后部皮质萎缩中外网状层和脉络膜改变与神经影像学和临床特征的关系。
Association of outer retinal and choroidal alterations with neuroimaging and clinical features in posterior cortical atrophy.
机构信息
Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
Department of Ophthalmology and Research Laboratory of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
出版信息
Alzheimers Res Ther. 2024 Aug 19;16(1):187. doi: 10.1186/s13195-024-01551-3.
BACKGROUND
Posterior cortical atrophy (PCA) is a rare condition characterized by early-onset and progressive visual impairment. Individuals with PCA have relatively early-onset and progressive dementia, posing certain needs for early detection. Hence, this study aimed to investigate the association of alterations in outer retinal and choroidal structure and microvasculature with PCA neuroimaging and clinical features and the possible effects of apolipoprotein E(APOE) ε4 allele on outer retinal and choroidal alterations in participants with PCA, to detect potential ocular biomarkers for PCA screening.
METHODS
This cross-sectional study included PCA and age- and sex-matched healthy control participants from June 2022 to December 2023. All participants with PCA completed a comprehensive neurological evaluation. All participants were recorded baseline information and underwent an ophthalmic evaluation. Quantitative analyses were performed using swept-source optical coherence tomography (SS-OCT) and angiography (SS-OCTA). Adaptive optics scanning laser ophthalmoscopy (AO-SLO) was performed in some patients. In participants with PCA, the influence of APOE ε4 on outer retinal and choroidal alterations and the correlation of outer retinal and choroidal alterations with PCA neuroimaging and clinical features in participants with PCA were investigated.
RESULTS
A total of 28 participants (53 eyes) with PCA and 56 healthy control participants (112 eyes) were included in the current study. Compared with healthy control participants, participants with PCA had significantly reduced outer retinal thickness (ORT) (p < 0.001), choriocapillaris vessel density (VD) (p = 0.007), choroidal vascular index (CVI) (p = 0.005) and choroidal vascular volume (CVV) (p = 0.003). In participants with PCA, APOE ε4 carriers showed thinner ORT (p = 0.009), and increased choriocapillaris VD (p = 0.004) and CVI (p = 0.004). The PCA neuroimaging features were positively associated with the ORT, CVI and CVV. Furthermore, differential correlations were observed of PCA clinical features with the CRT, CVV and CVI.
CONCLUSIONS
Our findings highlighted the association of outer retinal and choroidal alterations with PCA neuroimaging and clinical features in participants with PCA. Noninvasive SS-OCT and SS-OCTA can provide potential biomarkers for the diagnosis and management of PCA, improving awareness of PCA syndrome among ophthalmologists, neurologists, and primary care providers.
背景
后部皮质萎缩（PCA）是一种罕见的疾病，其特征是早期发病和进行性视力损害。患有 PCA 的个体存在相对较早的发病和进行性痴呆，因此需要早期发现。因此，本研究旨在探讨外视网膜和脉络膜结构及微血管改变与 PCA 神经影像学和临床特征的关系，以及载脂蛋白 E（APOE）ε4 等位基因对 PCA 患者外视网膜和脉络膜改变的可能影响，以发现 PCA 筛查的潜在眼部生物标志物。
方法
这是一项横断面研究，纳入了 2022 年 6 月至 2023 年 12 月间 PCA 患者和年龄、性别匹配的健康对照者。所有 PCA 患者均完成了全面的神经学评估。所有参与者均记录了基线信息并接受了眼科评估。采用扫频源光学相干断层扫描（SS-OCT）和血管造影（SS-OCTA）进行定量分析。在一些患者中进行了自适应光学扫描激光检眼镜（AO-SLO）检查。在 PCA 患者中，研究了 APOE ε4 对视网膜和脉络膜改变的影响，以及 PCA 患者的外视网膜和脉络膜改变与 PCA 神经影像学和临床特征的相关性。
结果
本研究共纳入 28 名（53 只眼）PCA 患者和 56 名健康对照者（112 只眼）。与健康对照组相比，PCA 患者的外视网膜厚度（ORT）显著降低（p<0.001），脉络膜毛细血管血管密度（VD）（p=0.007）、脉络膜血管指数（CVI）（p=0.005）和脉络膜血管容积（CVV）（p=0.003）降低。在 PCA 患者中，APOE ε4 携带者的 ORT 更薄（p=0.009），脉络膜毛细血管 VD（p=0.004）和 CVI（p=0.004）增加。PCA 的神经影像学特征与 ORT、CVI 和 CVV 呈正相关。此外，还观察到 PCA 临床特征与 CRT、CVV 和 CVI 的差异相关性。
结论
我们的研究结果强调了 PCA 患者的外视网膜和脉络膜改变与 PCA 神经影像学和临床特征的关系。非侵入性 SS-OCT 和 SS-OCTA 可为 PCA 的诊断和管理提供潜在的生物标志物，提高眼科医生、神经科医生和初级保健提供者对 PCA 综合征的认识。
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