中心性浆液性脉络膜视网膜病变患者厚玻璃膜疣的临床特征和危险因素  

Clinical characteristics and risk factors of pachydrusen in patients with central serous chorioretinopathy

作　　者：朱海燕 刘培[1] 安广琪 路晨雨 李姝 杜利平 金学民 Zhu Haiyan;Liu Pe;An Guangqi;Lu Chenyu;Li Shu;Du Liping;Jin Xuemin(The First Affiliated Hospital of Zhengzhou University,Henan Provincial Eye Hospital,Zhengzhou University School of Medical Sciences,Zhengzhou 450003,China;Institute of Fundus Diseases,Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院河南省眼科医院郑州大学医学科学院,郑州450003 [2]郑州大学眼底病研究所,郑州450052

出　　处：《中华眼底病杂志》2024年第12期930-935,共6页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察中心性浆液性脉络膜视网膜病变(CSC)患眼厚玻璃膜疣的临床特征及危险因素。方法回回顾性临床研究。2021年7月至2024年6月于郑州大学第一附属医院眼科检查确诊的CSC患者144例158只眼纳人研究。患眼均行验光、眼压、眼底彩色照相、荧光素眼底血管造影(FFA)、扫频源光相干断层扫描(OCT)检查;同时行吲哚青绿血管造影(ICGA)检查58只眼。横断面(en-face)OCT观察厚玻璃膜疣与大脉络膜血管扩张和脉络膜毛细血管层衰减区的共定位。设备自带软件计算中心凹下脉络膜厚度(SFCT)。FFA荧光素渗漏分为“墨渍样”、“炊烟样”、弥漫性点状渗漏。根据是否合并厚玻璃膜疣将患者分为CSC合并厚玻璃膜疣组、CSC未合并厚玻璃膜疣组。组间比较采用χ^(2)检验。与厚玻璃膜疣存在的相关因素分析采用logistic回归分析。结果158只眼中,合并厚玻璃膜疣72只眼(45.6%,72/158):en-face OCT像,厚玻璃膜疣与扩张的脉络膜大血管共同定位59只眼(81.94%,59/72);与脉络膜毛细血管层血流空洞相对应61只眼(84.72%,61/72)。行ICGA检查的58只眼中,厚玻璃膜疣与点状强荧光相对应46只眼(79.31%,46/58);位于脉络膜高通透性区域43只眼(74.14%,43/58)。与CSC未合并厚玻璃膜疣组比较,CSC合并厚玻璃膜疣组患眼脉络膜新生血管、扁平不规则色素上皮脱离、弥漫性点状渗漏和多渗漏点的发生率升高,差异均有统计学意义(X^(2)=6.217、8.455、5.363、17.749,P<0.05)。logistic回归分析结果显示,年龄[比值比(OR)=1.116,95%可信区间(CI)1.060~1.176,P<0.001]、慢性CSC(OR=2.628,95%CI 1.250~5.526,P=0.011)是厚玻璃膜疣发生的独立危险因素。结论CSC患眼厚玻璃膜疣发生率为45.6%;年龄和慢性CSC是厚玻璃膜疣发生的独立危险因素。厚玻璃膜疣与扩张的脉络膜血管及脉络膜高通透区域相对应,是CSC活动或发展的潜在风险因素。Objective To observe the clinical characteristics and risk factors associated with pachydrusen in eyes affected by central serous chorioretinopathy(CSC).Methods A retrospective clinical study.From July 2021 to June 2024,144 cases and 158 eyes of CsC patients diagnosed through ophthalmological examination at Department of Ophthalmology of The First Affiliated Hospital of Zhengzhou University were included.All affected eyes underwent a series of assessments,including refraction,intraocular pressure measurement,fundus color photography,fluorescein fundus angiography(FFA),and swept-source optical coherence tomography(OCT).Additionally,58 eyes underwent indocyanine green angiography(ICGA).Cross-sectional(en-face)OCT was utilized to observe the colocalization of pachydrusen with areas of dilation of large choroidal vessels and attenuation of the choriocapillaris layer.The device was used for OCT included software for calculating subfoveal choroidal thickness(SFCT).FFA fluorescein leakage was categorized into"ink stain","cooking smoke",and"diffuse point leakage".Patients were classified into groups of CSC patients complicated by pachydrusen and groups of CSC patients without pachydrusen.Comparisons between the groups were performed using the x^(2) test,and factors associated with the presence of pachydrusen were analyzed using logistic regression.ResultsAmong 158 eyes,72 eyes(45.6%,72/158)were complicated by pachydrusen.In en-face OCT images,pachydrusen were co-located with dilated large choroidal vessels in 59 eyes(81.94%,59/72)and corresponded to choroidal capillary layer blood flow holes in 61 eyes(84.72%,61/72).Among the 58 eyes that underwent ICGA examination,pachydrusen corresponded to punctate strong fluorescence in 46 eyes(79.31%,46/58)and were located in areas of choroidal hyperpermeability in 43 eyes(74.14%,43/58).Compared with the CSC group without pachydrusen,the incidence of choroidal neovascularization,flat irregular pigment epithelial detachment,diffuse punctal leakage and multiple leakage points increase

关 键 词：中心性浆液性脉络膜视网膜病变 厚玻璃膜疣 脉络膜厚度 眼底血管造影 体层摄影术 光学相干 

分 类 号：R774.1[医药卫生—眼科]