■使用宽视场光学相干断层扫描血管造影(OCTA)定量评估系统性红斑狼疮(SLE)的视网膜血管系统变化,并探讨其与全身临床特征的相关性。
■预期,横截面,观察性研究。
■收集2022年11月至2023年4月到北京协和医院眼科就诊的SLE患者。将受试者分为视网膜病变组和无视网膜病变组。选择年龄和性别匹配的健康受试者作为对照。
■SLE患者和对照受试者进行以中央凹为中心的24×20mmOCTA扫描和以视盘为中心的6×6mmOCTA扫描。通过设备的内置软件对OCTA图像的子层进行分层,然后自动测量视网膜厚度和血管密度。分析SLE患者视网膜OCTA参数的特点及其与无视网膜病变患者全身临床指标的相关性。
■OCTA参数,视敏度,眼内压,和患者的系统临床指标,如疾病活动指数,自身免疫抗体,并收集炎症标志物水平。
■共纳入102例SLE患者,其中24人患有视网膜病变,78人视网膜未受影响。宽视场OCTA能有效检测视网膜血管阻塞,非灌注区,狼疮视网膜病变患者的形态学异常。无视网膜病变的SLE患者中央凹视网膜浅表血管密度(SVD)明显增高(P=0.02),颞侧中央凹(P=0.01),鼻(P=0.01),周围中央凹颞叶(P=0.02),和下区域(P=0.02),与健康对照组(65名参与者的n=65只眼睛)相比,以及分区域(P=0.01)和下区域(P=0.03)。次区域下SVD合并下凹颞侧SVD的曲线下面积(AUC)值高达0.70。SLE无视网膜病变组SVD与疾病活动度呈显著正相关。活动严重的患者SVD增加最显著。
■宽场OCTA可以对SLE中的视网膜脉管系统进行相对全面的评估。在没有视网膜病理变化的情况下,SVD显著升高,且与SLE的疾病活动度呈正相关。
To assess the retinal vasculature changes quantitatively using wide-field optical coherence tomography angiography (OCTA) in systemic lupus erythematosus (SLE), and explore its correlation with systemic clinical features.
Prospective, cross-sectional, observational study.
Patients with SLE who presented to the Ophthalmology Department of Peking Union Medical College Hospital from November 2022 to April 2023 were collected. The subjects were divided into retinopathy and without retinopathy groups. Age and gender-matched healthy subjects were selected as controls.
Patients with SLE and control subjects were imaged with 24×20 mm OCTA scans centered on the fovea and 6×6 mm OCTA scans centered on the optic disc. The sub-layers of OCTA images were stratified by the built-in software of the device and then the retinal thickness and vessel density were measured automatically. The characteristics of retinal OCTA parameters of SLE and its correlation with systemic clinical indicators of patients without retinopathy were analyzed.
OCTA parameters, visual acuity, intraocular pressure, and systemic clinical indicators of patients such as disease activity index, autoimmune antibodies, and inflammatory marker levels were collected.
A total of 102 SLE patients were included, 24 of which had retinopathy, and 78 had unaffected retina. Wide-field OCTA could effectively detect retinal vascular obstruction, non-perfusion area, and morphological abnormalities in patients with lupus retinopathy. SLE patients without retinopathy had significantly higher retinal superficial vessel density (SVD) in foveal (P=0.02), para-foveal temporal (P=0.01), nasal (P=0.01), peripheral foveal temporal (P=0.02), and inferior areas (P=0.02), as well as subregion temporal (P=0.01) and inferior areas (P=0.03) when compared with healthy controls (n=65 eyes from 65 participants). The area under curve (AUC) value of subregion inferior SVD combined parafoveal temporal SVD was up to 0.70. There was a significantly positive correlation between SVD and disease activity in SLE without retinopathy group. Patients with severe activity had the most significant increase in SVD.
Wide-field OCTA can provide a relatively comprehensive assessment of the retinal vasculature in SLE. In the absence of pathological changes of the retina, the SVD was significantly increased and was positively correlated with the disease activity of SLE.