抗VEGF治疗糖尿病性黄斑水肿对黄斑区局部血流影响的观察  

Study on the macular-area-blood-flow effect when undergoing anti-VEGF treatment in diabetic macular edema patients

作　　者：姚盼盼 范亮亮 张洁 李冰 Yao Panpan;Fan Liangliang;Zhang Jie;Li Bing(Department of Ophthalmology,Wusong Hospital Branch,Zhongshan Hospital Affiliated to Fudan University,Shanghai 200940,China;Department of prevention and health care,Changhai Community Health Service Center,Yangpu District,Shanghai,200082,China;Department of Ophthalmology,Yangpu Hospital,Tongji University School of Medicine,Shanghai 200090,China)

机构地区：[1]复旦大学附属中山医院吴淞医院眼科,200940 [2]上海市杨浦区长海社区卫生服务中心院务办公室 [3]同济大学附属杨浦医院眼科

出　　处：《临床眼科杂志》2023年第5期391-397,共7页Journal of Clinical Ophthalmology

基　　金：上海市自然科学基金项目(19ZR1450500)。

摘　　要：目的基于抗血管内皮生长因子(VEGF)治疗效果,采用相干光层析血管成像术(OCTA)技术探讨抗VEGF治疗对糖尿病性黄斑水肿(DME)患者的黄斑区局部血流的影响。方法回顾性病例研究。分析2019年8月至2021年8月于我院经3+PRN抗VEGF治疗的DME患者53例(67只眼),根据抗VEGF治疗后黄斑中心凹视网膜厚度(CRT)下降的幅度分为解剖改善敏感组(△CRT>50μm)28例(35只眼)和解剖改善不敏感组(△CRT≤50μm)25例(32只眼),分别收集两组患者抗VEGF治疗前1个月内及治疗后6个月时的临床资料和OCTA影像学参数,包括最佳矫正视力(BCVA)、CRT、视网膜浅层毛细血管丛(SCP)和视网膜深层毛细血丛管(DCP)的平均血流密度(VD)、黄斑区视网膜外层血流密度(ORVD)、脉络膜毛细血管层血流密度(CCVD)和视网膜毛细血管无灌注区面积(RNPA),并对其进行统计学比较和相关性分析。结果非增生性糖尿病性视网膜病变与增生性糖尿病性视网膜病变(NPDR/PDR)比例敏感组明显高于不敏感组,两组间DR分期差异有统计学意义(P<0.05);对于敏感组,患者抗VEGF治疗后6个月比治疗前相比,CRT水平明显降低,BCVA显著提高(P<0.01),黄斑区视网膜血流(包括SCP-VD、DCP-VD、ORVD、CCVD和RNPA)的变化均无统计学意义(均P>0.05);对于不敏感组,患者上述指标在抗VEGF治疗前后的变化均无统计学意义(均P>0.05);治疗前敏感组患者基线CRT与不敏感组相比差异无统计学意义(P>0.05);在治疗后6个月敏感组CRT水平较不敏感组显著降低(P<0.01),敏感组患者BCVA、DCP-VD和RNPA在治疗前后均较不敏感组受损程度小(均P<0.05),而SCP-VD、ORVD和CCVD在治疗前后的变化与不敏感组相比差异无统计学意义(均P>0.05)。两组中每位患者各自对应的DCP-VD和RNPA×10值的散点图显示:治疗前和治疗后6个月DCP-VD与RNPA×10均存在负相关趋势,即DCP-VD越小,RNPA×10越大,在不敏感组中比敏感组更明显。两组患者上述各Objective Toinvestigate the effect of anti-VEGF treatment on macular-area-blood-flow(MABF)in diabetic macular edema(DME)patients.Methods In this retrospective study,53 DME patients(67 eyes)who were treated with 3+pro re nata(PRN)anti-vascular endothelial growth factor(VEGF)were enrolled and divided into two groups according to the decline range of central retinal thickness(CRT)after the treatment.28 DME patients(35 eyes)were assigned to anatomical improvement sensitive group(AISG,△CRT>50μm)and the other 25 DME patients(32 eyes)into anatomical improvement insensitive group(AIIG,△CRT≤50μm).The clinical data and OCTA metrics of patients in both groups were collected at 1 month before and 6 months after anti-VEGF treatment,which including best corrected visual acuity(BCVA),CRT,vessel density of superficial capillary plexus(SCP)and deep capillary plexus(DCP),outer retinal vessel density(ORVD)at the macular area,choroidal capillary vessel density(CCVD)and retinal capillary non-perfusion area(RNPA).Results The ratio of NPDR/PDR in the AISG was significantly higher than that in the AIIG,and the stages of diabetic retinopathy(DR)between the two groups have an obviously difference(P<0.05).the CRT and BCVA in the AISG was remarkably lower than that before the treatment at six months after anti-VEGF treatment(all P<0.01).While the macular-area-blood-flow did not change significantly before and after the treatment when comparing their(SCP,DCP,ORVD,CCVD and RNPA)(P>0.05).However,the above metrics of AIIG had no significantly different(P>0.05).The CRT in both groups had no difference at baseline(P>0.05),while significantly decreased CRT were oberserved in AISG at 6 months after the treatment(P<0.01).The damage degree of BCVA,DCP and RNPA in the AISG was less than those of the AIIG after the treatment(P<0.05),while there were no significant differences in the change of SCP,ORVD and CCVD after the treatment between the two groups(P>0.05).Considering the scatter plots of the corresponding DCP and RNPA×10 values in both gr

关 键 词：相干光层析血管成像术 抗VEGF治疗 糖尿病性黄斑水肿 黄斑区局部血流 

分 类 号：R587.2[医药卫生—内分泌] R774.5[医药卫生—内科学]