光学相干断层扫描血管造影技术在初诊2型糖尿病患者眼底筛查中的应用

沈泳芝; 黄家丽; 冼科贡; 李志辉; 赵奋图

doi:10.7619/jcmp.20222539

光学相干断层扫描血管造影技术在初诊2型糖尿病患者眼底筛查中的应用

Application of optical coherence tomography angiography in fundus screening in newly diagnosed patients with type 2 diabetes

摘要

摘要:
目的探讨光学相干断层扫描血管造影技术(OCTA)在初诊为2型糖尿病的患者中进行眼底筛查的诊断价值。
方法将2019年11月-2021年3月初诊确诊的40例2型糖尿病患者纳入本研究，由临床经验丰富的医师对其进行眼底检查，根据患者糖尿病性视网膜病变(DR)情况进行分组，将非DR(NDR)患者纳入NDR组(n=20)，将已出现轻度非增殖期糖尿病性视网膜病变(NPDR)的患者纳入早期DR组(n=20)。同时，将与其年龄匹配的20例健康者纳入对照组。采用OCTA对研究对象的黄斑区进行扫描并作定量分析，获得视网膜浅层视网膜血管丛(SVC)、深层视网膜血管丛(DVC)和脉络膜毛细血管层(CC)的黄斑区血流密度(MVD)和黄斑中心凹无血管区(FAZ)面积; 比较各组不同指标的差异以及对早期DR的筛查和诊断价值。
结果 NDR组SVC的血流密度为(0.52±0.09), DVC为(0.54±0.13), CC为(0.51±0.07); 早期DR组SVC的血流密度为(0.45±0.09), DVC为(0.43±0.09), CC为(0.45±0.06), 对照组SVC的血流密度为(0.54±0.01), DVC为(0.57±0.01), CC为(0.52±0.02)。与对照组比较, NDR组、早期DR组SVC、DVC、CC血流密度均减小。NDR组的FAZ面积为(0.39±0.06) mm², 早期DR组为(0.43±0.05) mm², 对照组为(0.29±0.01) mm²。NDR组和早期DR组的FAZ面积大于对照组, 且早期DR组的FAZ面积扩大最明显。多因素回归Logistic分析发现, DVC血流密度和FAZ面积均会对诊断产生影响。
结论初诊糖尿病患者采用OCTA检查，可以筛查出视网膜黄斑区的早期血运改变。早期糖尿病性视网膜病变患者的MVD减少，且FAZ面积扩大。DVC的血流密度和FAZ面积均能对早期DR的诊断产生影响，而FAZ面积对早期DR有更高的诊断价值。

Abstract:
Objective To explore the diagnostic value of optical coherence tomography angiography(OCTA) in fundus screening in newly diagnosed type 2 diabetic patients.
Methods Forty patients with newly diagnosed type 2 diabetes from November 2019 to March 2021 were included in this study. Experienced physicians performed fundus examination for them. According to diabetic retinopathy (DR) conditions, non-DR patients were included in NDR group (n=20), those with mild non-proliferative diabetic retinopathy (NPDR) were included in early DR group (n=20). At the same time, 20 healthy subjects matched with age were included in control group. OCTA was used to scan and quantitatively analyze the macular region of the study subjects, and macular blood flow density(MVD) of superficial vascular capillary(SVC), deep vascular capillary (DVC) and choroidal capillaries layer (CC) and the area of the macular fovea without blood vessels (FAZ) were obtained. The difference of different indicators in each group and the value of screening and diagnosis for early DR were compared.
Results The blood flow density of SVC, DVC and CC were (0.52±0.09), (0.54±0.13) and (0.51±0.07), respectively in the NDR group, were (0.45±0.09), (0.43±0.09) and (0.45±0.06), respectively in the early DR group, and were (0.54±0.01), (0.57±0.01) and (0.52±0.02), respectively in the control group. Compared with the control group, blood flow density of SVC, DVC and CC decreased in the NDR group and early DR group. The FAZ area was (0.39±0.06) mm² in the NDR group, (0.43±0.05) mm² in the early DR group, and (0.29±0.01) mm² in the control group. The FAZ area of the NDR group and the early DR group was larger than that of the control group, and the early DR group had the most obvious expansion of FAZ area. Multivariate Logistic analysis showed that DVC blood flow density and FAZ area both affected the diagnosis.
Conclusion Early changes of macular vascular density and enlargement of FAZ can be observed in early diabetic retinopathy by OCTA. Patients with early diabetic retinopathy have reduced MVD and enlarged FAZ area. Both blood flow density and FAZ area of DVC can affect the diagnosis of early DR, and FAZ area has higher diagnostic value for early DR.

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