基于OCTA观察视网膜分支静脉阻塞患者血液生化及凝血参数的相关性分析

Study on Association between Blood Parameters and Retinal Branch Vein Occlusion with Macular Edema Based on OCTA Observation

摘要: 目的：应用光学相干断层扫描血管成像(OCTA)定量评估视网膜分支静脉阻塞(BRVO)患者黄斑区水肿改变，探讨OCTA黄斑区水肿参数与外周血凝血、血脂及炎症指标之间的相关性。方法：回顾性纳入2018年2026年于我院确诊的单眼非缺血型BRVO同时继发黄斑水肿患者30例(30只眼)，另选取年龄匹配的因白内障手术入我院治疗的单眼20例作为对照。所有患者行最佳矫正视力(BCVA)、眼压、眼底彩照、OCT及OCTA (3 mm × 3 mm黄斑扫描)检查，记录黄斑中心凹水肿参数。同期采集空腹静脉血检测：纤维蛋白原(FIB)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、血小板计数(PLT)、平均血小板体积(MPV)、中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)。采用独立样本t检验或Mann-Whitney U检验比较组间差异，Spearman秩相关分析水肿参数与血液参数的相关性，多元线性回归分析影响因素。结果：① BRVO-ME组黄斑区水肿程度显著低于对照组(P < 0.05)。② BRVO-ME组FIB、NLR、PLR、MPV高于对照组，APTT、PT短于对照组(P < 0.05)。③ 相关性分析显示：ME与FIB (r = −0.42, P < 0.01)、D-D (r = −0.38, P < 0.01)、NLR (r = −0.35, P < 0.05)呈正相关。④ 多元回归显示FIB是ME的独立正向影响因素(P < 0.05)。结论：BRVO伴黄斑水肿患者存在明显的黄斑区水肿，且与高凝状态(FIB升高)及系统性炎症指标(NLR、PLR)相关。OCTA微血管量化参数联合血液学指标有助于评估BRVO-ME患者的视网膜缺血程度及全身血栓倾向。

Abstract: Objective: The optical coherence tomography angiography (OCTA) was applied to quantitatively evaluate the macular edema changes in patients with branch retinal vein occlusion with macular edema (BRVO-ME), and to explore the correlations between the OCTA macular edema parameters and peripheral blood coagulation, lipid, and inflammatory indicators. Methods: A total of 30 patients (30 eyes) diagnosed with unilateral non-ischemic BRVO accompanied by secondary macular edema in our hospital from 2018 to 2026 were retrospectively included. Another 20 patients with unilateral cataract surgery who were treated in our hospital were selected as controls. All patients underwent examinations including best corrected visual acuity (BCVA), intraocular pressure, fundus color photography, OCT and OCTA (3 mm × 3 mm macular scan), and the parameters of macular foveal edema were recorded. During the same period, fasting venous blood was collected for the following tests: fibrinogen (FIB), activated partial thromboplastin time (APTT), prothrombin time (PT), platelet count (PLT), mean platelet volume (MPV), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C). An independent sample t-test or Mann-Whitney U test was used to compare differences between groups. Spearman rank correlation analysis was used to analyze the correlation between macular edema parameters and blood parameters. Multiple linear regression analysis was used to analyze the influencing factors. Results: ① The degree of macular edema in the BRVO-ME group was significantly lower than that in the control group (P < 0.05). ② The FIB, NLR, PLR, and MPV in the BRVO-ME group were higher than those in the control group, while the APTT and PT were shorter (P < 0.05). ③ Correlation analysis showed that ME was positively correlated with FIB (r = −0.42, P < 0.01), D-D (r = −0.38, P < 0.01), and NLR (r = −0.35, P < 0.05). ④ Multiple regression analysis indicated that FIB was an independent positive influencing factor for ME (P < 0.05). Conclusion: Patients with BRVO accompanied by macular edema exhibit significant macular edema, and it is associated with a hypercoagulable state (increased FIB) and systemic inflammatory indicators (NLR, PLR). The OCTA microvascular quantification parameters combined with hematological indicators are helpful in assessing the degree of retinal ischemia and the systemic thrombotic tendency in patients with BRVO-ME.