摘要
目的 观察眼底无明显糖尿病视网膜病变（DR）的 2 型糖尿病患者黄斑区微血管改变的光相干断层扫描血管成像（OCTA）特征。 方法 前瞻性临床病例对照研究。经散瞳检查明确眼底无明显DR的糖尿病患者22例43只眼（糖尿病组）及同期年龄、性别与之匹配的健康体检者20例40只眼（正常对照组）纳入研究。所有受检者均行OCTA检查，选择视网膜血流成像模式，黄斑区扫描范围3 mm×3 mm、6 mm×6 mm，扫描信号强度指标＞45，横向扫描和纵向扫描各需3 s。采用系统内置分析软件测量分析浅层毛细血管层图像中黄斑区扫描范围3 mm×3 mm内黄斑中心凹无血管区（FAZ）面积及平均血管密度；同时观察FAZ旁1 mm直径范围内的毛细血管无灌注区、微动脉瘤及其他微血管异常改变。 结果 糖尿病组患眼和对照组受检眼FAZ平均面积分别为（0.397±0.141）、（0.253±0.112）mm2；平均血管密度分别为（44.6±0.62）%、（48.6±0.58）%。糖尿病组患眼FAZ平均面积较正常对照组受检眼明显扩大，差异有统计学意义（t=1.017，P＜0.05）；但两组受检眼平均血管密度比较，差异无统计学意义（t=1.499，P＞0.05）。正常对照组受检眼FAZ呈蛛网样形态，拱环形态规则。糖尿病组患眼可观察到FAZ旁毛细血管无灌注区、拱环形态异常、微动脉瘤、血管走形纡曲等表现。糖尿病组患眼中存在FAZ旁毛细血管无灌注区（χ2=4.542）及微动脉瘤（χ2=5.183）比例明显大于正常对照组，差异有统计学意义（P＜0.05）。 结论 OCTA可在 2 型糖尿病患者尚未出现明显DR之前观察到黄斑区FAZ面积扩大、FAZ旁毛细血管无灌注区、拱环形态异常、微动脉瘤、血管走形纡曲等微血管异常改变。
Objective To observe the morphological changes of macular capillary in type 2 diabetic mellitus （DM） patients without clinical features of diabetic retinopathy （DR） by optical coherence tomography angiography （OCTA）. Methods This is a prospective clinical case-control study. Forty-three eyes of 22 patients with DM without clinical features of DR （case group） and 40 control eyes of 20 age- and sex-matched healthy physical examination subjects （control group） were enrolled in this study. All subjects underwent OCTA examination with mode of retinal blood flow imaging, macular 3 mm×3 mm and 6 mm×6 mm area, signal strength 〉45. Foveal avascular zone （FAZ） area, foveal capillary density, parafovea capillary non-perfusion, and micro-aneurysm in shallow capillary vessel layer were evaluated. Results In case group, the mean FAZ area was （0.397±0.141） mm2 and the mean foveal capillary density was （44.6±0.62） %. In control group, the mean FAZ area was （0.253±0.112） mm2 and the mean foveal capillary density was （48.6±0.58） %. FAZ area of eyes in case group was larger than that in control group （t=1.017,P〈0.05）. There was no difference of foveal capillary density between two groups （t=1.499,P〉0.05）. The spider web-like FAZ and normal foveolar avascular zone were observed in eyes of control group. The parafovea capillary non-perfusion, abnormal foveolar avascular zone, micro-aneurysm and tortuosity of vessels were observed in eyes of case group. Parafovea capillary non-perfusion （χ2=4.542）, micro-aneurysms （χ2=5.183） were seen more often in case group than control group （P〈0.05）. Conclusion Type 2 DM patients have abnormal retinal vascular microcirculation before DR using OCTA, including larger FAZ area, parafovea capillary non-perfusion, abnormal foveolar avascular zone, micro-aneurysm and tortuosity of vessels.
出处
《中华眼底病杂志》
CAS
CSCD
北大核心
2017年第1期15-18,共4页
Chinese Journal of Ocular Fundus Diseases
