Optical coherence tomography angiography in diabetic retinopathy:focusing on microvascular changes  

应用OCTA观察糖尿病视网膜病变的微血管变化

作　　者：Yang Xiongyi Yi Guoguo Chen Yanxia Yang Siyu Ai Shibei Zheng Cong Cao Mingzhe Fu Min 杨雄一;易果果;陈艳霞;杨思宇;艾诗蓓;郑枞;曹明哲;符敏(南方医科大学珠江医院,广东省广州市510000;中山大学附属第六医院2眼科,广东省广州市510000;中山大学附属第六医院生物医学融合创新中心,广东省广州市510000;厦门大学附属妇女儿童医院眼科,福建省厦门市361000;中山大学附属第七医院眼科,广东省深圳市518000;南方医科大学珠江医院眼科,广东省广州市510000)

机构地区：[1]Zhujiang Hospital,Southern Medical University,Guangzhou 510000,Guangdong Province,China [2]Zhujiang Hospital,Southern Medical University,Department of Ophthalmology,Guangzhou 510000,Guangdong Province,China [3]Biomedical Innovation Center,the Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510000,Guangdong Province,China [4]Department of Ophthalmology,Women and Children s Hospital Affiliated to Xiamen University,Xiamen 361000,Fujian Province,China [5]Department of Ophthalmology,the Seventh Affiliated Hospital,Sun Yat-sen University,Shenzhen 518000,Guangdong Province,China [6]Department of Ophthalmology,Zhujiang Hospital,Southern Medical University,Guangzhou 510000,Guangdong Province,China

出　　处：《国际眼科杂志》2025年第2期179-190,共12页International Eye Science

摘　　要：AIM:To investigate the value of optical coherence tomography angiography(OCTA)indicators in the diagnosis of diabetic retinopathy(DR),and to provide patients with diabetic nephropathy(DN)with more sensitive OCTA screening indicators to detect concurrent DR at an early stage.METHODS:A total of 200 patients who treated in the ophthalmology department of the Seventh Affiliated Hospital,Sun Yat-sen University from 2022 to 2023 were included,including 95 first-diagnosed DR patients and 105 patients without DR,and all patients underwent OCTA examination and a collection of demographics and renal function parameters.After a quality check,automated measurements of the foveal avascular zone area,vessel density(VD),and perfusion density(PD)of both 3 mm×3 mm and 6 mm×6 mm windows were obtained.RESULTS:Using random forest and multivariate Logistic regression methods,we developed a diagnostic model for DR based on 12 variables(age,FBG,SBP,DBP,HbA1c,ALT,ALP,urea/Scr,DM duration,HUA,DN,and CMT).Adding specific OCTA parameters enhanced the efficacy of the existing diagnostic model for DR(outer vessel density in 6 mm×6 mm window,AUC=0.837 vs 0.819,P=0.03).In the study of DN patients,the parameters in the 6 mm×6 mm window improved the diagnostic efficacy of DR(inner VD;outer VD;full VD;outer PD;full PD).CONCLUSION:The outer VD in the 6 mm×6 mm window can enhance the efficacy of the traditional DR diagnostic model.Meanwhile,compared with the 3 mm×3 mm window,the microvascular parameters in the 6 mm×6 mm window focusing on DN patients can be more sensitive to diagnosing the occurrence of DR.目的:探究光学相干断层血管造影(OCTA)参数在糖尿病视网膜病变(DR)诊断中的价值,并为糖尿病肾病(DN)患者提供更灵敏的OCTA筛查参数,以便在疾病早期诊断DR的并发。方法:纳入2022/2023就诊于中山大学附属第七医院眼科的患者200例,其中包括95例首次诊断为DR的患者和105例未诊断为DR的患者,所有患者均进行OCTA检查,收集人口统计数据和肾功能参数。经质量检查后,测量患者3 mm×3 mm和6 mm×6 mm窗口的中央凹无血管区面积、血管密度(VD)和灌注密度(PD)指标情况。结果:利用随机森林和多因素回归方法建立一个基于12个变量(年龄、血糖、血压、血脂、糖化血红蛋白、尿素、糖尿病持续时间、HUA、DN、CMT)的DR诊断模型。添加特定的OCTA参数(6 mm×6 mm窗口中的外层血管密度,AUC=0.837 vs 0.819,P=0.03)增强了现有DR诊断模型的有效性。在对DN患者的研究中,6 mm×6 mm窗口中的参数(内层血管密度;外层血管密度;全血管密度;外层灌注密度;全灌注密度)提高了DR的诊断效果。结论:6 mm×6 mm窗口中外层血管密度参数的加入可以提高传统DR诊断模型的效果。同时,与3 mm×3 mm窗口相比,聚焦于6 mm×6 mm窗口中的微血管参数对诊断DN患者并发DR更有意义。

关 键 词：optical coherence tomography angiography(OCTA) diabetic retinopathy diabetic nephropathy prediction model 

分 类 号：R774.1[医药卫生—眼科]