应用光相干断层扫描血管造影灌注毛细血管密度揭示临床前期糖尿病视网膜病变的最早证据。
Earliest Evidence of Preclinical Diabetic Retinopathy Revealed Using Optical Coherence Tomography Angiography Perfused Capillary Density.
机构信息
Icahn School of Medicine at Mount Sinai, New York, New York, USA; Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA.
Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA.
出版信息
Am J Ophthalmol. 2019 Jul;203:103-115. doi: 10.1016/j.ajo.2019.01.012. Epub 2019 Jan 26.
PURPOSE
To compare perfused capillary density (PCD) in diabetic patients and healthy controls using optical coherence tomography angiography (OCTA).
METHODS
Forty controls, 36 diabetic subjects without clinical retinopathy (NoDR), 38 with nonproliferative retinopathy (NPDR), and 38 with proliferative retinopathy (PDR) were imaged using spectral-domain optical coherence tomography. A 3 × 3-mm full-thickness parafoveal OCTA scan was obtained from each participant. Following manual delineation of the foveal avascular zone (FAZ), FAZ area, perimeter, and acircularity index were determined. Seven consecutive equidistant 200-μm-wide annular segments were drawn at increasing eccentricities from the FAZ margin. Annular PCD (%) was defined as perfused capillary area divided by the corresponding annulus area after subtraction of noncapillary blood vessel areas. Nonparametric Kruskal-Wallis testing with Bonferroni correction was performed in pairwise comparisons of group PCD values.
RESULTS
The NoDR group demonstrated consistently higher PCD compared to the control group in all 7 annuli, reaching statistical significance (36.6% ± 3.30% vs 33.6% ± 3.98%, P = .034) at the innermost annulus (FAZ margin to 200 μm out). The NPDR and PDR groups demonstrated progressively decreasing PCD. Differences in FAZ metrics between the NoDR and control groups did not reach statistical significance.
CONCLUSIONS
Relative to healthy controls, increased PCD values in the NoDR group likely represent an autoregulatory response to increased metabolic demand, while the decrease in PCD that follows in NPDR and PDR results largely from an incremental loss of capillary segments. These findings, consistent with previous studies, demonstrate the potential of OCTA as a clinical tool for earlier objective detection of preclinical diabetic retinopathy. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
目的
利用光相干断层扫描血管造影术（OCTA）比较糖尿病患者和健康对照者的灌注毛细血管密度（PCD）。
方法
对 40 名对照者、36 名无临床视网膜病变（NoDR）的糖尿病患者、38 名非增殖性视网膜病变（NPDR）患者和 38 名增殖性视网膜病变（PDR）患者进行频域光相干断层扫描成像。从每位参与者获取一个 3×3mm 的全层黄斑区 OCTA 扫描。在手动描绘黄斑无血管区（FAZ）后，确定 FAZ 面积、周长和非圆度指数。在 FAZ 边缘从内向外依次画出 7 个连续的、等距的 200μm 宽的环形节段。环形 PCD（%）定义为灌注毛细血管面积减去非毛细血管血管区域后的相应环形区域。采用非参数 Kruskal-Wallis 检验，用 Bonferroni 校正进行组间 PCD 值的两两比较。
结果
NoDR 组在所有 7 个环形中，PCD 值均明显高于对照组，在最内层环形（FAZ 边缘至 200μm 处）达到统计学意义（36.6%±3.30%比 33.6%±3.98%，P=0.034）。NPDR 和 PDR 组的 PCD 值逐渐降低。NoDR 和对照组之间 FAZ 指标的差异没有达到统计学意义。
结论
与健康对照组相比，NoDR 组 PCD 值升高可能代表对代谢需求增加的自动调节反应，而 NPDR 和 PDR 组的 PCD 值下降则主要是由于毛细血管节段的逐渐丧失。这些发现与之前的研究一致，表明 OCTA 作为一种临床工具，具有更早地客观检测临床前期糖尿病视网膜病变的潜力。注：本文的发表得到了美国眼科学会的赞助。
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