基于SS-OCT探究急性高糖对明暗适应中视网膜脉络膜血流及结构改变的影响  

Acute Hyperglycemia Affects Retinal and Choroidal Changes in Dark to Light Adaptation Using SS-OCT

作　　者：于焕凯 黄天皓 施策 林志阳 林广青 沈梅晓 吕帆 Huankai Yu;Tianhao Huang;Ce Shi;Zhiyang Lin;Guangqing Lin;Meixiao Shen;Fan Lu(Eye Hospital,Wenzhou Medical University,Wenzhou 325027,China)

机构地区：[1]温州医科大学附属眼视光医院,温州325027

出　　处：《中华眼视光学与视觉科学杂志》2023年第4期264-270,共7页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：国家重点研发计划(2020YFC2008200)。

摘　　要：目的:利用扫频光源光学相干断层成像技术(SS-OCT)探究急性血糖升高对视网膜血流及脉络膜血管结构在明、暗适应过程中反应的改变。方法:前瞻性临床研究。随机纳入2021年8—10月温州医科大学附属眼视光医院在校学生24例(24眼),均为健康受检者,利用SS-OCT对其进行测量,对该24例受检者依次进行2次试验,分为对照组和观察组。对照组不做任何干预;观察组为受检者在暗适应开始前口服75 g无水葡萄糖。采用SS-OCT分别拍摄对照组和观察组在暗适应开始前、暗适应结束时及转为明适应后的30 s、2 min、5 min这几个时间点的视网膜结构及血流图片,并分析获取3层毛细血管丛的视网膜血管密度(VD)以及脉络膜血管结构参数。在校正年龄、眼轴和图像质量等因素后,比较对照组及观察组不同时间点的视网膜血流及脉络膜血管结构反应差异。采用配对t检验进行组间差异比较。结果:暗适应中,对照组浅层毛细血管丛(SCP)的VD较基线水平明显下降(t=2.42,P=0.024),而在给予急性高糖干预后视网膜SCP(t=5.11,P<0.001)和中层细血管丛(ICP)(t=2.17,P=0.041)的VD均较基线水平明显下降。在转为明适应5 min后,观察组SCP的VD较对照组明显上升(t=2.19,P=0.039)。暗适应中,与对照组相比,观察组的脉络膜血管指数(CVI)明显下降(t=3.90,P=0.001)。明适应5 min后,观察组的血管体积(LV)(t=3.23,P=0.002)较暗适应后明显上升,且与对照组相比,LV(t=2.68,P=0.013)和脉络膜总体积(TCV)(t=2.25,P=0.034)的变化量明显增加。结论:暗环境时,急性高糖会引起视网膜SCP血管密度下降以及CVI下降。急性高糖会改变视网膜血流及脉络膜血管结构对光环境变化作出的反应。Objective:To investigate the effect of acute hyperglycemia on alternations of retinal vessels and choroidal vascular structure during dark and light adaptation using swept-source optical coherence tomography(SS-OCT).Methods:In this prospective clinical study,totally 24 healthy(24 eyes)students of Wenzhou Medical University Eye Hospital from August to October 2021 were randomly recruited and imaged using SS-OCT.Two experiments were performed on 24 subjects successively:Observation group received a 75 g oral glucose solution before dark adaptation,while control group received no intervention.In both experiments,SS-OCT imaging was performed before dark adaptation,dark-adapted stage,and 30 seconds,2 minutes,5 minutes at ambient light.Then the vessel density(VD)of three retinal capillary plexuses and choroid vascular structure parameters were analyzed.Differences between the observation and control groups among the different stages were compared after adjusting for age and image quality.The differences between two groups were compared using paired t test.Results:After dark adaptation,compared to baseline,VD of superficial capillary plexuses(SCP)was decreased significantly(t=2.42,P=0.024).During hyperglycemia,the VD of SCP(t-5.11,P<0.001)and intermediate retinal capillary plexus(ICP)(t-2.17,P=0.041)decreased significantly compared to baseline.With a transition to light after 5 minutes in observation group,VD in SCP significantly increased(t-2.19,P-0.039).Compared to the control experiment,choroidal vascularity(CVI)significantly decreased in observation group during dark adaptation(t-3.90,P=0.001).After light adaptation 5 minutes,luminal volume(LV)significantly increased in observation group(t-3.23,P=0.002).And the alternations of LV(t-2.68,P-0.013)and total choroidal volume(t-2.25,P-0.034)were also significantly increased compared to control experiment.Conclusions:In dark,acute hyperglycemia caused a significant decrease in SCP vessel density and CVI.Hyperglycemia not only disrupted retinal blood flow significantly,but

关 键 词：光学相干断层扫描 脉络膜血管结构 暗适应 急性高糖 视网膜毛细血管 

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