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ENGLISH ABSTRACT
扫频源OCTA对系统性红斑狼疮患者黄斑区脉络膜厚度及微循环改变的评估
毕萌
樊芳
夏会卡
梁福珍
季彤
张风肖
贾志旸
作者及单位信息
·
DOI： 10.3760/cma.j.cn115989-20221027-00497
Assessment of macular choroidal thickness and microvascular changes in patients with systemic lupus erythematosus by swept-source OCTA
Bi Meng
Fan Fang
Xia Huika
Liang Fuzhen
Ji Tong
Zhang Fengxiao
Jia Zhiyang
Authors Info & Affiliations
Bi Meng
Graduate School, North China University of Science and Technology, Tangshan 063210, China
Fan Fang
Department of Ophthalmology, Hebei General Hospital, Shijiazhuang 050057, China
Xia Huika
Department of Ophthalmology, Hebei General Hospital, Shijiazhuang 050057, China
Liang Fuzhen
Graduate School, Hebei Medical University, Shijiazhuang 050000, China
Ji Tong
Graduate School, North China University of Science and Technology, Tangshan 063210, China
Zhang Fengxiao
Department of Rheumatology and Immunology, Hebei General Hospital, Shijiazhuang 050057, China
Jia Zhiyang
Department of Ophthalmology, Hebei General Hospital, Shijiazhuang 050057, China
·
DOI： 10.3760/cma.j.cn115989-20221027-00497
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摘要

目的利用扫频源光学相干断层扫描血管成像(OCTA)技术探讨系统性红斑狼疮(SLE)患者黄斑区脉络膜厚度及脉络膜微血管形态的早期变化特征。

方法采用横断面研究方法，纳入2022年1—7月就诊于河北省人民医院风湿免疫科、无明显眼部症状的SLE患者37例37眼作为SLE组，同时纳入与病例组年龄、性别相匹配的正常成年人35例35眼作为对照组。采用扫频源OCT对受试者进行黄斑区9 mm×9 mm放射状扫描，获得受试者黄斑中心凹区域、旁中心凹区域(1~3 mm)、中心凹周围区域(3~6 mm)的平均脉络膜厚度。采用OCTA对受试者进行黄斑区3 mm×3 mm扫描，获得黄斑区视网膜浅层毛细血管丛(SCP)和深层毛细血管丛(DCP)血流密度、脉络膜毛细血管丛(CC)血流密度及微血管血流图像，采用Image J软件对脉络膜毛细血管血流图像进行二值化处理(Phansalkar法)并计算脉络膜毛细血管流空区域面积(FDa)及百分比(FD%)。

结果SLE组黄斑中心凹区域平均脉络膜厚度为(268.73±81.67)μm，较对照组的(230.14±68.14)μm明显增厚，差异有统计学意义( t＝2.170， P＝0.033)。SLE组黄斑中心凹区域视网膜SCP、视网膜DCP、CC血流密度值分别为(16.58±3.90)%、(14.25±3.15)%和(51.80±4.27)%，均明显低于对照组的(20.55±4.41)%、(16.57±3.74)%和(54.33±3.41)%，差异均有统计学意义( t＝－4.043、－2.851、－2.763，均 P<0.05)。SLE组脉络膜毛细血管流空区域FDa及FD%分别为3.43(3.25，3.56)mm 2和38.11%(36.13%，39.52%)，明显大于对照组的3.25(3.21，3.32) mm 2和36.11%(35.64%，36.84%)，差异均有统计学意义( Z＝－3.470、－3.476，均 P<0.05)。

结论OCTA可检测到无明显眼部症状SLE患眼脉络膜厚度的增加及CC层血流密度的减少。

系统性红斑狼疮;脉络膜厚度;血管流空;脉络膜毛细血管丛;光学相干断层扫描血管成像
ABSTRACT

ObjectiveTo observe the characteristics of early changes in choroidal thickness and choroidal microvascular morphology in the macula of patients with systemic lupus erythematosus (SLE) using swept-source optical coherence tomography angiography (OCTA).

MethodsA cross-sectional study was conducted.Thirty-seven patients (37 eyes) who were diagnosed with SLE without obvious ocular symptoms in Hebei General Hospital from January 2022 to July 2022 were enrolled in this study as a SLE group.At the same time, 35 normal adults (35 eyes) matched with age and sex were included as a control group.Swept-source OCT was used to perform a 9 mm×9 mm radial scan of the macular region of subjects to obtain the average choroidal thickness of the macular central concave area, the paracentral concave area (1-3 mm), and the pericentral concave area (3-6 mm). OCTA was used to perform a 3 mm×3 mm scan of the macular region and images of retinal superficial capillary plexus (SCP) and deep capillary plexus (DCP) blood flow density, choroidal capillary plexus (CC) blood flow density, and microvascular blood flow in the macular region were obtained and binarized using ImageJ software (Phansalkar method) to calculate the choroidal capillary flow void area (FDa) and percentage of flow deficits (FD%). The study protocol followed the Declaration of Helsinki and was approved by the Ethics Committee of Hebei General Hospital (No.202310). Informed consent was obtained from all subjects.

ResultsThe choroidal thickness of the subfoveal region in SLE group was (268.73±81.67)μm, which was significantly higher than (230.14±68.14) μm of control group ( t=2.170, P=0.033). The blood flow density of SCP, DCP and CC in the macular central zone area of SLE group were (16.58±3.90)%, (14.25±3.15)% and (51.80±4.27)%, respectively, which were significantly lower than (20.55±4.41)%, (16.57±3.74)% and (54.33±3.41)% of control group ( t=-4.043, -2.851, -2.763; all at P<0.05). The FDa and FD% in SLE group were 3.43(3.25, 3.56)mm 2 and 38.11%(36.13%, 39.52%), which were greater than 3.25(3.21, 3.32)mm 2 and 36.11%(35.64%, 36.84%) of control group, and the differences were statistically significant ( Z=-3.470, -3.476; both at P<0.05).

ConclusionsOCTA can detect an increase in choroidal thickness and a decrease in blood flow density of CC in eyes with SLE without obvious ocular symptoms.

Systemic lupus erythematosus;Choroidal thickness;Flow deficits;Choriocapillaris;Optical coherence tomography angiography
Jia Zhiyang, Email: mocdef.aabnis9702gnayihzaij
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引用本文

毕萌,樊芳,夏会卡,等. 扫频源OCTA对系统性红斑狼疮患者黄斑区脉络膜厚度及微循环改变的评估[J]. 中华实验眼科杂志,2023,41(11)：1084-1090.

DOI:10.3760/cma.j.cn115989-20221027-00497

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系统性红斑狼疮(systemic lupus erythematosus，SLE)是一种全身性、慢性自身免疫性结缔组织病，损伤可累及多种器官，约1/3患者眼部受累 [ 1 ]。SLE常见的眼部临床表现包括干燥性角结膜炎、视网膜及脉络膜血管炎、视神经损害等，其中视网膜及脉络膜血管炎的发病率约为10%，是导致患者视力严重损害的主要原因 [ 2 , 3 ]。SLE患者眼部血管受累时可引发眼底微血管病变，狼疮性视网膜病变(lupus retinopathy，LR)为其主要表现之一，脉络膜也会受到不同程度影响 [ 4 , 5 ]。研究表明，脉络膜视网膜病变是SLE处于疾病活动期的敏感指标，其存在往往表明患者可能同时合并狼疮性肾病，且SLE患者的脉络膜厚度改变还与其中枢神经系统受累相关 [ 6 , 7 ]。因此，对SLE患者视网膜及脉络膜微观结构与微循环变化进行评估，一定程度上有助于SLE疾病进展的早期监测和及时干预，为患者的预后评估提供一定参考。光学相干断层扫描血管成像(optical coherence tomography angiography，OCTA)技术具有无创、快速、高分辨率、可定量测量眼底微血管等优点，广泛应用于眼底血管疾病及影响眼部血管的全身血管性疾病研究 [ 8 , 9 , 10 ]。以往研究中多侧重于应用OCTA观察SLE患者的视网膜微循环变化 [ 11 , 12 , 13 ]，而对脉络膜微循环变化研究较少；但脉络膜受免疫系统、全身血管异常及各种炎症的影响较大，因此有必要对SLE患者脉络膜厚度及血流变化等观察指标进行检测。在SLE患者脉络膜微循环相关研究中，多采用脉络膜血管指数及脉络膜毛细血管丛(choriocapillaris，CC)血流密度等指标，目前尚无对SLE患者脉络膜毛细血管流空(flow deficits，FDs)的研究。FDs的概念最初由Spaide [ 14 ]提出以评估脉络膜血流的变化情况，并广泛应用于正常人、年龄相关性黄斑变性(age-related macular degeneration，AMD)及中心性浆液性脉络膜视网膜病中 [ 15 , 16 , 17 ]。本研究采用OCTA检测并比较无明显眼部症状的亚临床LR患者与健康对照人群黄斑区平均脉络膜厚度、视网膜浅层毛细血管丛(superficial capillary plexus，SCP)及视网膜深层毛细血管丛(deep capillary plexus，DCP)血流密度、CC血流密度、脉络膜毛细血管FDs平均面积(flow deficits area，FDa)和FDs百分比(percentage of flow deficits，FD%)的差异，从而探讨SLE患者黄斑区早期脉络膜微血管的变化特征，为SLE早期眼科检查和随访监测提供参考依据。
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毕萌：直接参与选题、酝酿和设计试验、采集数据、分析/解释数据、起草文章、文章修改；樊芳、夏会卡：参与文章修改、数据分析；梁福珍、季彤、张风肖：参与采集数据；贾志旸：设计试验、对文章的知识性内容做批评性审阅及定稿

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