值流速(PSV)、缩张末期流速(EDV)、平均缺损(MD)及丢失方差(LV)较非PAMM组明显增加(P<0.05)。SFCT与脉络膜总面积(TCA)、腔面积(LA)、脉络膜血管指数(CVI)及MS呈正相关,与PSV、EDV、MD及LV呈负相关,与血管阻力指数(RI)无显著相关性。SFCT与PAMM呈线性负相关关系,当SFCT≥243.5μm时,SFCT每增加20μm,RAO患者发生PAMM的风险降低14%(OR=0.92,95%CI:0.88~0.98,P<0.05)。SFCT、TCA、LA、CVI及MS为患者发生PAMM的独立危险因素,PSV、EDV、MD及LV为患者发生PAMM的独立保护因素,依据独立影响因素构建的列线图预测模型具有较高的区分度、准确性和临床适用性。结论与单纯RAO患者相比,PAMM患者SFCT更低,且SFCT变化与患者视功能及眼部供血相关。本研究旨在为该类患者的临床治疗及预后提供理论参考。

Objective To investigate the relationship between the changes of choroidal thickness,ocular blood supply and function in patients with retinal artery occlusion with paracentral acute middle maculopathy(PAMM).Methods A retrospective case series study.Ninety patients with retinal artery occlusion(RAO)who were treated in our hospital from January 2016 to January 2021 were selected as the study subjects.According to whether the patients were diagnosed with PAMM,they were divided into PAMM group(n=21)and non PAMM group(n=69).The subjects were examined with macular optical coherence tomography(OCT),and detected the retinal hemodynamic parameters.Pearson analyzed the correlation between subfoveal choroidal thickness(SFCT)changes and ocular blood supply and visual function.The relationship between SFCT and PAMM was analyzed by fitting curve and threshold effect,and the independent risk factors of PAMM were analyzed by multifactor logistic regression model to build a nomogram model.Results The levels of SFCT,total choroidal area(TCA),luminal area(LA),choroidal vascularity index(CVI)and mean sensitivity(MS)in the PAMM group were significantly lower than those in the non PAMM group(P<0.05).The peak systolic velocity(PSV),end diastolic velocity(EDV),mean defect(MD),and loss variance(LV)in PAMM group were significantly higher than those in non PAMM group(P<0.05).SFCT was positively correlated with TCA,LA,CVI and MS,and negatively correlated with PSV,EDV,MD and LV,and had no significant correlation with vascular resistance index(RI).SFCT had a linear negative correlation with PAMM,when SFCT≥243.5μm,every increase of SFCT was 20μm.The risk of PAMM in RAO patients decreased by 14%,with a statistically significant difference(odds ratio(OR)=0.92,95%confidence interval(CI):0.88~0.98,P<0.05).SFCT,TCA,LA,CVI and MS were independent risk factors for patients with PAMM,and PSV,EDV,MD and LV were independent protective factors for patients with PAMM.The nomogram prediction model based on independent influencing factors has high differentiation,accuracy and clinical applicability.Conclusions The SFCT of PAMM patients is lower as compared with RAO patients,and the changes of SFCT are related to the visual function and blood supply of the eyes.This study provides theoretical reference for the clinical treatment and prognosis of this kind of patients.