利用光学相干断层扫描血管成像技术对喀什地区非增殖期糖尿病性视网膜病变情况分析

蒋 红文, 韩 晶, 蔡 丹
喀什地区第一人民医院 新疆喀什 844000

摘要

摘要：目的：利用光学相干断层扫描血管成像(OpticalCoherenceTomographyAngiography,OCTA)技术了解喀什地区非增殖期糖尿病性视网膜病变(Non-proliferative diabetic retinopathy，NPDR)情况。方法：纳入2022年8月至2023年4月就诊于我院NPDR患者32例，正常对照组50例。获得两组OCTA数据，包括视网膜浅层视网膜血管丛(theSuperficialretinalVascularPlexus，SVP)、深层视网膜血管丛(theDeepretinalVascularPlexus,DVP)和无灌注区(FovealAvascularZone,FAZ)面积,比较不同指标在两组间的差异。结果：NPDR组男性11例(占34.375%)，平均年龄58±9.89岁，平均患糖尿病年限为13.39±7.2，平均糖化血红蛋白值为9.48±2.28mmol/L，最佳矫正视力(BCVA)(小数视力)为0.54±0.3。正常对照组50例，男性21例(42%)，最佳矫正视力(BCVA)为0.97±0.12。NPDR组SVP血流密度(%)为(21.65±5.38)，正常对照组为(26.36±6.23)，NPDR组DVP血流密度(%)为(19.12±4.3)，正常对照组为(27.51±2.95)，NPDR组FAZ面积(mm2)为(0.51±0.15)，正常对照组为(0.41±0.14),NPDR组与正常对照组相比，SVP血流密度、DVP血流密度明显减低，FAZ面积明显增大，且有统计学意义(分别为P=0.001，P<0.001，P=0.003)。糖化血红蛋白(HbA1c)与SVP血流密度(%)、DVP血流密度(%)均呈负相关(Pearson相关系数分别为-0.381，P=0.032和-0.583，P<0.001)，糖化血红蛋白(HbA1c)与FAZ面积无明显相关性(Pearson相关系数为-0.203，P=0.301)。结论：喀什地区非增殖期糖尿病性视网膜病变患者在OCTA上出现了血流密度及FAZ面积改变，对疾病早发现早治疗有重要意义。

关键词

关键词：非增殖期糖尿病性视网膜病变；光学相干断层扫描成像；血流密度；无灌注区面积

参考

[1]张竞,罗蕴之,李素丽,古再丽努尔•居来提,张玉媛,王新玲.新疆乌鲁木齐维吾尔族≥18岁居民糖尿病患病率及其影响因素调查[J].中国热带医学,2020,20(09):826-830.[2]胡博杰,路秋海,谌建群.新疆和田地区40岁及以上维吾尔族2型糖尿病患者糖尿病视网膜病变流行病学调查 [J] .武警后勤学院学报(医学版), 2016, 25(08):664-666.[3]徐培兰,木日扎提•买买提,孜克娅•乃吉木,孙虹,魏晶晶,王昕.新疆居民慢性病疾病谱现况调查及对策研究[J] .卫生软科学, 2021, 35(02):73-76.[4]唐慧,张雪婷,王翠喆,高留喜,冯家乐,陈柯茹,等.中国新疆地区肥胖、糖尿病前期和2型糖尿病检出率及民族分布特征 [J] .实用医学杂志, 2020, 36(10):1381-1389.[5]李宏亮,吴胜利,敖丽君,高梅,解红莲,李农.新疆维吾尔族和汉族糖尿病性视网膜病变患病率及危险因素的分析 [J] .中国糖尿病杂志, 2000(05):53-54.[6]FLAXEL C J,ADELMAN R A,BAILEY S T,et al.Diabetic Retinopathy Preferred Practice Pattern(R) [J] .Ophthalmology, 2020, 127(1):P66-P145.[7]BONED-MURILLO A,ALBERTOS-ARRANZ H,DIAZ-BARREDA M D,et al.Optical Coherence Tomography Angiography in Diabetic Patients: A Systematic Review [J] .Biomedicines, 2021, 10(1).[8]MEMON A S,MEMON N A,MAHAR P S.Role of Optical Coherence Tomography Angiography to differentiate Intraretinal microvascular abnormalities and retinal neovascularization in Diabetic Retinopathy [J] .Pak J Med Sci, 2022, 38(1):57-61.[9]SUN Z,YANG D,TANG Z,et al.Optical coherence tomography angiography in diabetic retinopathy: an updated review [J] .Eye (Lond), 2021, 35(1):149-161.[10]WAHEED N K,ROSEN R B,JIA Y,et al.Optical coherence tomography angiography in diabetic retinopathy [J] .Prog Retin Eye Res, 2023, 97:101206.[11]THOMPSON I A,DURRANI A K,PATEL S.Optical coherence tomography angiography characteristics in diabetic patient without clinical diabetic retinopathy [J] .Eye (London), 2019, 33(4):648-652.[12]CAO D,YANG D,HUANG Z,et al.Optical coherence tomography angiography discerns preclinical diabetic retinopathy in eyes of patients with type 2 diabetes without clinical diabetic retinopathy [J] .Acta Diabetol, 2018, 55(5):469-477.[13]ONISHI A C,NESPER P L,ROBERTS P K,et al.Importance of Considering the Middle Capillary Plexus on OCT Angiography in Diabetic Retinopathy [J] .Invest Ophthalmol Vis Sci, 2018, 59(5):2167-2176.[14]张碧磊,陈有信.广角光相干断层扫描血管成像对临床前期糖尿病视网膜病变的定量评估 [J] .影像研究与医学应用, 2023, 7(18):32-34.ZHANG Bilei,CHEN Youxin.Quantitative evaluation of preclinical diabetic retinopathy using widefield optical coherence tomography angiography [J] .Journal of ImagingResearch and Medical Applications, 2023, 7(18):32-34.[15]艾诗蓓,郑枞,曹明哲,杜芳芳,刘鑫鑫,徐楠,等.不同程度糖尿病性视网膜病变患者的生化指标及光学相干断 层 扫 描 血 管 成 像 的 差 异 [J] . 眼 科 学 报 , 2022, 37(12):918-925.A.I. Shibei,ZHENG Zong,CAO Mingzhe,et al.Differences of biochemical indicators and optical coherence tomography angiography in patients with different degrees of diabetic retinopathy [J] .Eye Science, 2022, 37(12):918-925.[16]沈泳芝,黄家丽,冼科贡,李志辉,赵奋图.光学相干断层扫描血管造影技术在初诊2型糖尿病患者眼底筛查中的应用 [J] .实用临床医药杂志, 2023, 27(4):56-60.SHEN Yongzhi,HUANG Jiali,XIAN Kegong,et al.Application of optical coherence tomography angiography in fundus screening in newly diagnosed patients with type 2 diabetes [J] .Journal of Clinical Medicine in Practice, 2023, 27(4):56-60.[17]XU B,CHEN J,ZHANG S,et al.Association Between the Severity of Diabetic Retinopathy and Optical Coherence Tomography Angiography Metrics [J] .Frontiers in endocrinolo-gy (Lausanne), 2021, 12:777552.[18]代梦欢,李冬莉,崔忆辛,申璐,李齐瑞,饶玲娜,等.不同程度非增殖性糖尿病视网膜病变的OCTA表现 [J] .国际眼科杂志, 2024, 24(02):307-311.[19]DACOSTA J,BHATIA D,CROTHERS O,et al.Utilisation of optical coherence tomography and optical coherence tomography angiography to assess retinal neovascularisation in diabetic retinopathy [J] .Eye (Lond), 2022, 36(4):827-834.[20]CHUA J,SIM R,TAN B,et al.Optical Coherence Tomography Angiography in Diabetes and Diabetic Retinopa-thy [J] .J Clin Med, 2020, 9(6):1723.[21]刘启玲,王金蕾,马汀.光学相干断层扫描血管造影技术在糖尿病视网膜病变评估中的应用进展 [J] .武警医学, 2024, 35(01):79-84.[22]TANG F Y,NG D S,LAM A,et al.Author Correction: Determinants of Quantitative Optical Coherence Tomography Angiography Metrics in Patients with Diabetes [J] .Sci Rep, 2018, 8(1).[23]YIN L,ZHANG D,REN Q,et al.Prevalence and risk factors of diabetic retinopathy in diabetic patients:A communi-ty based cross-sectional study [J] .Medicine (Baltimore),2020,99(9):e19236.[24]承德医学院硕士研究生毕业论文 [J].[25]XIE N,TAN Y,LIU S,et al.Macular vessel density in diabetes and diabetic retinopathy with swept-source opticalcoherence tomography angiography [J] .Graefes Arch Clin Exp Ophthalmol, 2020, 258(12):2671-2679.[26]TAN F,CHEN Q,ZHUANG X,et al.Associated risk factors in the early stage of diabetic retinopathy [J] .Eye Vis (Lond), 2019, 6:23.[27]DURBIN M K,AN L,SHEMONSKI N D,et al.Quantification of Retinal Microvascular Density in Optical Coheren-ce Tomographic Angiography Images in Diabetic Retinopa-thy[J] .JAMA Ophthalmol, 2017, 135(4):370-376.[28]INANC M,TEKIN K,KIZILTOPRAK H,et al.Chang-es in Retinal Microcirculation Precede the Clinical Onset of Diabetic Retinopathy in Children With Type 1 Diabetes Mellitus [J] .Am J Ophthalmol, 2019, 207:37-44.