不同屈光状态儿童黄斑区脉络膜微循环改变研究  

Study on the Changes in Macular Choroidal Microcirculation in Children with Different Refractive States

作　　者：张秀清 张红[2] 蔡志鹏[2] 赵芳 张津京[2] 周剑[3] ZHANG Xiuqing;ZHANG Hong;CAI Zhipeng;ZHAO Fang;ZHANG Jin-jing;ZHOU Jian(Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]北京中医药大学,北京100029 [2]中国中医科学院眼科医院,北京100040 [3]北京中医药大学东方医院,北京100078

出　　处：《中国中医眼科杂志》2024年第11期1009-1015,1046,共8页China Journal of Chinese Ophthalmology

基　　金：北京中医药薪火传承“新3+3”工程(2023-SZ-F-18);北京市石景山区疾病预防控制中心委托项目。

摘　　要：目的观察不同屈光状态儿童黄斑区脉络膜微循环特征,评估儿童近视眼的早期改变。方法纳入学校近视筛查后符合纳入标准的儿童青少年135例(135只眼),年龄6~11岁。按照屈光度分为正视组29例(29只眼)、低度近视组81例(81只眼),中高度近视组25例(25只眼)。散瞳后,采集学生的等效球镜(SE)度、眼轴(AL)、脉络膜厚度(CT)、脉络膜体积(CV)、脉络膜毛细血管灌注面积(CCPA)、脉络膜血管指数(CVI)指标,比较不同屈光状态学生脉络膜参数差异性,分析AL、SE与脉络膜参数相关性,及脉络膜厚度影响因素。结果(1)脉络膜参数比较:①CT,与正视组相比,低度近视组各区域CT变薄,中高度近视组进一步变薄,差异均有统计学意义(F整体平均=10.523、F_(中心凹)=11.565、F_(旁中心凹)=10.362、F_(上方)=8.715、F_(颞侧)=8.693、F_(下方)=10.664、F_(鼻侧)=10.645,均P=0.000);②CV,黄斑区0~3 mm范围,与正视组相比,低度近视组儿童整体CV(TCV)及基质CV(SCV)减少,中高度近视组进一步减少,差异均有统计学意义(F_(TCV)=11.216、F_(SCV)=11.847,均P=0.000),而3组LCV比较,差异无统计学意义(P>0.05);③CVI,与正视组、低度正视组相比,中高组近视组各区域CVI均变大,差异均有统计学意义(F整体=6.146,P=0.004;F_(中心凹)=6.799,P=0.002;F_(旁中心凹)=6.293,P=0.004;F_(上方)=4.297,P=0.019;F_(颞侧)=6.619,P=0.002;F_(下方)=4.595,P=0.012;F_(鼻侧)=4.027,P=0.025);④CCPA,中高度近视组CCPA较正视组减小(H=8.317,P=0.016),而不同屈光状态其余区域CCPA比较,差异均无统计学意义(P>0.05)。(2)AL、SE与脉络膜参数的相关性分析:黄斑中心直径3 mm范围内,CT、TCV、SCV与SE呈正相关(r_(CT)=0.322、r_(TCV)=0.374、r_(SCV)=0.349,均P=0.000);与AL呈负相关(r_(CT)=-0.451、r_(TCV)=-0.403、r_(SCV)=-0.451,均P=0.000)。CVI与SE呈负相关(r=-0.237,P=0.006);与AL呈正相关(r=0.276,P=0.001)。CCPA、LCV与AL、SE均无明显相关性(P>0.05)。(3)脉络膜厚度影响OBJECTIVE To observe the characteristics of macular choroidal microcirculation in children with different refractive states and to assess the early changes in myopia in children.METHODS A total of 135 children and adolescents(135 eyes),aged 6 to 11 years,were included in the study following school myopia screening and met the inclusion criteria.They were divided into three groups according to refractive error:29 cases(29 eyes)in the emmetropia group,81 cases(81 eyes)in the low myopia group,and 25 cases(25 eyes)in the moderate-to-high myopia group.After pupil dilation,indices such as spherical equivalent(SE),axial length(AL),choroidal thickness(CT),choroidal volume(CV),choroidal capillary perfusion area(CCPA),and choroidal vascularity index(CVI)were measured.The differences in choroidal parameters between the groups were compared.Correlation analysis was performed between AL,SE,and choroidal parameters,and the influencing factors for CT were evaluated.RESULTS(1)Comparison of choroidal parameters.①CT:Compared with the emmetropia group,the CT in all regions was thinner in the low myopia group and further thinned in the moderate-to-high myopia group,with statistically significant differences(F_(whole)=10.523,F_(fovea)=11.565,F_(parafovea)=10.362,F_(superior)=8.715,F_(temporal)=8.693,F_(inferior)=10.664,F_(nasal)=10.645,all P=0.000).②CV:Within the 0~3 mm range of the macular region,the total choroidal volume(TCV)and stromal volume(SCV)decreased in the low myopia group compared to the emmetropia group,and further decreased in the moderate-to-high myopia group,with statistically significant differences(F_(TCV)=11.216,F_(SCV)=11.847,both P=0.000).However,there was no statistically significant difference in luminal volume(LCV)among the three groups(P>0.05).③CVI:Compared with the emmetropia and low myopia groups,the CVI increased in each region in the moderate-to-high myopia group,with statistically significant differences(F_(whole)=6.146,P=0.004;F_(fovea)=6.799,P=0.002;F_(parafovea)=6.293,P=0.004;F_(superior)=4.297,

关 键 词：儿童 近视 脉络膜 光学相干断层扫描血管成像技术 

分 类 号：R778.11[医药卫生—眼科]