[1]雷颖庆,周琦,段成霞,等.OCTA定量分析糖尿病视网膜病变患者黄斑区微血管改变[J].眼科新进展,2020,40(2):161-164.[doi:10.13389/j.cnki.rao.2020.0038]
　LEI Yingqing,ZHOU Qi,DUAN Chengxia,et al.Quantification of macular microvascular changes in patients with diabetic retinopathy using OCTA[J].Recent Advances in Ophthalmology,2020,40(2):161-164.[doi:10.13389/j.cnki.rao.2020.0038]
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OCTA定量分析糖尿病视网膜病变患者黄斑区微血管改变/HTML
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《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
40卷
期数:
2020年2期
页码:
161-164
栏目:
应用研究
出版日期:
2020-02-05

文章信息/Info

Title:
Quantification of macular microvascular changes in patients with diabetic retinopathy using OCTA
作者:
雷颖庆; 周琦; 段成霞; 李友谊; 达诗彧; 吕红彬
646000　四川省泸州市，西南医科大学附属医院眼科
Author(s):
LEI Yingqing; ZHOU Qi; DUAN Chengxia; LI Youyi; DA Shiyu; LV Hongbin
Department of Ophthalmology，the Affiliated Hospital of Southwest Medical University，Luzhou 646000，Sichuan Province，China
关键词:
糖尿病视网膜病变; 光学相干断层扫描血管造影; 黄斑中心凹无血管区
Keywords:
diabetic retinopathy; optical coherence tomography angiography; foveal avascular zone
分类号:
R774
DOI:
10.13389/j.cnki.rao.2020.0038
文献标志码:
A
摘要:
目的　应用光学相干断层扫描血管造影(optical coherence tomography angiography，OCTA)观察糖尿病视网膜病变（diabetic retinopathy，DR）患者黄斑区血流特点并评价OCTA对DR的诊断价值。方法　选取2018年8月至12月就诊于西南医科大学附属医院眼科门诊及病房的糖尿病患者57例87眼作为DR组；另选取同期年龄、性别与DR组相符的健康体检者43人80眼作为正常对照组。采用OCTA检查两组受试者视网膜，选取视网膜浅层毛细血管层进行观察，将所得图像划分为以黄斑中心凹为圆心，直径1 mm和3 mm的内外2个同心圆，采用自带分析软件得到1 mm×1 mm、直径1 mm到3 mm以及3 mm×3 mm范围内的血管线性密度（vascular density，VD）和血流灌注密度（perfusion density，PD)值，分别记为VD1 mm×1 mm、VD1 mm×3 mm、VD3 mm×3 mm、PD1 mm×1 mm、PD1 mm×3 mm、PD3 mm×3 mm。同时，采用自带分析软件得到观察对象的黄斑中心凹无血管区域（foveal avascular zone，FAZ）面积、周长和形态指数。分析DR组与正常对照组受试者间定量指标差异，分析各指标与DR严重程度的相关性以及对DR的诊断价值。结果　DR组的VD1 mm×1 mm、VD1 mm×3 mm、VD3 mm×3 mm、PD1 mm×3 mm、PD3 mm×3 mm、FAZ形态指数均小于正常对照组（均为P<0.05），FAZ周长较正常对照组增长（P<0.05）。DR疾病严重程度与VD1 mm×3 mm、VD3 mm×3 mm、PD1 mm×3 mm、PD3 mm×3 mm、FAZ形态指数呈负相关（r=-0.694、-0.672、-0.559、-0.513、-0.626，均为P<0.05），与FAZ周长呈正相关（r=0.265，P<0.05）。VD1 mm×3 mm对DR的诊断效能最高（AUC=0.922、最佳诊断界限值为21.05 mm-1、灵敏度为0.909、特异度为0.849），而PD1 mm×1 mm、FAZ面积和FAZ周长对DR的诊断价值不大。结论　OCTA能准确反映DR患者黄斑区改变情况，在DR的无创化诊断和随访中具有重要作用。
Abstract:
Objective　To evaluate the features of macular blood flow in patients with diabetic retinopathy (DR) by optical coherence tomography angiography (OCTA),and explore the diagnostic value of OCTA for DR.Methods　Totally 87 eyes of 57 DR patients who received treatment in Department of Ophthalmology,the Affiliated Hospital of Southwest Medical University from August to December 2018 were enrolled in the DR group.Another 80 eyes of 43 healthy subjects with matched age and gender were enrolled in the control group.Superficial capillary layer of the retina was measured by OCTA in both two groups.The collected figures were classified as two concentric circles with the center of macular fovea and inside and outside diameters of 1 mm and 3 mm.Vascular density (VD) and perfusion density (PD) in the range of 1 mm×1 mm,1 mm to 3 mm in diameter and 3 mm×3 mm in diameter were obtained by the built-in analysis software,and respectively recorded as VD1 mm×1 mm,VD1 mm×3 mm,VD3 mm×3 mm,PD1 mm×1 mm,PD1 mm×3 mm,PD3 mm×3 mm.Foveal avascular zone (FAZ) area,FAZ perimeter and FAZ circularity index were measured with built-in analysis software.The difference of parameters between DR group and control group,the relationships of parameters with DR severity,and the diagnosis value of DR by these parameters were statistically analyzed.Results　The VD1 mm×1 mm,VD1 mm×3 mm,VD3 mm×3 mm,PD1 mm×3 mm,PD3 mm×3 mm and FAZ circularity index of patients in DR group were smaller than those in control group,but the FAZ perimeter of patients in DR group was larger than that in normal control group (all P<0.05).DR severity was negatively correlated with VD1 mm×3 mm,VD3 mm×3 mm,PD1 mm×3 mm,PD3 mm×3 mm and FAZ circularity index (r=-0.694,-0.672,-0.559,-0.513, -0.626;all P<0.05),but positively correlated with FAZ perimeter (r=0.265,P<0.05).VD1 mm×3 mm had the optimal diagnostic efficacy of DR (AUC=0.922;threshold value of optimal diagnostic efficacy=21.05 mm-1;sensitivity of 0.909 and specificity of 0.849),but PD1 mm×1 mm,FAZ area and FAZ perimeter had poor diagnostic efficacy of DR.Conclusion　OCTA can accurately reflect macular changes of DR patients,and plays an important role in noninvasive diagnosis and follow-up of DR.

参考文献/References:

［1］　中华医学会眼科学会眼底病学组.我国糖尿病视网膜病变临床诊疗指南(2014年)［J］.中华眼科杂志，2014，50(11):851-865.

CHINESE ACADEMY OF OPHTHALMOLOGY.Guidelines for clinical diagnosis and treatment of diabetic retinopathy in China (2014)［J］.Chin J Ophthalmol，2014，50(11):851-865.
［2］　KWITEROVICH K A，MAGUIRE M G，MURPHY R P，SCHACHAT A P，BRESSLER N M，BRESSLER S B，et al.Frequency of adverse systemic reactions after fluorescein angiography［J］.Ophthalmology，1991，98(7):1139-1142.
［3］　FINESCHI V，MONASTEROLO G，ROSI R，TURILLAZZI E.Fatal anaphylactic shock during a fluorescein angiography［J］.Forensic Sci Int，1999，100(1):137-142.
［4］　WANG R K，AN L，FRANCIS P，WILSON D J.Depth-resolved imaging of capillary networks in retina and choroid using ultrahigh sensitive optical microangiography［J］.Opt Lett，2010，35(9):1467-1469.
［5］　TAKASE N，NOZAKI M，KATO A，OZEKI H，YOSHIDA M，OGURA Y.Enlargement of foveal avascular zone in diabetic eyes evaluated by en face optical coherence tomography angiography［J］.Retina，2015，35(11):2377-2383.
［6］　CHOI W，WAHEED N K，MOULT E M，ADHI M，LEE B，DE CARLO T，et al.Ultrahigh speed swept source optical coherence tomography angiography of retinal and choriocapillaris alterations in diabetic patients with and without retinopathy［J］.Retina，2016，37(1):11-21.
［7］　DE CARLO T E，CHIN A T，BONINI FILHO M A，ADHI M，BRANCHINI L，SALZ D A，et al.Detection of microvascular changes in eyes of patients with diabetes but not clinical diabetic retinopathy using optical coherence tomography angiography［J］.Retina，2015，35(11):2364-2370.
［8］　LEI J，DURBIN M K，SHI Y，UJI A，BALASUBRAMANIAN S，BAGHDASARYAN E，et al.Repeatability and reproducibility of superficial macular retinal vessel density measurements using optical coherence tomography angiography en face images［J］.JAMA Ophthalmol，2017，135(10):1092-1098.
［9］　中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)［J］.中国糖尿病杂志，2014，30(8):893-942.

Chinese Diabetes Association.Guidelines for the prevention and treatment of type 2 diabetes in China (2013 edition)［J］.Chin J Diabetes，2014，30(8):893-942.
［10］　PROVIS J M，SANDERCOE T，HENDRICKSON A E.Astrocytes and blood vessels define the foveal rim during primate retinal development［J］.Invest Ophthalmol Vis Sci，2000，41(10):2827-2836.
［11］　CRAWFORD T N，RD A D，KERRISON J B.Diabetic retinopathy and angiogenesis［J］.Curr Diabetes Rev，2009，5(1):8-13.
［12］　MANSOUR A M，SCHACHAT A，BODIFORD G.Foveal avascular zone in diabetes mellitus［J］.Retina，1993，13(2):125-128.
［13］　CONRATH J，GIORGI R，RACCAH D，RIDINGS B.Foveal avascular zone in diabetic retinopathy:quantitative vs qualitative assessment［J］.Eye，2005，19(3):322-326.
［14］　GILL A，COLE E D，NOVAIS E A，LOUZADA R N，DE CARLO T，DUKER J S，et al.Visualization of changes in the foveal avascular zone in both observed and treated diabetic macular edema using optical coherence tomography angiography［J］.Int J Retina Vitreous，2017，3:19.
［15］　CARPINETO P，MASTROPASQUA R，MARCHINI G，TOTO L，DI NICOLA M，DI ANTONIO L.Reproducibility and repeatability of foveal avascular zone measurements in healthy subjects by optical coherence tomography angiography［J］.Br J Ophthalmol，2016，100(5):671-676.
［16］　LEI J，DURBIN M K，SHI Y，UJI A，BALASUBRAMANIAN S，BAGHDASARYAN E，et al.Repeatability and reproducibility of superficial macular retinal vessel density measurements using optical coherence tomography angiography en face images［J］.JAMA Ophthalmol，2017，135(10):1092-1098.
［17］　HWANG T S，GAO S S，LIU L，LAUER A K，BAILEY S T，FLAXEL C J，et al.Automated quantification of capillary nonperfusion using optical coherence tomography angiography in diabetic retinopathy［J］.JAMA Ophthalmol，2016:134(4):367-373.
［18］　DURBIN M K，AN L，SHEMONSKI N D，SOARES M，SANTOS T，LOPES M，et al.Quantification of retinal microvascular density in optical coherence tomographic angiography images in diabetic retinopathy［J］.JAMA Ophthalmol，2017，135(4):370-376.
［19］　BEK T.Transretinal histopathological changes in capillary-free areas of diabetic retinopathy［J］.Acta Ophthalmol，1994，72(4):409-415.

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更新日期/Last Update: 2020-02-05