诊断学理论与实践

诊断学理论与实践 ›› 2024, Vol. 23 ›› Issue (01): 67-76.doi: 10.16150/j.1671-2870.2024.01.009

• 论著 • 上一篇    下一篇

光学相干断层扫描血管成像参数诊断非增殖性糖尿病视网膜病变的价值分析

张琼, 吴彦霖, 胡起维, 张泽伟, 黄守约()   

  1. 上海交通大学医学院附属瑞金医院眼科，上海 200025
  • 收稿日期:2023-05-05 出版日期:2024-02-25 发布日期:2024-05-30
  • 通讯作者: 黄守约 E-mail: yachtjj@hotmail.com
  • 基金资助:
    国家自然科学基金青年项目(82000885);上海市自然科学基金面上项目(21ZR1439700)

Application value of optical coherence tomography angiography in diagnosis of the non-proliferative diabetic retinopathy

ZHANG Qiong, WU Yanlin, HU Qiwei, ZHANG Zewei, HUANG Shouyue()   

  1. Department of Ophthalmology，Ruijin Hospital，Shanghai Jiao Tong University School of Medicine，Shanghai 200025，China
  • Received:2023-05-05 Published:2024-02-25 Online:2024-05-30

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摘要：

目的：分析光学相干断层扫描血管成像（optical coherence tomography angiography， OCTA）诊断非增殖性糖尿病视网膜病变（non-proliferative diabetic retinopathy，NPDR）的价值。方法：连续纳入2021年1月至2023年6月期间在我科门诊收治的122例有2型糖尿病病史（包括伴或不伴有视网膜病变）的患者，均接受眼底荧光血管造影（fundus fluorescein angiography， FFA）检查和OCTA定量检查。以FFA结果为金标准，并将患者根据FFA结果分为对照组（无NPDR）、轻度NPDR组、中度NPDR组和重度NPDR组。OCTA观察指标包括，视网膜黄斑区中央视网膜厚度（central macular thickness， CMT）、血管线性密度（vascular density, VD）、血流灌注密度（perfusion density, PD）、黄斑中心凹无血管区面积（foveal avascular zone area, FAZ-A）、黄斑中心凹无血管区周长（foveal avascular zone perimeter, FAZ-P）、圆形指数（foveal avascular zone circularity index, FAZ-CI）。用单因素方差或非参数方法分析比较各组间定量指标的差异，取其中存在显著组间差异的指标纳入多因素Logistic回归模型，分析反映NPDR患病和严重程度的指标，并绘制受试者工作特征（receiver operating characteristic，ROC）曲线分析单独或联合指标对于NPDR的诊断价值。结果：VD在各NPDR组中较对照组均显著下降，重度NPDR组较轻度、中度NPDR组均显著下降（P<0.05）；PD在中度和重度NPDR组较对照组均显著下降（P<0.05），在重度NPDR组较轻度和中度NPDR组均显著下降（P<0.05）；FAZ-A在各NPDR组中较对照组均显著下降（P<0.05），但在各NPDR组间均无统计学差异；FAZ-P在各NPDR组中较对照组均显著下降（P<0.05），但在各NPDR组间均无统计学差异；FAZ-CI在各组间均无统计学差异。多因素Logistic回归分析结果显示，CMT升高、VD和FAZ-P下降与NPDR患病相关（P=0.03，<0.001和0.001）；CMT上升和VD下降与NPDR严重程度相关（P=0.01，<0.001）。ROC曲线分析显示，CMT(>260.00 μm)、VD(<16.55/mm2)和FAZ-P(<2.15 mm)对NPDR均具有单独诊断价值（AUC分别为0.63、0.78和0.70 ），其中VD的诊断效能显著高于CMT（P=0.02），CMT与VD或FAZ-P的诊断效能之间则无统计学差异（P均>0.05）。CMT、VD和FAZ-P指标联合诊断NPDR的诊断效能（AUC=0.86）显著高于任一单项指标的诊断效能（P均<0.05）。结论：OCTA检查参数CMT、VD和FAZ-P均独立具备对NPDR的诊断价值，将三者联合使用则能进一步提高其诊断效能。OCTA血流参数联合黄斑形态参数可有效提高NPDR的临床诊断。

关键词: 光学相干断层扫描血管成像技术, 眼底荧光血管造影, 糖尿病视网膜病变

Abstract:

Objective To analyze the application value of optical coherence tomography angiography (OCTA) in the diagnosis of non-proliferative diabetic retinopathy (NPDR). Methods A total of 122 patients with or without diabetic retinopathy who has the history of diabetes mellitus were consecutively enrolled from January 2021 to June 2023. All the patients were examined with fundus fluorescein angiography (FFA) followed by OCTA. According to the results of FFA, the patients were divided into four groups: control（non-OCTA）, mild, moderate and severe NPDR groups. OCTA indice included central macular thickness（CMT）， vascular density (VD), perfusion density (PD), foveal avascular zone area(FAZ-A), foveal avascular zone perimeter (FAZ-P), and foveal avascular zone circularity index (FAZ-CI) along with central macular thickness (CMT). The differences in quantitative levels of OCTA parameters were assessed with one-way analysis of variance or non-parametric test, and the risk for NPDR development and severity by OCTA parameters were evaluated with multiple Logistic regression modeling analysis.The diagnostic values of single OCTA parameter or in combination for NPDR were evaluated with receiver operating characteristic (ROC) curve and area under curve (AUC) analysis methods. Results VDs in the NPDR groups were significantly lower than that of control group, showing obvious decrease in severe NPDR group compared to the mild and the moderate groups (P<0.05). PD in moderate and severe NPDR groups were significantly lower than that of control group (P<0.05). PD in severe NPDR group was lower than those of mild and moderate NPDR groups. FAZ-A in the mild, moderate and severe NPDR groups were significantly lower than that of control group (P<0.05), but no difference was observed among the three NPDR groups. FAZ-P in the mild, moderate and severe NPDR groups were significantly lower than those of control group (P<0.05), but no difference was observed among these NPDR groups. There was no statistical difference in FAZ-CI between groups. Multiple logistic regression analysis showed that CMT increase, VD and FAZ-P decrease were accociated with NPRD (P=0.03, <0.001 and 0.001), while CMT increase and VD decrease were independent risk factors for NPDR severity (P=0.01, <0.001). ROC curve analysis showed that CMT(>260.00 μm), VD (<16.55/mm2) and FAZ-P (<2.15 mm) were of significant independent diagnostic value for NPDR (AUC=0.63, 0.78 and 0.70), among which the diagnostic efficiency of VD was significantly higher than that of CMT (P=0.02), and no statistical difference of diagnostic efficacy between CMT and VD or FAZ-P (P>0.05). A combination of CMT, VD and FAZ-P showed higher diagnostic value than any single measurement (AUC=0.86, all P <0.05). Conclusions The OCTA parameters CMT, VD and FAZ-P alone show significant independent diagnostic values for NPDR, and combination of three indices have more efficacy.Integrating the vascular parameters with macular morphology of OCTA measurement might effectively improve clinical diagnosis of NDPR.

Key words: Optical coherence tomography angiography, Fundus Fluorescein angiography, Diabetic retinopathy

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