基于光学相干断层扫描血管成像技术的视网膜静脉阻塞中医证型研究

Study on TCM Syndromes of Retinal Vein Occlusion Based on Optical Coherence Tomography Angiography

【目的】探究视网膜静脉阻塞(RVO)中医证型分布规律及各证型光学相干断层扫描血管成像技术(OCTA)的表现特点。【方法】选取63例RVO患者(126只眼)进行回顾性分析,采用Ward系统聚类法对患者证候进行聚类分析,确定证型,并根据患者资料进行归纳分析,探讨其证型分布规律;再根据证型进行分组,运用OCTA技术对各组患者进行检测,通过统计学分析,探索各证型的OCTA特征。【结果】(1)一般资料方面:63例患者中,视网膜中央静脉阻塞(CRVO)33例,视网膜分支静脉阻塞(BRVO)30例,2组患者的性别和患侧分布情况比较,差异均无统计学意义(P>0.05),而2组患者的季节分布情况比较,差异有统计学意义(P<0.05)。(2)聚类分析方面:经Ward系统聚类法分析结果显示,聚为4类最契合临床实际,分别对应气滞血瘀型、阴虚阳亢型、痰瘀阻络型和心脾俱虚型等4种证型。(3)中医证型分布方面:63例患者中,气滞血瘀型占比最高,为42.86%(27/63),其他从高到低依次为痰瘀阻络型[31.75%(20/63)]、阴虚阳亢型[14.29%(9/63)]、心脾俱虚型[11.10%(7/63)]。(4)各证型的OCTA特征方面:与健侧眼比较,气滞血瘀型与痰瘀阻络型RVO患者的患眼各层视网膜血流密度均明显降低(P<0.05),视网膜厚度均明显增加(P<0.05);其余证型患眼与健侧眼的各层视网膜血流密度、视网膜厚度比较,差异均无统计学意义(P>0.05)。各证型患眼间比较,视网膜血流密度方面,气滞血瘀型RVO患者的患眼各层视网膜血流密度均较其他证型降低(P<0.05),痰瘀阻络型又均较阴虚阳亢型和心脾俱虚型降低(P<0.05),而阴虚阳亢型与心脾俱虚型比较,差异无统计学意义(P>0.05);视网膜厚度方面,痰瘀阻络型RVO患者的患眼各层视网膜厚度均较其他证型增加(P<0.05),气滞血瘀型又均较阴虚阳亢型和心脾俱虚型增加(P<0.05),而阴虚阳亢型与心脾俱虚型比较,差异无统计学意义(P>0.05)。各证型RVO患者的患眼黄斑中心凹无血管区面积(FAZ)、周长(PERIM)、血流(FLOW)及非圆度指数(AI)比较,差异均无统计学意义(P>0.05)。【结论】气滞血瘀型与痰瘀阻络型的视网膜血流密度均降低,但气滞血瘀型的血流密度降低更明显;痰瘀阻络型与气滞血瘀型的视网膜厚度均增加,但痰瘀阻络型的视网膜厚度增加更明显;其余证型无明显特异性特征,各证型患者的FAZ、PERIM、FLOW及AI均无明显差别。

Objective To explore the distribution of traditional Chinese medicine(TCM)syndromes in retinal vein occlusion(RVO)and to study the characteristics of optical coherence tomography angiography(OCTA)in RVO patients with various TCM syndrome types.Methods A total of 63 patients(involving 126 eyes)with RVO were selected for retrospective analysis.The Ward hierarchical cluster method was used for the cluster analysis of the patients'syndromes,and then the syndrome types were defined.The clinical information of the patients were summarized and analyzed to explore the distribution of syndrome types.And then the OCTA characteristics of each syndrome type were explored by the OCTA technology and through statistical analysis.Results(1)The analysis of general data showed that among the 63 patients,there were 33 cases of central retinal vein occlusion(CRVO)and 30 cases of branch retinal vein occlusion(BRVO).There were no significant differences in the distribution of gender and the affected side between the two groups(P>0.05),but there was significant difference in the distribution of onset seasons between the two groups(P<0.05).(2)The results of Ward hierarchical clustering showed that the clustering of 4 categories of syndromes was accorded with the clinical practice,and the 4 categories corresponded to qi stagnation and blood stasis type,yin deficiency and yang hyperactivity type,phlegm and blood stasis blocking collaterals type and heart-spleen deficiency type.(3)The analysis of the distribution of TCM syndromes showed that among the 63 patients,qi stagnation and blood stasis type accounted for the highest proportion,being 42.86%(27/63),and the other syndrome types in descending order were phlegm and blood stasis blocking collaterals type[31.75%(20/63],yin deficiency and yang hyperactivity type[14.29%(9/63],heart-spleen deficiency type[11.10%(7/63)].(4)The analysis of OCTA characteristics of each syndrome type showed that compared with the healthy eyes,the blood flow density of each retinal layer of in RVO patients with qi stagnation and blood stasis type and phlegm and blood stasis blocking collaterals type was significantly decreased(P<0.05),and the retinal thickness was significantly increased(P<0.05).There was no significant diference in retinal blood flow density and retinal thickness between the affected eyes and the healthy eyes of the other syndromes(P>0.05).The comparison of affected eyes among various syndrome types showed that the blood flow density of each retinal layer of the affected eyes in RVO patients with qi stagnation and blood stasis type was lower than that of the other types(P<0.05),and the blood flow density of phlegm and blood stasis blocking collaterals type was lower than that of yin deficiency and yang hyperactivity type and heart and spleen deficiency type(P<0.05),while there was no significant difference between yin deficiency and yang hyperactivity type and heartspleen deficiency type(P>0.05).The retinal thickness of each retinal layer of the affected eyes in RVO patients with phlegm and blood stasis blocking collaterals was higher than that of the other types(P<0.05),and the retinal thickness of qi stagnation and blood stasis type was higher than that of yin deficiency and yang hyperactivity type and heart-spleen deficiency type(P<0.05),while there was no significant difference between yin deficiency and yang hyperactivity type and heart-spleen deficiency type(P>0.05).There were no significant differences in macular foveal avascular zone area(FAZ),perimeter(PERIM),blood flow(FLOW)and acircularity index(AI)among RVO patients with various syndrome types(P>0.05).Conclusion The decreased retinal blood flow density is presented in RVO patients with qi stagnation and blood stasis type and phlegm and blood stasis blocking collaterals type,particularly in RVO patients with qi stagnation and blood stasis type.The increased retinal thickness can be found in RVO patients with phlegm and blood stasis blocking collaterals type and qi stagnation and blood stasis type,particularly in RVO patients with phlegm and blood stasis blocking collaterals type.No specific OCTA characteristics are presented in RVO patients with other syndrome types.There are no significant differences in FAZ,PERIM,FLOW and AI among the RVO patients with various syndrome types,either.