不同分期糖尿病视网膜病变患者脉络膜厚度及体积变化的计算机自动分割方法分析

范雯; 陈强; 戈伟中; 刘庆淮; 袁松涛

doi:10.3760/cma.j.cn115989-20200630-00465

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中华实验眼科杂志

• 临床研究 •

ENGLISH ABSTRACT

不同分期糖尿病视网膜病变患者脉络膜厚度及体积变化的计算机自动分割方法分析

作者及单位信息

出版日期： 2022 -09 -10 ·

DOI： 10.3760/cma.j.cn115989-20200630-00465

Changes of subfoveal choroidal thickness and choroidal volume in different stages of diabetic retinopathy through automated choroid segmentation

Authors Info & Affiliations

Fan Wen

Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University (Jiangsu Province Hospital), Nanjing 210029, China

Chen Qiang

School of Computer Science and Engineering, Nanjing University of Science and Technology, Nanjing 210094, China

Ge Weizhong

Department of Ophthalmology, Yixing People's Hospital, Yixing 214200, China

Liu Qinghuai

Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University (Jiangsu Province Hospital), Nanjing 210029, China

Yuan Songtao

Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University (Jiangsu Province Hospital), Nanjing 210029, China

Published： 2022 -09 -10 ·

DOI： 10.3760/cma.j.cn115989-20200630-00465

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摘要

目的通过计算机自动分割方法分析糖尿病视网膜病变(DR)不同分期黄斑中心凹下脉络膜厚度(SFCT)和体积的变化。

方法采用横断面研究方法，纳入2016年5月至2017年5月于南京医科大学第一附属医院确诊的2型糖尿病患者64例88眼，其中，男27例32眼，女37例56眼；平均年龄(62.7±7.4)岁；平均糖尿病病程(13.7±7.2)年。所有患者均行最佳矫正视力、裂隙灯显微镜、间接检眼镜、频域光相干断层扫描(SD-OCT)检查。参照早期DR治疗研究组制定的分级诊断标准将患者分为糖尿病无DR(NDR)组28眼、非增生型DR(NPDR)组36眼和增生型DR(PDR)组24眼。同期纳入与患者年龄匹配的正常对照者19人32眼作为正常对照组。采用SD-OCT深度增强成像技术测量和自动分割方法计算受检眼SFCT和脉络膜体积。

结果正常对照组、NDR组、NPDR组和PDR组SFCT分别为(277.8±45.3)、(220.9±38.7)、(231.8±26.7)和(252.0±42.2)μm，脉络膜体积分别为(8.8±1.0)、(7.6±1.3)、(8.2±0.9)和(8.7±1.0)mm ³，总体比较差异均有统计学意义( F＝14.615、7.711，均 P<0.001)；NDR组和NPDR组SFCT和脉络膜体积较正常对照组减小，PDR组SFCT和脉络膜体积较NDR组增大，差异均有统计学意义(均 P<0.05)。

结论早期DR患者SFCT变薄、脉络膜体积减小，而随DR程度的加重，SFCT逐渐增厚，脉络膜体积增加。

关键词：糖尿病视网膜病变;光相干断层扫描;自动分割方法;脉络膜厚度;脉络膜体积

ABSTRACT

ObjectiveTo analyze the changes of subfoveal choroidal thickness (SFCT) and choroidal volume in type 2 diabetes patients with diabetic retinopathy (DR) through automated choroid segmentation.

MethodsA cross-sectional study was conducted.Sixty-four patients (88 eyes) with type 2 diabetes diagnosed in The First Affiliated Hospital with Nanjing Medical University from May 2016 to May 2017 were enrolled, including 27 males (32 eyes) and 37 females (56 eyes), with an average age of (62.7±7.4) years and an average diabetes duration of (13.7±7.2) years.Best corrected visual acuity, slit lamp ophthalmoscopy, indirect ophthalmoscopy and spectral domain optical coherence tomography (SD-OCT) examination were carried out among all the patients.The patients were divided into non-DR (NDR) group (28 eyes), nonproliferative DR (NPDR) group (36 eyes) and proliferative DR (PDR) group (24 eyes) according to the Early Treatment Diabetic Retinopathy Study.Nineteen age-matched normal subjects (32 eyes) were enrolled as normal control group.SFCT and choroidal volume were measured through automated choroid segmentation based on SD-OCT with enhanced depth imaging.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of The First Affiliated Hospital with Nanjing Medical University (No.2017-SR-176).

ResultsMean SFCT and choroidal volume of normal control group, NDR group, NPDR group and PDR group were (277.8±45.3)μm and (8.8±1.0)mm ³, (220.9±38.7)μm and (7.6±1.3)mm ³, (231.8±26.7)μm and (8.2±0.9)mm ³, (252.0±42.2)μm and (8.7±1.0)mm ³, respectively, with significant overall differences among the groups ( F=14.615, P<0.001; F=7.711, P<0.001). Mean SFCT and choroidal volume were significantly smaller in NDR and NPDR group than those in normal control group (both at P<0.05). Mean SFCT and choroidal volume of PDR group was greater than those of NDR group (both at P<0.05).

ConclusionsSFCT and choroidal volume decrease during the early course of diabetes and increase significantly as DR worsens from NDR to PDR.

KEYWORDS： Diabetic retinopathy;Tomography, optical coherence;Automated segmentation method;Choroidal thickness;Choroidal volume

Corresponding author: Yuan Songtao, Email: mocdef.3ab61.pivoatgnosnauy

FUNDING:

Nanjing Health Science and Technology Development Special Fund Program（GBX21339）

Jiangsu Province Hospital Clinical Ability Improvement Project（JSPH-MB-2021-8）

COPYRIGHTS:

No content published by the journals of Chinese Medical Association may be reproduced or abridged without authorization. Please do not use or copy the layout and design of the journals without permission.

All articles published represent the opinions of the authors, and do not reflect the official policy of the Chinese Medical Association or the Editorial Board, unless this is clearly specified.

引用本文

范雯,陈强,戈伟中,等. 不同分期糖尿病视网膜病变患者脉络膜厚度及体积变化的计算机自动分割方法分析[J]. 中华实验眼科杂志,2022,40(09)：827-831.

DOI:10.3760/cma.j.cn115989-20200630-00465

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糖尿病发病率呈逐年升高趋势，预计2040年世界范围内糖尿病患者将达到6.42亿 ^{[
1
]}。糖尿病视网膜病变(diabetic retinopathy，DR)是糖尿病引起的主要视网膜血管并发症，是全球工作年龄人群视力障碍和盲的主要原因 ^{[
2
]}。视网膜的氧气和营养不仅来源于自身血管，还来源于脉络膜血管，DR、年龄相关性黄斑变性等大部分视网膜疾病的病理生理学机制都与脉络膜异常有关 ^{[
3
,

4
]}。然而脉络膜厚度和体积的变化与DR之间的关系尚未明确。增强深部成像的光相干断层扫描(enhanced depth imaging optical coherence tomography，EDI-OCT)可将光源聚焦于更深层的脉络膜，呈现出更清晰的脉络膜影像。EDI-OCT可清晰显示全层脉络膜并进行定量检测，使人们对视网膜脉络膜疾病的研究发生了跨越式进步。近年国内外广泛开展了基于EDI-OCT图像的脉络膜厚度相关研究，但各个研究结论并不完全一致。Kim等 ^{[
5
]}研究发现随着DR严重程度的增加，脉络膜厚度也相应增加，并且有黄斑水肿患者的脉络膜增厚。而Querques等 ^{[
6
]}和Regatieri等 ^{[
7
]}研究发现存在黄斑水肿的DR患者脉络膜会进一步变薄。脉络膜体积与视网膜疾病的关系比脉络膜厚度更重要，但是脉络膜体积通常无法在机器上直接获取。本课题组前期通过合并EDI-OCT图像和128个三维B型扫描的频域光相干断层扫描(spectral domain optical coherence tomography，SD-OCT)图像来进行计算机自动脉络膜分割，获得黄斑中心凹下脉络膜厚度(subfoveal choroidal thickness，SFCT)和脉络膜体积，相较于传统手动测量方法展现出高效、便捷、稳定、精确的优点 ^{[
8
]}。本研究拟采用计算机自动分割方法来测量2型糖尿病患者不同DR分型OCT图像SFCT和脉络膜体积变化，进一步探索脉络膜异常在DR的病理生理机制中所扮演的角色，为DR的疾病进展预测和治疗提供新的线索。

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摘要
参考文献

参考文献

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Ogurtsova K ， da Rocha Fernandes JD ， Huang Y ，et al. IDF diabetes atlas：global estimates for the prevalence of diabetes for 2015 and 2040[J]．Diabetes Res Clin Pract， 2017，128∶40－50. DOI： 10.1016/j.diabres.2017.03.024 .