扫频源OCTA对系统性红斑狼疮患者黄斑区脉络膜厚度及微循环改变的评估  

Assessment of macular choroidal thickness and microvascular changes in patients with systemic lupus erythematosus by swept-source OCTA

作　　者：毕萌 樊芳[2] 夏会卡 梁福珍 季彤 张风肖[4] 贾志旸[2] Bi Meng;Fan Fang;Xia Huika;Liang Fuzhen;Ji Tong;Zhang Fengxiao;Jia Zhiyang(Graduate School,North China University of Science and Technology,Tangshan 063210,China;Department of Ophthalmology,Hebei General Hospital,Shijiazhuang 050057,China;Graduate School,Hebei Medical University,Shijiazhuang 050000,China;Department of Rheumatology and Immunology,Hebei General Hospital,Shijiazhuang 050057,China)

机构地区：[1]华北理工大学研究生院,唐山063210 [2]河北省人民医院眼科,石家庄050057 [3]河北医科大学研究生院,石家庄050000 [4]河北省人民医院风湿免疫科,石家庄050057

出　　处：《中华实验眼科杂志》2023年第11期1084-1090,共7页Chinese Journal Of Experimental Ophthalmology

基　　金：河北省医学适用技术跟踪项目(GZ2021040)

摘　　要：目的利用扫频源光学相干断层扫描血管成像(OCTA)技术探讨系统性红斑狼疮(SLE)患者黄斑区脉络膜厚度及脉络膜微血管形态的早期变化特征。方法采用横断面研究方法,纳入2022年1—7月就诊于河北省人民医院风湿免疫科、无明显眼部症状的SLE患者37例37眼作为SLE组,同时纳入与病例组年龄、性别相匹配的正常成年人35例35眼作为对照组。采用扫频源OCT对受试者进行黄斑区9 mm×9 mm放射状扫描,获得受试者黄斑中心凹区域、旁中心凹区域(1~3 mm)、中心凹周围区域(3~6 mm)的平均脉络膜厚度。采用OCTA对受试者进行黄斑区3 mm×3 mm扫描,获得黄斑区视网膜浅层毛细血管丛(SCP)和深层毛细血管丛(DCP)血流密度、脉络膜毛细血管丛(CC)血流密度及微血管血流图像,采用Image J软件对脉络膜毛细血管血流图像进行二值化处理(Phansalkar法)并计算脉络膜毛细血管流空区域面积(FDa)及百分比(FD%)。结果SLE组黄斑中心凹区域平均脉络膜厚度为(268.73±81.67)μm,较对照组的(230.14±68.14)μm明显增厚,差异有统计学意义(t=2.170,P=0.033)。SLE组黄斑中心凹区域视网膜SCP、视网膜DCP、CC血流密度值分别为(16.58±3.90)%、(14.25±3.15)%和(51.80±4.27)%,均明显低于对照组的(20.55±4.41)%、(16.57±3.74)%和(54.33±3.41)%,差异均有统计学意义(t=-4.043、-2.851、-2.763,均P<0.05)。SLE组脉络膜毛细血管流空区域FDa及FD%分别为3.43(3.25,3.56)mm^(2)和38.11%(36.13%,39.52%),明显大于对照组的3.25(3.21,3.32)mm^(2)和36.11%(35.64%,36.84%),差异均有统计学意义(Z=-3.470、-3.476,均P<0.05)。结论OCTA可检测到无明显眼部症状SLE患眼脉络膜厚度的增加及CC层血流密度的减少。Objective To observe the characteristics of early changes in choroidal thickness and choroidal microvascular morphology in the macula of patients with systemic lupus erythematosus(SLE)using swept-source optical coherence tomography angiography(OCTA).Methods A cross-sectional study was conducted.Thirty-seven patients(37 eyes)who were diagnosed with SLE without obvious ocular symptoms in Hebei General Hospital from January 2022 to July 2022 were enrolled in this study as a SLE group.At the same time,35 normal adults(35 eyes)matched with age and sex were included as a control group.Swept-source OCT was used to perform a 9 mm×9 mm radial scan of the macular region of subjects to obtain the average choroidal thickness of the macular central concave area,the paracentral concave area(1-3 mm),and the pericentral concave area(3-6 mm).OCTA was used to perform a 3 mm×3 mm scan of the macular region and images of retinal superficial capillary plexus(SCP)and deep capillary plexus(DCP)blood flow density,choroidal capillary plexus(CC)blood flow density,and microvascular blood flow in the macular region were obtained and binarized using ImageJ software(Phansalkar method)to calculate the choroidal capillary flow void area(FDa)and percentage of flow deficits(FD%).The study protocol followed the Declaration of Helsinki and was approved by the Ethics Committee of Hebei General Hospital(No.202310).Informed consent was obtained from all subjects.Results The choroidal thickness of the subfoveal region in SLE group was(268.73±81.67)μm,which was significantly higher than(230.14±68.14)μm of control group(t=2.170,P=0.033).The blood flow density of SCP,DCP and CC in the macular central zone area of SLE group were(16.58±3.90)%,(14.25±3.15)%and(51.80±4.27)%,respectively,which were significantly lower than(20.55±4.41)%,(16.57±3.74)%and(54.33±3.41)%of control group(t=-4.043,-2.851,-2.763;all at P<0.05).The FDa and FD%in SLE group were 3.43(3.25,3.56)mm^(2)and 38.11%(36.13%,39.52%),which were greater than 3.25(3.21,3.32)mm^(2)and 36.

关 键 词：系统性红斑狼疮 脉络膜厚度 血管流空 脉络膜毛细血管丛 光学相干断层扫描血管成像 

分 类 号：R593.241[医药卫生—内科学] R77[医药卫生—临床医学]