颈内动脉狭窄与黄斑区光学相干断层扫描血管成像微血管特征的相关性研究

doi:10.3969/j.issn.1673-5765.2024.11.004

中国卒中杂志 ›› 2024, Vol. 19 ›› Issue (11): 1277-1287.DOI: 10.3969/j.issn.1673-5765.2024.11.004

颈内动脉狭窄与黄斑区光学相干断层扫描血管成像微血管特征的相关性研究

张咪，蔺雪梅，刘佩，刘仲仲，逯青丽，刘国正，李云飞，饶兰平，宋沉生，李果，武翻艳，曹顺道，孙超，霍燕，王燕，刘燕，王凝，吴松笛

西安 710002 西安市第一医院（西北大学附属第一医院）神经内科和神经眼科，西安市神经免疫疾病创新转化重点实验室

收稿日期:2024-10-05 出版日期:2024-11-20 发布日期:2024-11-20
通讯作者: 吴松笛 wusongdi@gmail.com
基金资助:
陕西省重点研发计划项目（2022SF-507；2023-YBSF-041；2023-YBSF-052）
陕西省中医药管理局项目（2022-SLRH-LJ-013）
陕西省卫生健康委科研项目（2022C005）
西安市卫生健康委科研项目（2022qn11；2023qn03；2023qn04；2024yb15）
西安市科技计划项目（22YXYJ0061；22YXYJ0074；23YXYJ0005；23YXYJ0055；24YXYJ0081；24YXYJ0097）

Study on the Correlation between Internal Carotid Artery Stenosis and Microvascular Characteristics in Macular Lutea by Optical Coherence Tomography Angiography

Department of Neurology and Neuro-Ophthalmology, The First Hospital of Xi’an (The First Affiliated Hospital of Northwest University), Xi’an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi’an 710002, China

Received:2024-10-05 Online:2024-11-20 Published:2024-11-20
Contact: WU Songdi wusongdi@gmail.com

摘要/Abstract

摘要： 目的采用光学相干断层扫描血管成像（optical coherence tomography angiography，OCTA）技术，探讨颈内动脉狭窄（internal carotid artery stenosis，ICAS）患者黄斑区微血管特征及其与血管狭窄的相关性。
方法连续纳入2023年1月—2024年9月西安市第一医院（西北大学附属第一医院）神经内科和神经眼科收治的经血管评估确诊的ICAS患者，按狭窄侧别、程度分别进行分组，并纳入年龄、性别、既往史等相匹配的参与者为健康对照组。对研究对象进行黄斑区OCTA检查，并收集其小血管密度、血管密度、灌注面积、脉络膜层大中血管血管容积及血管指数等数据进行组间比较。
结果本研究共纳入66例研究对象，其中单侧ICAS组20例、双侧ICAS组26例、健康对照组20例，男性54例（81.8%），平均年龄为（67.5±8.7）岁。3组间除既往卒中或TIA病史外，其他临床特征差异均无统计学意义。单侧ICAS组与健康对照组相比，双眼脉络膜毛细血管层灌注面积低于健康对照组，但单侧ICAS患者双眼间各指标差异均无统计学意义。双侧ICAS组与健康对照组相比，浅层血管复合体小血管密度、视网膜内层灌注面积、脉络膜毛细血管层灌注面积、视网膜内层血管密度、浅层血管复合体血管密度差异均有统计学意义（P<0.05）；两两比较显示，狭窄严重侧眼上述指标均低于健康对照组（P<0.05）；而狭窄较轻侧眼仅脉络膜毛细血管层灌注面积、视网膜内层血管密度低于健康对照组（P<0.05）；狭窄严重侧眼各指标虽有低于狭窄较轻侧眼的趋势，但差异无统计学意义（P>0.05）。所有ICAS狭窄侧眼按狭窄程度分为中度及以下狭窄组（31只）、重度及以上狭窄组（41只），与健康对照组3组进行比较，发现浅层血管复合体小血管密度、脉络膜毛细血管层灌注面积、视网膜内层血管密度及浅层血管复合体血管密度差异均具有统计学意义（P<0.05），狭窄组间各指标虽然随狭窄程度有进一步降低趋势，但差异无统计学意义（P>0.05）。
结论 ICAS患者黄斑区微血管指标较健康对照组参与者降低，一侧ICAS病变可导致双眼黄斑区微循环受损，且受狭窄程度影响。

文章导读： 本研究发现颈内动脉狭窄可导致双眼黄斑区视网膜、脉络膜毛细血管层微循环损伤，且与狭窄程度相关。

关键词: 颈内动脉狭窄; 光学相干断层扫描血管成像; 血管密度; 灌注面积; 脉络膜

Abstract: Objective To explore the microvascular characteristics of the macular lutea in patients with internal carotid artery stenosis (ICAS) and their correlation with vascular stenosis using optical coherence tomography angiography (OCTA).
Methods Patients diagnosed with ICAS through vascular assessment, who were admitted to the Department of Neurology and Neuro-Ophthalmology at The First Hospital of Xi’an (The First Affiliated Hospital of Northwest University) from January 2023 to September 2024, were consecutively included. Patients were grouped according to the lesion side and stenosis degree. Age, gender, and medical history-matched participants were included as a healthy control group. OCTA examinations were conducted in the macular lutea for the enrolled subjects, and the data of small vessel density, vessel density, perfusion area, volume of medium to large choroidal vessels, and vascular index were all collected for inter-group comparison.
Results A total of 66 subjects were included in this study, including 20 cases in the unilateral ICAS group, 26 cases in the bilateral ICAS group, and 20 cases in the healthy control group. Among them, 54 (81.8%) were male, with an average age of (67.5 ± 8.7) years. There were no statistically significant differences in clinical characteristics among the three groups, except for the history of previous stroke or TIA. Compared with the healthy control group, the perfusion area of the choroidal capillary layer in both eyes of the unilateral ICAS group was lower than that of the healthy control group. However, there were no statistically significant differences in these indicators between both eyes of the unilateral ICAS patients. Compared with the healthy control group, there were statistically significant differences in the small vessel density of the superficial vascular complex, the perfusion area of the inner retinal layer, the perfusion area of the choroidal capillary layer, the vessel density of the inner retinal layer, and the vessel density of the superficial vascular complex in the bilateral ICAS group (P<0.05). Pairwise comparisons showed that the above indicators in the severe stenosis side were all lower than those in the healthy control group (P<0.05). However, in the mild stenosis side, only the perfusion area of the choroidal capillary layer and vessel density of the inner retinal layer were lower than those in the healthy control group (P<0.05). Although the indicators in the severe stenosis side tended to be lower than those in the mild stenosis side, the differences were not statistically significant (P>0.05). All eyes with ICAS were divided into moderate and below (31 cases) and severe and above (41 cases) stenosis groups. When comparing these two groups with the healthy control group, it was found that the differences in small vessel density of the superficial vascular complex, the perfusion area of the choroidal capillary layer, the vessel density of the inner retinal layer, and the vessel density of the superficial vascular complex were statistically significant (P<0.05). Although the indicators between the stenosis groups showed a further decreasing trend with the degree of stenosis, the differences were not statistically significant (P>0.05).
Conclusions In ICAS patients, microvascular indicators in the macular lutea were reduced compared to those in the healthy control group. Unilateral ICAS lesions can lead to impaired macular microcirculation in both eyes, with the degree of impairment influenced by the severity of stenosis.

Key words: Internal carotid artery stenosis; Optical coherence tomography angiography; Vessel density; Perfusion area; Choroid

中图分类号:

张咪, 蔺雪梅, 刘佩, 刘仲仲, 逯青丽, 刘国正, 李云飞, 饶兰平, 宋沉生, 李果, 武翻艳, 曹顺道, 孙超, 霍燕, 王燕, 刘燕, 王凝, 吴松笛. 颈内动脉狭窄与黄斑区光学相干断层扫描血管成像微血管特征的相关性研究[J]. 中国卒中杂志, 2024, 19(11): 1277-1287.

ZHANG Mi, LIN Xuemei, LIU Pei, LIU Zhongzhong, LU Qingli, LIU Guozheng, LI Yunfei, RAO Lanping, SONG Chensheng, LI Guo, WU Fanyan, CAO Shundao, SUN Chao, HUO Yan, WANG Yan, LIU Yan, WANG Ning, WU Songdi. Study on the Correlation between Internal Carotid Artery Stenosis and Microvascular Characteristics in Macular Lutea by Optical Coherence Tomography Angiography[J]. Chinese Journal of Stroke, 2024, 19(11): 1277-1287.

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颈内动脉狭窄与黄斑区光学相干断层扫描血管成像微血管特征的相关性研究

Study on the Correlation between Internal Carotid Artery Stenosis and Microvascular Characteristics in Macular Lutea by Optical Coherence Tomography Angiography

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