Murueta-Goyena Ane, Barrenechea Maitane, Erramuzpe Asier, Teijeira-Portas Sara, Pengo Marta, Ayala Unai, Romero-Bascones David, Acera Marian, Del Pino Rocío, Gómez-Esteban Juan Carlos, Gabilondo Iñigo
Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.
Department of Preventive Medicine and Public Health, University of the Basque Country (UPV/EHU), Leioa, Spain.
Front Neurosci. 2021 Jul 12;15:708700. doi: 10.3389/fnins.2021.708700. eCollection 2021.
Retinal microvascular alterations have been previously described in Parkinson's disease (PD) patients using optical coherence tomography angiography (OCT-A). However, an extensive description of retinal vascular morphological features, their association with PD-related clinical variables and their potential use as diagnostic biomarkers has not been explored.
We performed a cross-sectional study including 49 PD patients (87 eyes) and 40 controls (73 eyes). Retinal microvasculature was evaluated with Spectralis OCT-A and cognitive status with Montreal Cognitive Assessment. Unified PD Rating Scale and disease duration were recorded in patients. We extracted microvascular parameters from superficial and deep vascular plexuses of the macula, including the area and circularity of foveal avascular zone (FAZ), skeleton density, perfusion density, vessel perimeter index, vessel mean diameter, fractal dimension (FD) and lacunarity using Python and MATLAB. We compared the microvascular parameters between groups and explored their association with thickness of macular layers and clinical outcomes. Data were analyzed with General Estimating Equations (GEE) and adjusted for age, sex, and hypertension. Logistic regression GEE models were fitted to predict diagnosis of PD versus controls from microvascular, demographic, and clinical data. The discrimination ability of models was tested with receiver operating characteristic curves.
FAZ area was significantly smaller in patients compared to controls in superficial and deep plexuses, whereas perfusion density, skeleton density, FD and lacunarity of capillaries were increased in the foveal zone of PD. In the parafovea, microvascular parameters of superficial plexus were associated with ganglion cell-inner plexiform layer thickness, but this was mainly driven by PD with mild cognitive impairment. No such associations were observed in controls. FAZ area was negatively associated with cognition in PD (non-adjusted models). Foveal lacunarity, combined with demographic and clinical confounding factors, yielded an outstanding diagnostic accuracy for discriminating PD patients from controls.
Parkinson's disease patients displayed foveal microvascular alterations causing an enlargement of the vascular bed surrounding FAZ. Parafoveal microvascular alterations were less pronounced but were related to inner retinal layer thinning. Retinal microvascular abnormalities helped discriminating PD from controls. All this supports OCT-A as a potential non-invasive biomarker to reveal vascular pathophysiology and improve diagnostic accuracy in PD.
先前已使用光学相干断层扫描血管造影（OCT-A）对帕金森病（PD）患者的视网膜微血管改变进行了描述。然而，尚未对视网膜血管形态特征进行详尽描述，未探究其与PD相关临床变量的关联以及作为诊断生物标志物的潜在用途。
我们进行了一项横断面研究，纳入49例PD患者（87只眼）和40名对照者（73只眼）。使用Spectralis OCT-A评估视网膜微血管系统，使用蒙特利尔认知评估量表评估认知状态。记录患者的统一PD评定量表和病程。我们使用Python和MATLAB从黄斑的浅表和深部血管丛中提取微血管参数，包括无血管区（FAZ）的面积和圆形度、骨架密度、灌注密度、血管周长指数、血管平均直径、分形维数（FD）和孔隙度。我们比较了两组之间的微血管参数，并探究了它们与黄斑层厚度和临床结局的关联。使用广义估计方程（GEE）分析数据，并对年龄、性别和高血压进行校正。拟合逻辑回归GEE模型，根据微血管、人口统计学和临床数据预测PD患者与对照者的诊断。使用受试者工作特征曲线测试模型的辨别能力。
与对照者相比，患者浅表和深部血管丛中的FAZ面积显著更小，而PD患者黄斑区的灌注密度、骨架密度、FD和毛细血管孔隙度增加。在黄斑旁区域，浅表血管丛的微血管参数与神经节细胞-内丛状层厚度相关，但这主要由伴有轻度认知障碍的PD患者驱动。在对照者中未观察到此类关联。在PD患者中，FAZ面积与认知呈负相关（未校正模型）。黄斑孔隙度与人口统计学和临床混杂因素相结合，在区分PD患者与对照者方面具有出色的诊断准确性。
帕金森病患者表现出黄斑微血管改变，导致FAZ周围血管床扩大。黄斑旁微血管改变不太明显，但与视网膜内层变薄有关。视网膜微血管异常有助于将PD与对照者区分开来。所有这些都支持OCT-A作为一种潜在的非侵入性生物标志物，以揭示血管病理生理学并提高PD的诊断准确性。
