摘要
目的 应用光学相干断层扫描血流成像技术(OCTA)分析糖化血红蛋白(HbA1c)水平对无糖尿病视网膜病变(NDR)黄斑中心凹区、黄斑旁中心凹区及黄斑区血管线性密度(VD)、血管灌注密度(PD)及黄斑区(FAZ)面积(FAZ Area)、周长(FAZ Perimeter)、形态指数(FAZ Circularity)的影响。方法 收集68位糖尿病患者无糖尿病视网膜病变的68只眼纳入研究,依据糖化血红蛋白水平依次分为3组:A组为糖化血红蛋白控制理想(HbA1c<7%)20人、B组为糖化血红蛋白控制一般(7%≤HbA1c≤10%)18人、C组为糖化血红蛋白控制不佳(HbA1c>10%)20人。招募20名健康者为对照组D。所有受试者行OCTA检查,测量黄斑中心凹区、黄斑旁中心凹区及黄斑区血管线性密度、血管灌注密度及黄斑区面积、周长、形态指数。结果 A组、B组、C组、D组的黄斑中心凹血管线性密度(VCD)与黄斑中心凹血管灌注密度(PCD)分别为9.30、9.00、10.65、11.25 mm和0.17、0.17、0.19、0.20mm~2,相比差异有统计学意义(P<0.05);A组、B组、C组、D组的黄斑旁中心凹血管线性密度(VID)与黄斑旁中心凹血管灌注密度(PID)分别为22.20、21.45、20.70、22.70 mm~2和0.40、0.39、0.39、0.41mm~2,相比差异有统计学意义(P<0.05);A组、B组、C组、D组的黄斑区血管线性密度(VFD)与黄斑区血管灌注密度(PFD)分别为21.00、20.20、19.90、21.45 mm~2和0.39、0.37、0.37、0.39 mm~2,相比差异有统计学意义(P<0.05);A组、B组、C组、D组的黄斑中心凹区的面积、周长与形态指数分别为0.38、0.40、0.31、0.25mm~2,2.48、2.81、2.32、2.13 mm和0.68、0.61、0.57、0.69,差异均有统计学意义(P<0.05)。结论 无糖尿病视网膜病变的糖尿病患者浅层黄斑中心凹区、黄斑旁中心凹区及黄斑区的血管线性密度和血管灌注密度均低于正常人,这使得对糖尿病患者视网膜血管变化的观察时间提早到眼底照相发生改变之前,且黄斑旁中心凹区缺血发生早于黄斑中心凹区。无DR的糖尿病患者FAZ区面积和周长均高于正常人,形态指数均低于正常人,但与HbA1c升高不同步,其无相关性。
Objective To investigate the effect of HbA1c on vessel density, perfusion density, FAZ area, FAZ perimeter and FAZ circularity of macular foveal, paramacular foveal and macular areas in diabetic patients of non-diabetic retinopathy by OCTA.Methods A total of 68 eyes of 68 diabetic patients without diabetic retinopathy was collected and included in the study.They were divided into 3 groups based on the level of glycated hemoglobin: 20 people were in group A with ideal control of glycated hemoglobin(HbA1c < 7%),18 people were in group B with average control of glycated hemoglobin(7% ≤HbA1c≤10%),and 20 people were in group C with poor control of glycated hemoglobin(HbA1c > 10%).20 healthy people were recruited as control group D.All subjects underwent OCTA examination,the vessel density,perfusion density and FAZ area,circumference and macular circularity in the foveal area,paramacular foveal area and macular area were measured.Results The central vessel density(VCD) of macular foveal in patients of group A,B and C was 9.30 mm~2,9.00 mmand 10.65 mm~2,respectively,which were lower than that in patients of group D(11.25 mm~2)(P<0.05).The central perfusion density(PCD) of macular foveal in patients of group A,B and C was 0.17 mm~2,0.17 mm~2 and 0.19 mm~2,respectively,which were lower than that in patients of group D(0.20 mm~2)(P<0.05).The inner vessel density(VID) of paramacular foveal in patients of group A,B and C was 22.20 mm~2,21.45 mmand 20.70 mm~2,respectively,which were lower than that in patients of group D(22.70 mm~2)(P<0.05).The inner perfusion density(PID) of paramacular foveal in patients of group A,B and C was 0.40 mm~2,0.39 mm~2 and 0.39 mm~2,respectively,which were lower than that in patients of group D(0.41 mm~2)(P<0.05).The full vessel density(VFD) of macular areas in patients of group A,B and C was 21.00 mm~2,20.20 mm~2 and 19.90 mm~2,respectively,which were lower than that in patients of group D(21.45 mm~2)(P<0.05).The full perfusion density(PFD) of macular areas in patients of group A,B and C was 0.39 mm~2,0.37 mm~2and 0.37 mm~2,respectively,which were lower than that in patients of group D(0.39 mm)(P<0.05).The FAZ area of macular foveal in group A,B and C was 0.38 mm,0.40 mm~2 and 0.31 mm~2,respectively,which were higher than that in patients of group D(0.25 mm)(P<0.05).The FAZ Perimeter of macular foveal in patients of group A,B and C was 2.48 mm,2.81 mm and 2.32 mm,respectively,which were higher than that in patients of group D(2.13 mm)(P<0.05).The FAZ Circularity of macular foveal in patients of group A,B and C was 0.68,0.61 and 0.57,respectively,which were higher than that in patients of group D(0.69)(P<0.05).Conclusion This study shows that HbA1c is an important indicator for the progression of NDR and the observation time of retinal vascular changes can be advanced before the changes of fundus photography in diabetic patients of non-diabetic retinopathy by OCTA.
作者
胡瑾
朱德军
王娟
刘文舟
邹文青
HU Jin;ZHU Dejun;WANG Juan;LIU Wenzhou;ZOU Wenqing(Department of Ophthalmology,People′s Hospital of Ningxia Hui Autonomous Region,Yinchuan 750002,China)
出处
《宁夏医学杂志》
CAS
2022年第11期964-967,F0002,共5页
Ningxia Medical Journal
基金
宁夏回族自治区人民医院培育振兴科研项目(201908)
宁夏重点研发计划项目(2021BEG03110)。
作者简介
胡瑾(1990-),女,硕士研究生,主治医师,主要从事眼科疾病的研究。;通讯作者:邹文青,主任医师,Email:931757371@qq.com。
