目的应用扫频源光学相干断层扫描(SS-OCT)评估正常儿童黄斑区脉络膜血管指数(CVI)的分布特征，并探讨其影响因素。
方法采用横断面研究，连续纳入2021年5—11月于郑州大学第一附属医院眼科就诊的6~12岁正常儿童63人，测量其等效球镜度数、眼轴长度及其他眼部生物学参数。并以黄斑为中心，采用SS-OCT血管成像测量黄斑区CVI及脉络膜厚度(ChT)，根据ETDRS分区将图像划分为黄斑中心凹区(直径0~1 mm)、内环区(直径1~3 mm)和外环区(直径3~6 mm)。均选取右眼数据纳入统计分析，比较3个环区和内、外环区上方、颞侧、下方和鼻侧4个区域的CVI。采用单因素线性回归分析和多元线性回归分析3个环区的CVI与性别、眼轴长度、前房深度、ChT和瞳孔直径等参数的关系。
结果黄斑中心凹区、内环区和外环区3个环区的CVI平均值分别为0.35±0.12、0.32±0.10和0.27±0.08，总体比较差异有统计学意义( F＝10.96， P<0.001)，其中3个环区的CVI两两比较差异均有统计学意义(均 P<0.05)。内环区和外环区上方、颞侧、下方、鼻侧不同区域CVI比较，差异均有统计学意义( F 环区＝11.60， P＝0.001； F 部位＝12.02， P<0.05)，其中内环区上方和鼻侧CVI值低于颞侧，外环区上方、颞侧和下方CVI值高于鼻侧，外环区上方CVI低于内环区，差异均有统计学意义(均 P<0.001)。经单因素线性回归分析，黄斑中心凹区、内环区和外环区ChT均是对应3个环区CVI的影响因素(均 β＝0.001， P<0.001)。瞳孔直径( β＝0.034， P＝0.038； β＝0.040， P＝0.003； β＝0.024， P＝0.011)和前房深度( β＝0.097， P＝0.034； β＝0.097， P＝0.013； β＝0.061， P＝0.032)均是黄斑中心凹区、内环区、外环区CVI的影响因素。经多重线性回归分析，建立的回归方程分别为：黄斑中心凹区CVI＝0.001×黄斑中心凹区ChT+0.001×内环区ChT+0.001×外环区ChT－0.301( R 2＝0.514， F＝6.875， P<0.001)；内环区CVI＝0.001×黄斑中心凹区ChT+0.001×内环区ChT+0.001×外环区ChT+0.088×前房深度－0.307( R 2＝0.603， F＝9.870， P<0.001)；外环区CVI＝0.001×黄斑中心凹区ChT+0.001×内环区ChT+0.001×外环区ChT－0.135( R 2＝0.601， F＝9.781， P<0.001)。
结论6~12岁正常儿童黄斑中心凹区的CVI较内环区和外环区高，且在内环区和外环区，均是鼻侧区域的CVI最低。ChT越厚的儿童，黄斑相对应的所有区域CVI越高；前房深度越深的儿童，内环区的CVI越高。
ObjectiveTo evaluate the distribution characteristics of choroidal vascularity index (CVI) in macula among normal children using swept-source optical coherence tomography (SS-OCT), and to investigate the influencing factors.
MethodsA cross-sectional study was conducted.Sixty-three children aged 6 to 12 years were enrolled in The First Affiliated Hospital of Zhengzhou University from May 2021 to November 2021.Spherical equivalent refraction, axial length (AL) and other ocular biological parameters were measured.Macula-centered CVI and choroidal thickness (ChT) were measured by SS-OCT angiography.According to the ETDRS partition, the obtained image was divided into macular central fovea (0-1 mm diameter), inner ring (1-3 mm diameter) and outer ring (3-6 mm diameter) zones.Data from the right eye were selected for statistical analysis.CVI in the three rings and four zones (superior, temporal, inferior and nasal zones) of the inner and outer rings were compared.Univariate and multiple linear regression analyses were used to analyze the correlation between CVI and sex, AL, anterior chamber depth (ACD), ChT and pupil diameter.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of The First Affiliated Hospital of Zhengzhou University (No.2021-KY-0399-003). Written informed consent was obtained from each guardian.
ResultsThe average CVI in the macular central fovea, inner ring and outer ring were 0.35±0.12, 0.32±0.10 and 0.27±0.08, respectively, with a significant difference ( F=10.96, P<0.001), and significant differences in CVI were found in pairwise comparisons of the three ring zones (all at P<0.05). Significant differences in CVI were found among superior, temporal, inferior and nasal zones in inner and outer rings ( F ring=11.60, P=0.001; F zone=12.02, P<0.05). The CVI was smaller in superior and nasal zones in inner ring than in temporal zone, greater in superior, temporal and inferior zones in outer ring than in nasal zone, smaller in superior zone of outer ring than that of the inner ring, and the differences were statistically significant (all at P<0.001). The single factor linear regression analysis showed that ChT in the fovea, inner ring and outer ring were the influencing factors of CVI in the three ring zones (all at β=0.001, P<0.001). Pupil diameter ( β=0.034, P=0.038; β=0.040, P=0.003; β=0.024, P=0.011) and ACD ( β=0.097, P=0.034; β=0.097, P=0.013; β=0.061, P=0.032) were the influencing factors of CVI in fovea, inner ring and outer ring.After multiple linear regression analysis, the regression equations were established as follows: CVI in the macular fovea=0.001×ChT in the macular fovea + 0.001×ChT in the inner ring+ 0.001×ChT in the outer ring-0.301 ( R 2=0.514, F=6.875, P<0.001); CVI in the inner ring=0.001×ChT in the macular fovea+ 0.001×ChT in the inner ring+ 0.001×ChT in the outer ring+ 0.088×AL-0.307 ( R 2=0.603, F=9.870, P<0.001); CVI in the outer ring=0.001×ChT in the macular fovea+ 0.001×ChT in the inner ring+ 0.001×ChT in the outer ring-0.135 ( R 2=0.601, F=9.781, P<0.001).
ConclusionsIn children aged 6-12 years old, the CVI is higher in the macular central fovea than in inner and outer rings, and the CVI in nasal zone is the smallest in both inner and outer rings.The thicker the ChT, the higher the CVI in all zones in the macular area; the deeper the anterior chamber, the higher the CVI in the inner ring.
马娜娜,符爱存,于世傲,等. 正常儿童脉络膜血管指数分布特征及影响因素分析[J]. 中华实验眼科杂志,2023,41(06)：568-575.
DOI:10.3760/cma.j.cn115989-20220130-00033版权归中华医学会所有。
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马娜娜：参与实施研究、采集数据、分析/解释数据、文章撰写及修改；符爱存：参与试验设计、实施研究、采集数据、分析/解释数据、文章撰写；于世傲、黄聪聪、尚丽丽、常铭航：参与实施研究、采集数据；金学民、雷博：参与文章修改；高莎莎：参与试验设计、实施研究、分析/解释数据、文章撰写及定稿
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