Department of Ophthalmology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, PR China; Department of Ophthalmology, Changning County Hospital of Traditional Chinese Medicine, Yibin, PR China.
Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, PR China; Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan 646000, PR China.
Microvasc Res. 2022 Nov;144:104407. doi: 10.1016/j.mvr.2022.104407. Epub 2022 Jul 18.
To compare the microvascular parameters of macular and peripapillary areas in adults with primary nephrotic syndrome (PNS) and healthy controls (HCs).
In this cross-sectional study, optical coherence tomography angiography (OCTA) was used to evaluate the changes in retinal microvascular in 37 adult patients with PNS and 30 HCs in this study. All subjects underwent OCTA for measuring vascular density (VD), perfusion density (PD), and foveal avascular zone (FAZ) in the superficial capillary plexus (SCP) and optical coherence tomography (OCT) for measuring central macular thickness (CMT) and retinal nerve fiber layer (RNFL) thickness. The following clinical data of the PNS group were collected: hemoglobin, platelet, total protein, albumin, prealbumin, creatinine, urea nitrogen, glomerular filtration rate, blood lipid, urinary protein, urine microalbumin, urine microalbumin/creatinine, 24-h urine volume, and 24-h urine protein quantification. The OCTA data were compared between patients with PNS and HCs, and the correlation between the OCTA data and clinical data was analyzed in the PNS group.
VD and PD in the macular area of the PNS group were significantly lower than those in the HC group (VD: 17.025 ± 2.229 vs. 18.290 ± 0.721, P = 0.001; PD: 0.417 ± 0.058 vs. 0.450 ± 0.019, P = 0.003). No significant differences in the FAZ area and perioptic disc microvascular parameters were observed between the two groups, and patients in the PNS group showed consistent changes in the left and right eyes. VD and PD in the central macular area were positively correlated with plasma prealbumin level (VD: ρ = 0.541, P = 0.001; PD: ρ = 0.562, P < 0.001) and negatively correlated with urinary protein level (VD: ρ = -0.579, P < 0.001; PD: ρ = -0.596, P < 0.001).
In adult patients with PNS, the decrease in VD and PD was mainly occurred in the macular area. Partly vascular density of the macular area was positively correlated with plasma prealbumin level and negatively correlated with urinary protein level. OCTA provides a convenient, non-invasive and effective method for evaluating and monitoring retinal microcirculation damage in patients with PNS.
比较原发性肾病综合征（PNS）成年患者与健康对照者（HCs）的黄斑和视盘周围区域的微血管参数。
在这项横断面研究中，使用光学相干断层扫描血管造影术（OCTA）评估 37 例 PNS 成年患者和 30 例 HCs 的视网膜微血管变化。所有受试者均接受 OCTA 测量浅层毛细血管丛（SCP）的血管密度（VD）、灌注密度（PD）和黄斑中心无血管区（FAZ），并接受 OCT 测量中心黄斑厚度（CMT）和视网膜神经纤维层（RNFL）厚度。收集 PNS 组的以下临床数据：血红蛋白、血小板、总蛋白、白蛋白、前白蛋白、肌酐、尿素氮、肾小球滤过率、血脂、尿蛋白、尿微量白蛋白、尿微量白蛋白/肌酐、24 小时尿量和 24 小时尿蛋白定量。比较 PNS 组患者与 HCs 之间的 OCTA 数据，并分析 PNS 组 OCTA 数据与临床数据的相关性。
PNS 组黄斑区的 VD 和 PD 明显低于 HCs 组（VD：17.025±2.229 比 18.290±0.721，P=0.001；PD：0.417±0.058 比 0.450±0.019，P=0.003）。两组间 FAZ 面积和视盘周围微血管参数无显著差异，PNS 组患者左右眼表现出一致的变化。中央黄斑区的 VD 和 PD 与血浆前白蛋白水平呈正相关（VD：ρ=0.541，P=0.001；PD：ρ=0.562，P<0.001），与尿蛋白水平呈负相关（VD：ρ=-0.579，P<0.001；PD：ρ=-0.596，P<0.001）。
在 PNS 成年患者中，VD 和 PD 的降低主要发生在黄斑区。黄斑区部分血管密度与血浆前白蛋白水平呈正相关，与尿蛋白水平呈负相关。OCTA 为评估和监测 PNS 患者视网膜微循环损伤提供了一种方便、无创和有效的方法。
