糖尿病黄斑缺血患者黄斑区结构和微血管改变定量分析

Quantitative analysis of macular structure and microvascular changes in patients with diabetic macular ischemia

目的观察糖尿病黄斑缺血(DMI)患眼黄斑区结构和微血管改变。方法回顾性病例研究。2023年1~7月于唐山市眼科医院检查确诊的DMI患者23例31只眼纳入本研究。其中,男性14例23只眼,女性9例8只眼;年龄(59.5±4.6)岁。根据糖尿病视网膜病变早期治疗研究小组制定的DMI分级标准,将患者分为轻度DMI组、中度DMI组、重度DMI组,分别为8、12、11只眼。采用扫频源光相干断层扫描仪测量患眼黄斑中心凹1 mm范围内视网膜浅层毛细血管丛(SVP)的血流密度(VD)、灌注面积(FA)、小血管VD(SVD),内层视网膜毛细血管丛VD、FA以及外层视网膜、脉络膜、神经节细胞复合体(GCC)厚度。对比观察不同程度DMI组患眼黄斑区结构和微血管改变。组间比较采用单因素方差分析或Kruskal-Wallis H检验;采用Spearman相关性分析法分析DMI严重程度与GCC、外层视网膜、脉络膜厚度以及内层视网膜VD、FA和SVP的VD、SVD、FA的相关性。结果轻度DMI组、中度DMI组、重度DMI组患眼GCC(F=70.670)、外层视网膜厚度(H=12.393),视网膜SVP的VD(F=105.506)、SVD(H=25.300)、FA(F=107.655),内层视网膜VD(H=24.098)、FA(H=25.300)比较,差异均有统计学意义(P<0.05);脉络膜厚度比较,差异无统计学意义(H=2.441,P>0.05)。组间两两比较:GCC厚度和SVP的VD、SVD、FA以及内层视网膜VD:重度DMI组与中度DMI组、中度DMI组与轻度DMI组,差异有统计学意义(P<0.05);外层视网膜厚度:重度DMI组与中度DMI组,差异有统计学意义(P<0.05);内层视网膜FA:重度DMI组与中度DMI组、轻度DMI组,差异均有统计学意义(P<0.05)。Spearman相关性分析结果显示,GCC(r_(s)=-0.918)、外层视网膜厚度(r_(s)=-0.448)以及内层视网膜VD(r_(s)=-0.894)、FA(r_(s)=-0.918),视网膜SVP的VD(r_(s)=-0.919)、SVD(r_(s)=-0.924)、FA(r_(s)=-0.939)均与DMI程度呈负相关(P<0.05);脉络膜厚度与DMI程度无相关性(rs=-0.081,P>0.05)。结论不同程度DMI患眼GCC、外层视网膜、脉络膜厚度以及视网膜SVP的VD、SVD、FA和内层视网膜VD、FA降低,且除脉络膜厚度外,均与DMI程度呈负相关。

Objective To observe the changes of macular structure and microvessels in eyes with diabetes macular ischemia(DMI).Methods A retrospective case study.From January 2023 to July 2023,23 patients of 31 eyes diagnosed with DMI at Tangshan Ophthalmological Hospital were included in this study.Among them,there were 14 males with 23 eyes;Female cases with 8 eyes.Age were(59.5±4.6)years old.According to the DMI grading standard formulated by the research group for early treatment of diabetes retinopathy,the patients were divided into mild DMI group,moderate DMI group,and severe DMI group,with 8,12,and 11 eyes respectively.The blood flow density(VD),perfusion area(FA),small vessel VD(SVD),inner retinal capillary plexus VD,FA,and outer retinal,choroidal,and ganglion cell complex(GCC)thickness within 1 mm of the macular fovea in retinal superficial vascular plexus(SVP)were measured using a scanning frequency light source optical coherence tomography instrument.The changes in macular structure and microvasculature in the affected eyes of different degrees of DMI groups were compared and observed.Inter group comparisons were conducted using one-way ANOVA or Kruskal Wallis H-test.Spearman correlation analysis was used to analyze the correlation between DMI severity and GCC,outer retina,choroid thickness,VD,FA and SVP VD,SVD and FA in inner retina.Results The GCC(F=70.670),outer retinal thickness(H=12.393),VD(F=105.506),SVD(H=25.300),FA(F=107.655),and VD(H=24.098)and FA(H=25.300)of the retinal SVP in the mild,moderate,and severe DMI groups were compared,and the differences were statistically significant(P<0.05).There was no statistically significant difference in choroidal thickness(H=2.441,P>0.05).Pairwise comparison between groups:VD,SVD,FA of GCC thickness and SVP,and VD of inner retina were statistically significant between severe DMI group and moderate DMI group,and between moderate DMI group and mild DMI group(P<0.05).The thickness of outer retina was statistically significant between severe DMI group and moderate DMI group(P<0.05).Inner retinal FA:there were statistically significant differences between severe DMI group,moderate DMI group and mild DMI group(P<0.05).The correlation analysis results showed that GCC(r_(s)=-0.918),outer retinal thickness(r_(s)=-0.448),and inner retinal VD(r_(s)=-0.894)and FA(r_(s)=-0.918),as well as VD(r_(s)=-0.919),SVD(r_(s)=-0.924),and FA(r_(s)=-0.939)of retinal SVP,were all negatively correlated with the degree of DMI(P<0.05).There was no correlation between choroidal thickness and degree of DMI(r_(s)=-0.081,P>0.05).Conclusion The thickness of GCC,outer retina and choroid,the VD,SVD,and FA of the retinal SVP,the VD and FA of inner retina are all reduced in eyes with different degrees of DMI,while all of them are negatively correlated with the degree of DMI,except for choroid thickness.