急性髓系白血病患者早期视网膜微血管改变及其相关因素分析  

Early retinal microvascular changes in patients with acute myeloid leukemia and their related factors

作　　者：邢傲君 张雅楠 王贺 李明新 XING Aojun;ZHANG Yanan;WANG He;LI Mingxin(Department of Ophthalmology,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China;Department of Hematology,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China;Graduate School of Xuzhou Medical University,Xuzhou 221004,China)

机构地区：[1]徐州医科大学附属医院眼科,徐州221002 [2]徐州医科大学研究生学院,徐州221004 [3]徐州医科大学附属医院血液科,徐州221002

出　　处：《中国眼耳鼻喉科杂志》2022年第3期250-259,共10页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：目的通过光学相干层析血管成像(OCTA)评估未出现临床可见视网膜病变的急性髓系白血病患者的视网膜微血管损害,并与血液学指标、病程、化疗疗程进行相关性分析。方法纳入40例经扩瞳检眼镜检查无临床可见视网膜病变的急性髓系白血病患者(研究组)和42例健康人群(对照组)作为研究对象,所有受试者均接受常规眼科检查,并进行以黄斑为中心6.0 mm×6.0 mm区域和以视盘为中心4.5 mm×4.5 mm区域OCTA扫描,测量指标包括浅表毛细血管丛(SCP)和深层毛细血管丛(DCP)的血管密度(VD)、中心凹无血管区(FAZ)周长、FAZ面积、黄斑中心凹无血管区周围300μm毛细血管密度(FD300)、视网膜神经纤维层(RNFL)厚度、视盘周围血管密度。同时进行血液学相关指标检查,包括血红蛋白、白细胞计数、红细胞计数、血小板计数和幼稚细胞比例、乳酸脱氢酶(LDH)水平、血管内皮生长因子(VEGF)水平;并将研究组OCTA参数与血液学相关指标、病程、化疗疗程进行相关性研究。结果研究组旁中心凹区和中心凹周围区、中心凹区、黄斑总体的SCP、DCP的血管密度分别低于对照组相应指标(P<0.05)。研究组黄斑区FAZ的面积、周长较对照组增大(P<0.05),FD300较对照组明显降低(P<0.05)。2组间RNFL厚度、视盘周围血管密度差异无统计学意义(P>0.05)。多元线性回归分析结果显示,中央凹区SCP、DCP的血流密度,FD300与血红蛋白指标呈正相关(β=0.14,P=0.008;β=0.131,P=0.033;β=0.156,P=0.014);FAZ的面积与血红蛋白水平呈负相关(β=-0.102,P=0.009);FAZ的周长与红细胞计数呈负相关(β=-0.261,P=0.033);黄斑总体及中心凹周围区DCP的血流密度与幼稚细胞比例呈负相关(β=-0.129,P=0.006;β=-0.151,P=0.003);黄斑总体及中心凹旁、中心凹周围区SCP的血流密度,FD300与血清中VEGF水平呈负相关(β=-0.025,P=0.018;β=-0.037,P=0.017;β=-0.022,P=0.036;β=-0.037,P=0.025)。中心凹周围区SCPObjective To assess the retinal microvascular damages in patients with acute myeloid leukemia without clinically visible retinopathy by optical coherence tomography angiography(OCTA)and to analyze their correlations with hematological indicators,duration and chemotherapy.Methods Forty patients with acute myeloid leukemia without clinical visible retinopathy under mydriatic ophthalmoscope examination(research group)and 42 cases of healthy people(control group)were recruited.All the subjects accept regular eye examinations,and OCTA scanning centered on the macular area of 6.0 mm×6.0 mm and on the optic disc region of 4.5 mm×4.5 mm.Indexes including vascular density of superficial capillary plexus(SCP)and deep capillary plexus(DCP),foveal avascular zone(FAZ)circumference,FAZ area,the capillary density at 300μm around the fovea avascular area(FD300),retinal nerve fiber layer(RNFL)thickness and peripapillary vascular density were measured.At the same time,related parameters of hematology were examined,including hemoglobin,white blood cell count,red blood cell count,platelet count,immature cells proportion,and level of LDH and VEGF.The correlation between OCTA parameters and hematology-related indexes,duration of disease and chemotherapy course was investigated.Results The vascular density of both SCP and DCP in the para-fovea and peri-fovea of the study group was lower than those of the control group(P<0.05).The area and circumference of FAZ in macular area of the study group was larger compared to that of the control group(P<0.05),and FD300 was significantly lower than that of the control group(P<0.05).There was no significant difference in the thickness of RNFL or in the peripapillary vascular density between the two groups(P>0.05).The results of multiple linear regression analysis showed that the VD of SCP,DCP,FD300 in the fovea was positively correlated with the hemoglobin index(β=0.14,P=0.008;β=0.131,P=0.033;β=0.156,P=0.014),the area of FAZ was negatively correlated with hemoglobin level(β=-0.102,P=0.009),

关 键 词：急性髓系白血病 白血病性视网膜病变 光学相干层析血管成像 血管密度 中心凹无血管区 

分 类 号：R733.71[医药卫生—肿瘤] R774.1[医药卫生—临床医学]