高血压患者早期视网膜和脉络膜微血管结构改变的研究

Early changes of retinal and choroidal microvascular structure in hypertensive patients

摘要:

目的：探讨SS-OCTA评估高血压患者早期视网膜和脉络膜微循环改变的可行性。方法：前瞻性临床研究。纳入2022-07/11于西安市第一医院心内科检查确诊的2级或3级原发性高血压病患者27例(高血压组)。其中，男性14例，女性13例； 年龄(57.11±3.36)岁。选取同期年龄、性别匹配且无高血压病史的正常人27名(对照组)：男性12名，女性15名； 年龄(55.74±2.95)岁。均行BCVA(LogMAR)、眼压、眼轴、裂隙灯检查、眼底彩色照相及SS-OCTA检查。采用SS-OCTA对受检者右眼黄斑区6mm×6mm范围进行扫描。将视网膜及脉络膜根据ETDRS分区划分为以黄斑中心凹为中心直径分别为0～1mm、1～3mm、3～6mm的3个同心圆。分析并记录黄斑区0～1mm、1～3mm、3～6mm的视网膜浅层毛细血管丛(SCP)及深层毛细血管丛(DCP)的血管密度(VD)、灌注面积(PA)、黄斑中心凹视网膜厚度(CMT)、脉络膜厚度(CT)、脉络膜血管容积(CVV)及脉络膜血管指数(CVI)。对比观察两组之间VD、PA、CMT、CT、CVV及CVI的变化。两组之间VD、PA、CMT及CVI的比较采用独立样本t检验； CT、CVV及LogMAR视力采用独立样本的Wilcoxon符号秩和检验。结果：高血压组在黄斑区0～3mm区域内DCP的VD较对照组降低(0～1mm，t=-3.144； 1～3mm，t=-3.611，P<0.05)； 3～6mm区域内的VD较对照组有增高的趋势(t=1.715，P>0.05)。高血压组在黄斑区0～1mm区域内CMT较对照组降低(t=-2.624，P<0.05)，两组之间CT、CVV及CVI均无统计学差异(P>0.05)。结论：高血压组黄斑区0～3mm区域内DCP的VD降低，0～1mm区域内CMT降低。两组之间CT、CVV及CVI均无统计学差异。黄斑区DCP的VD及CMT可能成为评估高血压患者早期视网膜和脉络膜微循环改变的指标。

Abstract:

AIM: To explore the feasibility of swept source optical coherence tomography angiography(SS-OCTA)in evaluating early retinal and choroidal microcirculation changes in patients with hypertension.METHODS:Prospective clinical study. A total of 27 patients with grade 2 or 3 essential hypertension(hypertension group)diagnosed in the Department of Cardiology of Xi'an First Hospital from July to November 2022 were included in the study. There were 14 males and 13 females. The mean age was(57.11±3.36)years. During the same period, 27 age- and sex-matched normal people without a history of hypertension were selected as the control group, including 12 males and 15 females. The average age was(55.74±2.95)years old. All patients underwent BCVA(LogMAR), intraocular pressure, axial length, slit lamp examination, fundus color photography and SS-OCTA examination. SS-OCTA was used to scan the macular area of the right eye in the range of 6×6 mm. The retina and choroid were divided into three concentric circles with diameters of 0-1 mm, 1-3 mm and 3-6 mm around the fovea according to ETDRS. Macular vessel density(VD), perfusion area(PA), retinal thickness(CMT), choroidal thickness(CT), choroidal vessel volume(CVV)and choroidal vasculr index(CVI)of the superficial capillary plexus(SCP)and the deep capillary plexus(DCP)in the macular area of 0-1 mm, 1-3 mm and 3-6 mm were analyzed and recorded. The changes in VD, PA, CMT, CT, CVV and CVI were compared between the two groups. Independent sample t-test was used to compare VD, PA, CMT and CVI between the two groups; CT, CVV and LogMAR visual acuity were analyzed by Wilcoxon signed rank test of independent samples.RESULTS:Compared with the control group, the hypertensive group had significantly lower VD in the macular area 0-3 mm(0-1 mm, t=-3.144; 1-3 mm, t=-3.611, P<0.05). VD in the area of 3-6 mm showed a tendency to increase compared with the control group(t=1.715, P>0.05). The CMT in the 0-1mm area of the macular area in the hypertension group was lower than that in the control group(t=-2.624, P<0.05). There was no significant difference in CT, CVV and CVI between the two groups(P>0.05).CONCLUSION:The VD of DCP in the 0-3 mm area and the CMT in the 0-1 mm area are decreased in hypertensive patients. There were no significant differences in CT, CVV and CVI between the two groups. VD and CMT in macular DCP may be used as indicators to evaluate the early changes of retinal and choroidal microcirculation in hypertensive patients.