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  

Differences of biochemical indicators and optical coherence tomography angiography in patients with different degrees of diabetic retinopathy

作　　者：艾诗蓓 郑枞 曹明哲 杜芳芳 刘鑫鑫 徐楠[1] 彭鸿钧 陆丽娇 AI Shibei;ZHENG Zong;CAO Mingzhe;DU Fangfang;LIU Xinxin;XU Nan;PENG Hongjun;LU Lijiao(Department of Ophthalmology,The Seventh Affiliated Hospital of Sun Yat-sen University,Shenzhen Guangdong 518000,China)

机构地区：[1]中山大学附属第七医院眼科,广东深圳518000

出　　处：《眼科学报》2022年第12期918-925,共8页Eye Science

摘　　要：目的:探讨光学相干断层扫描血管成像(optical coherence tomography angiography,OCTA)在糖尿病性视网膜病变中的应用。方法:选取2021年中山大学附属第七医院眼科63例糖尿病患者为研究对象,分为无糖尿病性视网膜病变(T0,21眼)、轻度非增殖期(T1,21眼)、中重度非增殖期(T 2, 1 4眼)及增殖期(T3,7眼)。收集各组生化指标,包括空腹血糖、糖化血红蛋白、谷丙转氨酶、谷草转氨酶、碱性磷酸酶、血清尿素氮、肌酐、尿素氮肌酐比值,及OCTA数据,即中心视网膜厚度、Angiography3×3及Angiography6×6血管线性密度及血管灌注密度等。采用单因素方差分析比较各组间差异。结果:T2组、T3组与T0组相比,T3组与T1组相比,糖尿病病程延长;T3组与其他各组相比,尿素氮升高;T1组、T2组、T3组与T0组相比,T3组与T1组相比,6 mm×6 mm外层血流线性密度减少;与T0组相比,T1组、T2组及T3组6 mm×6 mm完整血流线性密度减少;与T0相比,T2组、T3组6 mm×6 mm外层血流灌注密度减少;与T0组相比,T3组6 mm×6 mm完整血流灌注密度减少;T2组、T3组与T0组相比,T3与T1相比,3 mm×3 mm内层血流线性密度明显减少;T3组与T0组及T1组相比,3 mm×3 mm完整血流线性密度减少。结论:随着糖尿病性视网膜病变的进展,患者的尿素氮及肌酐逐渐升高,OCTA的血流线性密度及血流灌注密度逐渐减少。与血流灌注密度相比,血流线性密度对于早期糖尿病性视网膜病变筛查可能更为敏感。而利用Angiography6×6模式可能可以更早地发现糖尿病性视网膜病变的视网膜血流变化。Objective:To explore the applications of optical coherence tomography angiography(OCTA) in diabetic retinopathy.Methods:A total of 63 diabetic patients in the Department of Ophthalmology,Seventh Affiliated Hospital of Sun Yat-sen University in 2021 were divided into 4 groups:the patients without diabetic retinopathy(T0,n=21),mild non-proliferative diabetic retinopathy(T1,n=21),moderate-to-severe non-proliferative diabetic retinopathy(T2,n=14) and proliferative diabetic retinopathy(T3, n=7).Biochemical Indicators were collected in all patients,such as fasting plasma glucose(FPG),glycated hemoglobin A1c(HbA1c),alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),the blood urea nitrogen(BUN),creatinine(CRE) and the ratio of blood urea nitrogen and creatinine(BUN/CRE).The Macular Cube521×128,Angiography3×3,and Angiography6×6 models of OCTA were used to obtain central retinal thickness(CRT),vascular density(VD) and perfusion density(PD) of each group.The data of all subjects was applied to do one-way ANOVA.Results:Prolonged duration of diabetes in T2 and T3 compared to T0 and in T3 compared to T1.Elevated BUN in T3 compared to all other groups.When T1,T2 and T3 were compared to T0,and T3was compared to T1,the VD of the 6 mm ×6 mm outer layer decreased.Reduced VD of intact 6 mm ×6 mm region in T1,T2 and T3 compared to T0.Declining PD of the 6 mm ×6 mm outer layer in T2 and T3 compared to T0.Diminished PD of whole 6 mm ×6 mm area at T3 compared to T0.The VD of 3 mm ×3 mm inner layer was significantly reduced in T3 compared to T0 and T1.The VD of 3 mm ×3 mm intact area gradually dwindled in T3 compared with T0 and T1(P<0.05).Conclusion:With the progression of diabetic retinopathy,the levels of BUN and CRE gradually increased,and the OCTA-derived vascular density and perfusion density gradually decrease.Vascular density may be more sensitive for early diabetic retinopathy screening than perfusion density.The use of the Angiography6×6 model may result in an earlier detection of

关 键 词：糖尿病性视网膜病变 光学相干断层扫描成像 生化指标 血流线性密度 血流灌注密度 

分 类 号：R587.2[医药卫生—内分泌] R774.1[医药卫生—内科学]