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ENGLISH ABSTRACT
正常人脉络膜厚度分布特征及肥厚型脉络膜诊断界线值
张新媛
邱冰洁
王艳红
李志清
曾依云
陈晓思
作者及单位信息
·
DOI： 10.3760/cma.j.cn115989-20220401-00127
Distribution characteristics of choroidal thickness in normal population and the diagnostic cut-off value for pachychoroid
Zhang Xinyuan
Qiu Bingjie
Wang Yanhong
Li Zhiqing
Zeng Yiyun
Chen Xiaosi
Authors Info & Affiliations
Zhang Xinyuan
Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Institute of Ophthalmology and Visual Sciences, Beijing 100730, China
Qiu Bingjie
Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Institute of Ophthalmology and Visual Sciences, Beijing 100730, China
Wang Yanhong
Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences & School of Basic Medicine Peking Union Medical College, Beijing 100005, China
Li Zhiqing
Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
Zeng Yiyun
Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Institute of Ophthalmology and Visual Sciences, Beijing 100730, China
Chen Xiaosi
Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Institute of Ophthalmology and Visual Sciences, Beijing 100730, China
·
DOI： 10.3760/cma.j.cn115989-20220401-00127
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摘要

目的探讨正常人脉络膜厚度的分布情况并界定肥厚型脉络膜的诊断值。

方法采用横断面研究设计，对2018年4月至2021年6月在北京同仁医院招募的肥厚型脉络膜谱系疾病(PCD)以及正常人研究队列中正常者230人446眼进行脉络膜厚度分布分析，并选取其中屈光度、年龄及性别与PCD组匹配者199人382眼进行似然比分析。纳入PCD患者274例314眼作为PCD组，包括中心性浆液性视网膜脉络膜病变患者133例149眼、息肉样脉络膜血管病变患者81例95眼、新生血管性年龄相关性黄斑变性患者60例70眼进行肥厚型脉络膜的诊断界值研究。所有受试者接受视力、眼压、裂隙灯显微镜、扩瞳眼底检查和彩色眼底照相；采用扫频源光相干断层扫描成像技术采集黄斑区9 mm×9 mm范围B扫描图像，用仪器自带TABS软件获取早期糖尿病视网膜病变干预研究分区的黄斑中心凹下脉络膜厚度(SFCT)值；采用Pearson线性相关分析、Spearman秩相关分析评估SFCT与年龄和屈光度的相关性；采用多重线性回归模型分析SFCT的影响因素；采用似然比检验界定校正年龄及屈光度后肥厚型脉络膜的诊断值。

结果Pearson线性相关分析显示，正常眼SFCT与年龄呈负相关( r＝-0.34， P<0.001)，男性及女性正常人SFCT与年龄均呈负相关( r＝-0.43， P<0.001； r＝-0.38， P<0.001)。Spearman秩相关分析显示，近视度数与SFCT呈弱正相关( r s ＝0.19， P<0.001)。多重线性回归分析显示，年龄和屈光度是正常人SFCT的影响因素(均 P<0.001)。20~39岁组、40~59岁组、60~79岁组、≥80岁组正常人肥厚型脉络膜的临界诊断值分别为320~330、330~340、250~275、200~225 μm。正常人20~39岁、40~59岁和≥60岁组中肥厚型脉络膜的占比分别为14.71%(10/68)、24.48%(47/192)和28.89%(55/184)，组间比较差异有统计学意义( χ 2＝6.170， P＝0.046；LR＝6.579， P＝0.037)，其中≥60岁组占比明显高于20~39岁组，差异有统计学意义( χ 2＝5.982， P＝0.014；LR＝6.479， P＝0.011)。

结论正常人不同年龄中肥厚型脉络膜的分布特点不同，年龄和屈光度是SFCT变化的独立影响因素。

肥厚型脉络膜疾病;脉络膜厚度;扫频源光相干断层扫描技术;似然比检验;正常人;诊断界线值
ABSTRACT

ObjectiveTo characterize the distribution characteristics of choroidal thickness in healthy normal subjects and to define the diagnostic cut-off value for pachychoroid.

MethodsA cross-sectional study design was carried out.Four hundred and forty-six eyes of 230 healthy subjects from the pachychoroid disease spectrum (PCD) cohort in Beijing Tongren Hospital from April 2018 to June 2021, were enrolled for the choroidal thickness distribution analysis.Three hundred and fourteen eyes of 274 patients with PCD including 149 eyes of 113 patients with central serous chorioretinopathy, 95 eyes of 81 patients with polypoid choroidal vasculopathy, 70 eyes of 60 patients with neovascular age-related macular degeneration, along with 382 eyes of 199 normal subjects matched for refractive error, age and gender with PCD were selected for likelihood ratio analysis.Routine eye examinations including the best corrected visual acuity, intraocular pressure, slit-lamp microscopy, dilated fundus examination and color fundus photography were performed in all subjects.Swept-source optical coherence tomography (SS-OCT) of 9 mm×9 mm scanning mode was used to measure the subfoveal choroidal thickness (SFCT) automatically in nine macular regions according to the Early Treatment Diabetic Retinopathy Study classification system using TOPCON Advanced Boundary Segmentation (TABS) software.Pearson linear correlation analysis and Spearman rank correlation analysis were adopted to evaluate the correlations between SFCT and age, diopter.Multiple linear regression was employed to analyze the factors affecting SFCT.After age and refractive error adjustment, the likelihood ratio test was used to determine the diagnostic cut-off value for pachychoroid.This study adhered to the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of Beijing Tongren Hospital (No.TRECKY2016-054). Written informed consent was obtained from each subject prior to entering the cohort.

ResultsA negative correlation was found between SFCT and age in normal eyes ( r=-0.34, P<0.001), in both normal male and female subjects ( r=-0.43, P<0.001; r=-0.38; P<0.001). A weak positive correlation was found between SFCT and diopter ( r s =0.19, P<0.001). It was found that age and diopter were strongly correlated with SFCT (both at P<0.001). The cut-off values for pachychoroid in 20-39 years group, 40-59 years group, 60-79 years group and ≥80 years group were 320-330 μm, 330-340 μm, 250-275 μm and 200-225 μm, respectively.The percentages of eyes with pachychoroid in 20-39 years group, 40-59 years group and ≥60 years group were 14.71%(10/68), 24.48%(47/192) and 28.89%(55/184), respectively, showing statistically significant differences among them ( χ 2=6.170, P=0.046; LR=6.579, P=0.037). The proportion of pachychoroid in ≥60 years group was significantly higher than that of 20-39 years group, showing a statistically significant difference ( χ 2=5.982, P=0.014; LR=6.479, P=0.011).

ConclusionsThe distribution characteristics of pachychoroid vary in normal subjects over age.Age and diopter are the independent influencing factors of SFCT.

Pachychoroid disease spectrum;Choroidal thickness;Tomography, optical coherence, swept source;Likelihood ratio test;Normal subject;Cut-off value
Zhang Xinyuan, Email: mocdef.3ab610102yxzmm
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引用本文

张新媛,邱冰洁,王艳红,等. 正常人脉络膜厚度分布特征及肥厚型脉络膜诊断界线值[J]. 中华实验眼科杂志,2022,40(06)：548-555.

DOI:10.3760/cma.j.cn115989-20220401-00127

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肥厚型脉络膜谱系疾病(pachychoroid disease spectrum，PCD)是以脉络膜慢性增厚以及脉络膜血管功能失代偿为基本病理特征的一组疾病，是近年来随着眼底成像技术，特别是光相干断层扫描(optical coherent tomography，OCT)技术的巨大进步提出的新概念 [ 1 , 2 ]。2017年，本研究团队首次将PCD的概念引入国内并规范了其中文命名 [ 2 ]。作为感光细胞的主要营养来源，脉络膜的结构和功能变化在多种视网膜脉络膜疾病的发病机制中起重要作用。近年来随着眼底影像学技术的不断进步，脉络膜生物学参数的测量、定量及其与眼病的关系受到普遍关注，对多种视网膜脉络膜疾病的发病机制有了更深入的认知，其中脉络膜厚度参数能更直观地显示脉络膜的形态学变化，可作为视网膜脉络膜疾病诊断、干预效果评估及随访监测的重要影像学指标。自1979年以来，已有多种检查方法用于脉络膜厚度的测量，如超声检查法、磁共振成像(magnetic resonance imaging，MRI)和OCT。相较于超声检查法和MRI，OCT测量，特别是扫频源OCT(swept source OCT，SS-OCT)不仅方便、快捷，在定量测量的准确性方面也有不可比拟的优点 [ 3 , 4 ]。随着OCT扫描分辨率的提高，脉络膜结构成像，特别是脉络膜-巩膜边界和脉络膜血管的成像更为清晰。目前根据OCT设备性能的不同，脉络膜厚度的测量主要有手动法和自动分割法 [ 5 ]，肥厚型脉络膜诊断值的确定也有采用均值±标准差等多种方法 [ 6 , 7 ]。由于肥厚型脉络膜的定量诊断尚无统一标准，给一些疾病的诊断和治疗评价带来了很大的不确定性，难以进行同类研究的评价和比较，此外相关研究未能考虑屈光状态以及生理因素，如年龄和性别对脉络膜厚度的影响，也未考虑脉络膜厚度测量指标对疾病诊断的灵敏度、准确性、特异性和可重复性等，因此研究结果存在较大的局限性。PCD仍是一种新认识的谱系疾病，脉络膜厚度的精确测量以及对于肥厚型脉络膜诊断值的界定无疑对其发病机制的理解乃至相关疾病的诊断和防治均具有重要意义，然而，目前国际上尚无对脉络膜厚度参数进行规范获取及准确定量的方法。本研究拟对肥厚型脉络膜进行测量和分析，进而对其诊断临界值进行界定，并进一步探讨我国限定性人群中正常人脉络膜厚度的分布特点。
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备注信息
A
张新媛，Email： mocdef.3ab610102yxzmm
B

张新媛：参与选题、研究设计、数据收集及分析、论文撰写、文章智力性内容修改及最终定稿；邱冰洁：参与受试者招募、眼部参数测量、数据收集及论文修改；王艳红：参与研究设计、研究数据整理和分析、论文修改；李志清：参与受试者招募、研究数据分析、论文智力性内容修改；曾依云、陈晓思：参与眼部参数测量、研究数据收集和整理、论文修改

C
所有作者均声明不存在利益冲突
D
国家自然科学基金面上项目 (81570850、82070988)
国家重点研发计划重大慢性非传染性疾病防控研究项目 (2016YFC1305600)
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中华实验眼科杂志 2017,35(10)
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