不同程度DR对三维脉络膜血管指数变化的影响及其意义

Influence of the severity of diabetic retinopathy on three-dimensional choroidal vascularity index and its significance

目的采用扫频源光学相干断层扫描血管成像(SS-OCTA)测量糖尿病患者三维脉络膜血管指数(3D CVI)并评估其与不同程度糖尿病视网膜病变(DR)的关系。方法采用横断面研究方法,纳入2022年3—12月在合肥市第二人民医院就诊的139名受试者139眼,包括糖尿病患眼115眼和无糖尿病对照眼24眼。根据早期治疗糖尿病视网膜病变研究标准七视野彩色眼底图像对DR进行分级,将糖尿病患眼分为无DR组34眼、非增生性糖尿病视网膜病变(NPDR)组42眼、NPDR合并糖尿病黄斑水肿(DME)组21眼和增生性糖尿病视网膜病变(PDR)组18眼。采用SS-OCTA扫描以黄斑中心凹为中心3 mm×3 mm区域,利用仪器内置软件分别测量黄斑中心凹1 mm(C1)及旁中心凹3 mm(C3)3D-CVI、脉络膜血管体积(CVV)、脉络膜间质体积和脉络膜厚度;旁中心凹进一步分为上方、下方、颞侧、鼻侧区域,测量其3D CVI。3D CVI定义为CVV与脉络膜总体积的比值。比较各组间不同区域脉络膜参数差异;采用多重线性回归分析评估3D CVI的影响因素。结果各组受检眼3D CVI-C1和3D CVI-C3总体比较差异均有统计学意义(F=3.103、3.036,均P<0.05),其中PDR组3D CVI-C1小于无DR组,3D CVI-C3小于对照组和无DR组,差异均有统计学意义(均P<0.05)。各组受检眼旁中心凹下方和鼻侧3D CVI总体比较差异均有统计学意义(F=2.714、4.020,均P<0.05),其中PDR组下方3D CVI小于无DR组,PDR组鼻侧3D CVI均小于对照组、无DR组、NPDR组和NPDR合并DME组,差异均有统计学意义(均P<0.05)。多重线性回归分析显示控制年龄、病程和糖化血红蛋白后,DR病变程度是中心凹及旁中心凹3D CVI的影响因素,PDR眼对中心凹及旁中心凹3D CVI影响最大,与无DR眼相比,PDR眼中心凹3D CVI降低0.019(95%CI:-0.031~-0.007,P=0.003),旁中心凹3D CVI降低0.019(95%CI:-0.030~-0.008,P=0.001);与无DR眼相比,NPDR合并DME眼中心凹3D CVI降低0.014(95%CI:-0.027~0.000,P=0.044)。结论黄斑中心凹3D CVI与DR严重程度有关,黄斑区脉络膜中大血管3D CVI的降低可能是DR加重的敏感指标。

Objective To investigate the relationship between three-dimensional choroidal vascularity index(3D CVI)and the severity of diabetic retinopathy(DR)using swept-source optical coherence tomography angiography(SS-OCTA).Methods A cross-sectional study was conducted.A total of 139 eyes of 139 subjects,including 115 eyes with diabetes mellitus and 24 control eyes without diabetes,were enrolled in the Second People's Hospital of Hefei from March to December 2022.DR was graded according to the standard seven-field ETDRS color fundus photographs.Eyes with diabetes mellitus were divided into non-DR(NDR)group(34 eyes),non-proliferative DR(NPDR)group(42 eyes),NPDR with diabetic macular edema(DME)group(21 eyes)and PDR group(18 eyes).3D CVI in central fovea 1 mm(C1)and parafoveal 3 mm(C3),choroidal vascular volume(CVV),and choroidal thickness were measured by SS-OCTA in the area of 3 mm×3 mm centered on the fovea using the built-in automated quantification software.Parafoveal region was divided into superior,inferior,temporal and nasal quadrants,and 3D CVI of the different quadrants was detected.3D CVI was defined as the ratio of CVV to total choroidal volume.The monocular data were analyzed to compare 3D CVI among the five groups,and multiple linear regression analysis was used to evaluate the influencing factors.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of the Second People's Hospital of Hefei,Hefei Hospital Affiliated to Anhui Medical University(No.2022064).All subjects were aware of the study purpose and agreed to participate the study.Results There were significant differences in 3D CVI-C1 and 3D CVI-C3 among all groups(F=3.103,3.036,both at P<0.05).In PDR group,3D CVI-C1 was lower than in non-DR group,and 3D CVI-C3 was lower than in control group and non-DR group,with statistically significant differences(all at P<0.05).There were significant differences in 3D CVI in the inferior and nasal quadrants among all groups(F=2.714,4.020,both at P<0.05).In PDR group,3D CVI in the inferior quadrant was lower than that in non-DR group,and 3D CVI in nasal quadrant in PDR group was lower than that in control group,non-DR group,NPDR group and NPDR with DME group,with statistically significant differences(all at P<0.05).Multiple linear regression showed that after controlling for age,course of disease and glycosylated hemoglobin,the severity of DR was the influencing factor of 3D CVI in fovea and parafovea.PDR eyes had the greatest impact on 3D CVI in fovea and parafovea.Compared with non-DR eyes,there was a-0.019(95%CI:-0.031--0.007,P=0.003)decrease in central foveal 3D CVI and a-0.019(95%CI:-0.030--0.008,P=0.001)decrease in parafoveal 3D CVI in PDR eyes,followed by a 0.014(95%CI:-0.027-0.000,P=0.044)decrease in central foveal 3D CVI in NPDR with DME eyes.Conclusions Macular foveal 3D CVI correlates with DR severity,and a decrease in 3D CVI of large vessels in the macular choroid may be a sensitive indicator of DR exacerbation.