妊娠期高血糖患者黄斑浅层血流变化的研究

A Study of Macular Superficial Blood Flow Changes in Patients with Hyperglycemia during Pregnancy

目的:采用光学相干断层扫描血管成像(optical coherence tomography angiography, OCTA)观察妊娠期高血糖(hyperglycemia in pregnancy, HIP)患者黄斑区浅层毛细血管丛(superficial capillary plexus, SCP)血流密度的变化,分析HIP视网膜生理病理改变。方法:横断面观察性临床研究。纳入妊娠组和对照组:妊娠组根据妊娠前是否患有糖尿病以及糖耐量试验血糖情况分为高血糖组(HIP组),正常血糖组。其中,高血糖组分为孕前糖尿病(pregestational diabetes mellitus, PGDM)和妊娠期糖尿病(gestational diabetes mellitus, GDM)两个小组;正常血糖组作为孕妇对照组(IP组),健康育龄期女性作为对照组(NP组)。对所有研究对象进行双眼黄斑区OCTA检查,并分析黄斑区SCP的血管长度密度(vessel length density, VLD)、血管灌注密度(vessel perfusion density, VPD)和黄斑中心凹无血管区(foveal avascular zone, FAZ)等参数。结果:本研究对象共98例183眼:HIP组48例92眼(50.27%),其中PGDM组18例34眼,GDM组30例58眼。IP组25例48眼(26.23%),NP组25例43眼(23.50%)。IP组在黄斑区内环及总体区域的SCP-VLD、SCP-VPD低于NP组,差异有统计学意义。GDM组与IP组在黄斑区SCP-VLD、SCP-VPD的差异无统计学意义。PGDM组在黄斑区SCP-VLD低于IP组差异有统计学意义,在黄斑区中心和总体区域的SCP-VPD低于IP组,差异有统计学意义;PGDM组在黄斑区中心区域的SCP-VLD、SCP-VPD低于GDM组,差异有统计学意义。PGDM组的FAZ形态指数低于NP组,差异有统计学意义。结论:妊娠期间的适应性变化包括视网膜血管系统。在妊娠和高血糖状态下,黄斑浅层血流密度降低且内环区域变化显著,PGDM患者变化更加明显。

Objective: To observe the superficial capillary plexus (SCP) blood flow density in the macula of pa-tients with hyperglycemia in pregnancy (HIP) using optical coherence tomography angiography (OCTA). The changes of blood flow density in the superficial capillary plexus (SCP) of the macula in patients with hyperglycemia in pregnancy (HIP) were observed by OCTA to analyze the physio-pathological changes of the HIP retina. Methods: Cross-sectional observational clinical study. Preg-nancy and control groups were included: the pregnancy group was divided into a hyperglycemic group (HIP group), and a normoglycemic group according to whether they had diabetes before pregnancy and the glycemic status of the glucose tolerance test. Among them, the hyperglycemic group was divided into two groups of pregestational diabetes mellitus (PGDM) and gestational dia-betes mellitus (GDM);the normoglycemic group served as a control group for pregnant women (IP group) and healthy women of reproductive age as a control group (NP group). OCTA of the macular area was performed in both eyes and the parameters of vessel length density (VLD), vessel perfu-sion density (VPD) and foveal avascular zone (FAZ) and other parameters were analyzed in the macular SCP of all study subjects. Results: There were 98 cases and 183 eyes in this study: 48 cases and 92 eyes in the HIP group (50.27%), including 18 cases and 34 eyes in the PGDM group and 30 cases and 58 eyes in the GDM group;25 cases and 48 eyes in the IP group (26.23%) and 25 cases and 43 eyes in the NP group (23.50%). The differences between the GDM group and the IP group in the macular area SCP-VLD and SCP-VPD were not statistically significant. the differences between the PGDM group in the macular area SCP-VLD were lower than those of the IP group, and the differ-ences in the macular area center and overall area SCP-VPD were lower than those of the IP group, and the differences were statistically significant;the PGDM group in the macular area center area SCP-VLD and SCP-VPD in the central region of the macula were lower in the PGDM group than in the GDM group, and the difference was statistically significant. The FAZ morphological index in the PGDM group was lower than in the NP group, and the difference was statistically significant. Conclu-sion: Adaptive changes during pregnancy include the retinal vascular system. In pregnancy and hyperglycemic state, the superficial macular blood flow density decreased and the inner ring region changed significantly, and the changes were more pronounced in PGDM patients.