糖尿病性视网膜病变患者视盘周围微循环变化和神经纤维层厚度相关性分析  

Analysis of correlation between microcirculation changes around the optic disc and retinal nerve fiber layer thickness in patients with diabetic retinopathy

作　　者：崔腾 谢驰[2] 蔡亚珍 徐玥 方严[2] Cui Teng;Xie Chi;Cai Yali;Xu Yue;Fang Yan(School of Medicine,Anhui University of Science and Technology,Huainan,Anhui 232001,China;The First Affiliated Hospital of Anhui University of Science and Technology(Huainan First People's Hospital),Eye Institute of Anhui University of Science and Technology,Huainan,Anhui 232001,China)

机构地区：[1]安徽理工大学医学院,安徽淮南232000 [2]安徽理工大学第一附属医院(淮南市第一人民医院),安徽理工大学眼科研究所,安徽淮南232000

出　　处：《齐齐哈尔医学院学报》2025年第2期112-117,共6页Journal of Qiqihar Medical University

基　　金：淮南市科技计划项目(2023181)。

摘　　要：目的探讨应用扫频源光学相干断层扫描血管成像技术(Swept-source optical coherence tomography angiography,SS-OCTA)分析比较年龄匹配的健康受试者和糖尿病性视网膜病变(Diabetic Retinopathy,DR)患者视盘周围微循环变化和视网膜神经纤维层厚度相关性。方法选择2023年6-9月本院眼科和内分泌科收治的158例患者进行了横断面研究。根据早期治疗糖尿病视网膜病变研究(Early treatment diabetic retinopathy study,ETDRS)的准则,将研究对象划分为三个组别:对照组(53例)、无糖尿病视网膜病变组(No Diabetic Retinopathy,NDR)(53例)和非增殖性糖尿病视网膜病变组(52例)。使用SS-OCTA技术对视盘周围各扇区的三个指标进行测量和比较分析:视网膜毛细血管血流密度(Retinal vessel density,RVD)、血流灌注面积(Perfusion density,PD)以及视盘周视网膜神经纤维层(Peripapillary retinal nerve fiber layer,pRNFL)厚度。结果与对照组相比,NDR组在四个象限RVD、PD的差异并无统计学意义(P>0.05),NPDR组除N象限RVD、PD的变化均无统计学意义(P>0.05)外,其余象限RVD变化均有统计学意义(P<0.05)。NDR组的pRNFL厚度较对照组增厚(P<0.05),而NPDR组与对照组比较pRNFL厚度无显著差异(P>0.05)。对照组视盘周RVD与pRNFL厚度呈中度正相关(r=0.7645,P<0.0001),NDR视盘周RVD与pRNFL厚度呈中度正相关(r=0.5252,P<0.0001),NPDR组视盘周RVD与pRNFL厚度呈中相关(r=0.4652,P<0.001)。对照组视盘周PD与pRNFL厚度呈中度正相关(r=0.7587,P<0.0001),NDR视盘周PD与pRNFL厚度呈中度正相关(r=0.5695,P<0.0001),NPDR组视盘周PD与pRNFL厚度呈中相关(r=0.5895,P<0.0003)。结论在DR的发展中,PD和RVD在各个象限的变化可能具有一致性。在DR初期未发生病变时,pRNFL明显变薄,这提示在DR初期pRNFL可能是视网膜血管、神经损害的标志。SS-OCTA在评估早期DR微循环变化中具有重要价值。Objective To apply swept-source optical coherence tomography angiography(SS-OCTA)and compare the changes in peripapillary optic disc microcirculation and retinal nerve fiber layer thickness related to diabetic retinopathy among age-matched healthy subjects and patients with diabetic retinopathy.Methods A total of 158 patients treated in the ophthalmology and endocrinology departments of the First Affiliated Hospital of Anhui University of Science and Technology from June to September 2023 were enrolled in a cross-sectional study.Based on the Early Treatment Diabetic Retinopathy Study(ETDRS)guidelines,the participants were divided into three groups:control group(53 patients),no diabetic retinopathy group(NDR,53 patients),and non-proliferative diabetic retinopathy group(NPDR,52 patients).Three indices were measured and comparatively analyzed using the SS-OCTA technique in each sector of the peripapillary optic disc:retinal vessel density(RVD),perfusion density(PD),and peripapillary retinal nerve fiber layer(pRNFL)thickness.Results Compared with the control group,the differences in RVD and PD in the four quadrants in the NDR group were not statistically significant(P>0.05).In the NPDR group,changes in RVD were statistically significant in all quadrants except the N quadrant(P<0.05).The pRNFL thickness was thicker in the NDR group compared to the control group(P<0.05),while there was no significant difference in pRNFL thickness between the NPDR group and the control group(P>0.05).The peripapillary RVD was moderately positively correlated with pRNFL thickness in the control group(r=0.7645,P<0.0001),in the NDR group(r=0.5252,P<0.0001),and in the NPDR group(r=0.4652,P=0.001).Similarly,peripapillary PD was moderately positively correlated with pRNFL thickness in the control group(r=0.7587,P<0.0001),in the NDR group(r=0.5695,P<0.0001),and in the NPDR group(r=0.5895,P=0.0003).Conclusions In the development of diabetic retinopathy,changes in PD and RVD in each quadrant may be consistent.In the early stages of diabetic retin

关 键 词：糖尿病性视网膜病变 扫频源光学相干断层扫描血管成像技术 视盘 局部血流 视盘周视网膜神经纤维层 

分 类 号：R774.1[医药卫生—眼科] R587.2[医药卫生—临床医学]