光学相干断层扫描血管成像技术在慢性肾脏病临床评估中的应用进展

doi:10.11958/20231571

天津医药 ›› 2024, Vol. 52 ›› Issue (8): 882-887.doi: 10.11958/20231571

光学相干断层扫描血管成像技术在慢性肾脏病临床评估中的应用进展

马良¹(), 胡立影², 石羽², 龙刚¹^,^△()

1 天津市人民医院肾脏病科（邮编300121）
2 天津医科大学眼科医院临床研究中心

收稿日期:2023-10-13 修回日期:2023-12-25 出版日期:2024-08-15 发布日期:2024-08-16
通讯作者: △E-mail：longgang@hotmail.com
作者简介:马良（1984），男，主治医师，主要从事糖尿病肾病及慢性肾脏病机制方面研究。E-mail：rmyymaliang@163.com
基金资助:
天津市教委科研计划项目(2022KJ258)

Application of optical coherence tomography angiography in clinical evaluation of chronic kidney disease

MA Liang¹(), HU Liying², SHI Yu², LONG Gang¹^,^△()

1 Department of Nephrology, Tianjin Union Medical Center, Tianjin 300121, China
2 Clinical Research Center, Tianjin Medical University Eye Hospital

Received:2023-10-13 Revised:2023-12-25 Published:2024-08-15 Online:2024-08-16
Contact: △E-mail：longgang@hotmail.com

马良, 胡立影, 石羽, 龙刚. 光学相干断层扫描血管成像技术在慢性肾脏病临床评估中的应用进展[J]. 天津医药, 2024, 52(8): 882-887.

MA Liang, HU Liying, SHI Yu, LONG Gang. Application of optical coherence tomography angiography in clinical evaluation of chronic kidney disease[J]. Tianjin Medical Journal, 2024, 52(8): 882-887.

摘要/Abstract

摘要：

慢性肾脏病（CKD）是常见的慢性疾病。视网膜和肾脏具有同源性。糖尿病视网膜病变、视网膜神经血管损伤均揭示了视网膜和肾脏存在共同的病理生理特征。光学相干断层扫描血管成像技术（OCTA）可用接近组织学的分辨率检测脉络膜视网膜微循环。由于微血管结构和功能的改变可促进高血压、糖尿病、CKD及相关心血管疾病（CVD）的发展。OCTA对CKD患者眼底神经微血管的检查有助于识别高危人群，评估CKD病情的进展，为CVD风险预测提供了新的视角；其与深度学习的结合，将会进一步拓展该方面研究。

关键词: 肾功能不全, 慢性, 体层摄影术, 光学相干, 视网膜血管, 糖尿病视网膜病变, 心血管疾病

Abstract:

Chronic kidney disease (CKD) is a common chronic disease. There is homology between retina and kidneys. Diabetic retinopathy and retinal neurovascular injury both reveal common pathophysiological features of ocular retina and kidney. Optical coherence tomography angiography (OCTA) detects chorioretinal microcirculation with near-histological resolution. Changes in microvascular structure and function can promote the development of hypertension, diabetes, CKD and related cardiovascular disease (CVD). The examination of fundus nerve microvessels by OCTA in patients with CKD is helpful to the identification of high-risk groups, and provides a new perspective for the assessment of disease progression and CVD risk prediction of patients with CKD. The combination of the deep learning will further expand this aspect of research and become the forefront of future development.

Key words: renal insufficiency, chronic, tomography, optical coherence, retinal vessels, diabetic retinopathy, cardiovascular diseases

中图分类号:

R770.4，R774

参考文献 52

[1]	WANG L, XU X, ZHANG M, et al. Prevalence of chronic kidney disease in China:Results from the Sixth China Chronic Disease and Risk Factor Surveillance[J]. JAMA Intern Med, 2023, 183(4):298-310. doi:10.1001/jamainternmed.2022.6817.
[2]	上海市肾内科临床质量控制中心专家组. 慢性肾脏病早期筛查,诊断及防治指南(2022年版)[J]. 中华肾脏病杂志, 2022, 38(5):453-464.
	Expert Group on Kidney Clinical Quality Control Center in Shanghai. Guidelines for early screening,diagnosis,prevention and treatment of chronic kidney disease(2022 Edition)[J]. Chinese Journal of Nephrology, 2022, 38(5):453-464. doi:10.3760/cma.j.cn441217-20210819-00067.
[3]	FURSOVA A Z, DERBENEVA A S, VASILYEVA M V, et al. Structural and microvascular changes in the retina and choroid in patients with chronic kidney disease[J]. Vestn Oftalmol, 2021, 137(6):99-108. doi:10.17116/oftalma202113706199.
[4]	FURSOVA A Z, DERBENEVA A S, VASILYEVA M A, et al. Development,clinical manifestations and diagnosis of retinal changes in chronic kidney disease[J]. Vestn Oftalmol, 2021, 137(1):107-114. doi:10.17116/oftalma2021137011107.
[5]	HUANG Y, YUAN Y, SETH I, et al. Optic nerve head capillary network quantified by optical coherence tomography angiography and decline of renal function in type 2 diabetes:a three-year prospective study[J]. Am J Ophthalmol, 2023, 253:96-105. doi:10.1016/j.ajo.2023.04.003.
[6]	SPAIDE R F, FUJIMOTO J G, WAHEED N K, et al. Optical coherence tomography angiography[J]. Prog Retin Eye Res, 2018, 64:1-55. doi:10.1016/j.preteyeres.2017.11.003.
[7]	WANG A, QI W, GAO T, et al. Molecular contrast optical coherence tomography and its applications in medicine[J]. Int J Mol Sci, 2022, 23(6):3038. doi:10.3390/ijms23063038.
[8]	FARRAH T E, DHILLON B, KEANE P A, et al. The eye,the kidney,and cardiovascular disease: old concepts, better tools, and new horizons[J]. Kidney Int, 2020, 98(2):323-342. doi:10.1016/j.kint.2020.01.039.
[9]	LI X, XIE J, ZHANG L, et al. Identifying microvascular and neural parameters related to the severity of diabetic retinopathy using optical coherence tomography angiography[J]. Invest Ophthalmol Vis Sci, 2020, 61(5):39. doi:10.1167/iovs.61.5.39.
[10]	WU I W, SUN C C, LEE C C, et al. Retinal neurovascular changes in chronic kidney disease[J]. Acta Ophthalmol, 2020, 98(7):e848-e855. doi:10.1111/aos.14395.
[11]	DOUGLAS V P, DOUGLAS K, TORUN N. Optical coherence tomography angiography in neuro-ophthalmology[J]. Curr Opin Ophthalmol, 2023, 34(4):354-360. doi:10.1097/ICU.0000000000000955.
[12]	ELTANAHY A M, FRANCO C, JEYARAJ P, et al. Ex vivo ocular perfusion model to study vascular physiology in the mouse eye[J]. Exp Eye Res, 2023, 233:109543. doi:10.1016/j.exer.2023.109543.
[13]	MURALI A, KRISHNAKUMAR S, SUBRAMANIAN A, et al. Bruch's membrane pathology:a mechanistic perspective[J]. Eur J Ophthalmol, 2020, 30(6):1195-1206. doi:10.1177/1120672120919337.
[14]	CICINELLI M V, RITTER M, TAUSIF H, et al. Characterization of choriocapillaris and choroidal abnormalities in Alport Syndrome[J]. Transl Vis Sci Technol, 2022, 11(3):23. doi:10.1167/tvst.11.3.23.
[15]	ZHU V, HUANG T, WANG D, et al. Ocular manifestations of the genetic causes of focal and segmental glomerulosclerosis[J]. Pediatr Nephrol, 2023. doi:10.1007/s00467-023-06073-y. [Epub ahead of print].
[16]	OSHITARI T. Advanced glycation end-products and diabetic neuropathy of the retina[J]. Int J Mol Sci, 2023, 24(3):2927. doi:10.3390/ijms24032927.
[17]	ZENG X, HU Y, CHEN Y, et al. Retinal neurovascular impairment in non-diabetic and non-dialytic chronic kidney disease patients[J]. Front Neurosci, 2021, 15:703898. doi:10.3389/fnins.2021.703898.
[18]	KASUMOVIC A, MATOC I, REBIC D, et al. Assessment of retinal microangiopathy in chronic kidney disease patients[J]. Med Arch, 2020, 74(3):191-194. doi:10.5455/medarh.2020.74.191-194.
[19]	GRUNWALD J E, PISTILLI M, YING G S, et al. Association between progression of retinopathy and concurrent progression of kidney disease:Findings from the Chronic Renal Insufficiency Cohort(CRIC)Study[J]. JAMA Ophthalmol, 2019, 137(7):767-774. doi:10.1001/jamaophthalmol.2019.1052.
[20]	MARX N, FEDERICI M, SCHüTT K, et al. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes[J]. Eur Heart J,2023, 44(39):4043-4140. doi:10.1093/eurheartj/ehad192.
[21]	中华医学会糖尿病学分会微血管并发症学组. 中国糖尿病肾脏病防治指南(2021年版)[J]. 中华糖尿病杂志, 2021, 13(8):762-784.
	Microvascular Complications Group of Chinese Diabetes Society. Clinical guideline for the prevention and treatment of diabetic kidney disease in China(2021 edition)[J]. Chinese Journal of Diabetes, 2021, 13(8):762-784. doi:10.3760/cma.j.cn115791-20210706-00369.
[22]	American Diabetes Association Professional Practice Committee. 3. Prevention or Delay of Type 2 Diabetes and Associated Comorbidities:Standards of Medical Care in Diabetes-2022[J]. Diabetes Care, 2022, 45(Suppl 1):S39-S45. doi:10.2337/dc22-S003.
[23]	TU X, LUO N, LV Y, et al. Prognostic evaluation model of diabetic nephropathy patients[J]. Ann Palliat Med, 2021, 10(6):6867-6872. doi:10.21037/apm-21-1454.
[24]	SHI S, GAO L, ZHANG J, et al. The automatic detection of diabetic kidney disease from retinal vascular parameters combined with clinical variables using artificial intelligence in type-2 diabetes patients[J]. BMC Med Inform Decis Mak, 2023, 23(1):241. doi:10.1186/s12911-023-02343-9.
[25]	SUN Z, TANG F, WONG R, et al. OCT Angiography metrics predict progression of diabetic retinopathy and development of diabetic macular edema:a prospective study[J]. Ophthalmology, 2019, 126(12):1675-1684. doi:10.1016/j.ophtha.2019.06.016.
[26]	CHEUNG C Y, TANG F, NG D S, et al. The relationship of quantitative retinal capillary network to kidney function in type 2 diabetes[J]. Am J Kidney Dis, 2018, 71(6):916-918. doi:10.1053/j.ajkd.2017.12.010.
[27]	WANG W, HE M, GONG X, et al. Association of renal function with retinal vessel density in patients with type 2 diabetes by using swept-source optical coherence tomographic angiography[J]. Br J Ophthalmol, 2020, 104(12):1768-1773. doi:10.1136/bjophthalmol-2019-315450.
[28]	ZHUANG X, CAO D, ZENG Y, et al. Associations between retinal microvasculature/microstructure and renal function in type 2 diabetes patients with early chronic kidney disease[J]. Diabetes Res Clin Pract, 2020, 168:108373. doi:10.1016/j.diabres.2020.108373.
[29]	AMEER O Z. Hypertension in chronic kidney disease:What lies behind the scene[J]. Front Pharmacol, 2022, 13:949260. doi:10.3389/fphar.2022.949260.
[30]	CHUA J, CHIN C, HONG J, et al. Impact of hypertension on retinal capillary microvasculature using optical coherence tomographic angiography[J]. J Hypertens, 2019, 37(3):572-580. doi:10.1097/HJH.0000000000001916.
[31]	MULÈ G, VADALà M, LA BLASCA T, et al. Association between early-stage chronic kidney disease and reduced choroidal thickness in essential hypertensive patients[J]. Hypertens Res, 2019, 42(7):990-1000. doi:10.1038/s41440-018-0195-1.
[32]	VADALÀ M, CASTELLUCCI M, GUARRASI G, et al. Retinal and choroidal vasculature changes associated with chronic kidney disease[J]. Graefes Arch Clin Exp Ophthalmol, 2019, 257(8):1687-1698. doi:10.1007/s00417-019-04358-3.
[33]	CHUA J, LE T T, TAN B, et al. Choriocapillaris microvasculature dysfunction in systemic hypertension[J]. Sci Rep, 2021, 11(1):4603. doi:10.1038/s41598-021-84136-6.
[34]	BASIONY A I, ATTA S N, DEWIDAR N M, et al. Association of chorioretinal thickness with chronic kidney disease[J]. BMC Ophthalmol, 2023, 23(1):55. doi:10.1186/s12886-023-02802-x.
[35]	SHIN Y U, LEE S E, KANG M H, et al. Evaluation of changes in choroidal thickness and the choroidal vascularity index after hemodialysis in patients with end-stage renal disease by using swept-source optical coherence tomography[J]. Medicine(Baltimore), 2019, 98(18):e15421. doi:10.1097/MD.0000000000015421.
[36]	HWANG H, CHAE J B, KIM J Y, et al. Changes in optical coherence tomography findings in patients with chronic renal failure undergoing dialysis for the first time[J]. Retina, 2019, 39(12):2360-2368. doi:10.1097/IAE.0000000000002312.
[37]	NAKANO H, HASEBE H, MURAKAMI K, et al. Choroid structure analysis following initiation of hemodialysis by using swept-source optical coherence tomography in patients with and without diabetes[J]. PLoS One, 2020, 15(9):e0239072. doi:10.1371/journal.pone.0239072.
[38]	ZHANG J F, WISEMAN S, VALDÉS-HERNÁNDEZ M C, et al. The application of optical coherence tomography angiography in cerebral small vessel disease, ischemic stroke,and dementia:a systematic review[J]. Front Neurol, 2020, 11:1009. doi:10.3389/fneur.2020.01009.
[39]	FINDLAY M D, DAWSON J, DICKIE D A, et al. Investigating the relationship between cerebral blood flow and cognitive function in hemodialysis patients[J]. J Am Soc Nephrol, 2019, 30(1):147-158. doi:10.1681/ASN.2018050462.
[40]	HUANG H. Pericyte-Endothelial interactions in the retinal microvasculature[J]. Int J Mol Sci, 2020, 21(19):7413. doi:10.3390/ijms21197413.
[41]	STEHOUWER C. Microvascular dysfunction and hyperglycemia:a vicious cycle with widespread consequences[J]. Diabetes, 2018, 67(9):1729-1741. doi:10.2337/dbi17-0044.
[42]	NÄGELE M P, BARTHELMES J, LUDOVICI V, et al. Retinal microvascular dysfunction in heart failure[J]. Eur Heart J, 2018, 39(1):47-56. doi:10.1093/eurheartj/ehx565.
[43]	CIMMINO G, NATALE F, ALFIERI R, et al. Non-conventional risk factors:"Fact" or "Fake" in cardiovascular disease prevention?[J]. Biomedicines, 2023, 11(9):2353. doi:10.3390/biomedicines11092353.
[44]	LEMMENS S, DEVULDER A, VAN KEER K, et al. Systematic review on fractal dimension of the retinal vasculature in neurodegeneration and stroke:assessment of a potential biomarker[J]. Front Neurosci, 2020, 14:16. doi:10.3389/fnins.2020.00016.
[45]	GRUNWALD J E, PISTILLI M, YING G S, et al. Progression of retinopathy and incidence of cardiovascular disease:findings from the chronic renal insufficiency cohort study[J]. Br J Ophthalmol, 2021, 105(2):246-252. doi:10.1136/bjophthalmol-2019-315333.
[46]	ARNOULD L, GUENANCIA C, AZEMAR A, et al. The EYE-MI pilot study:a prospective acute coronary syndrome cohort evaluated with retinal optical coherence tomography angiography[J]. Invest Ophthalmol Vis Sci, 2018, 59(10):4299-4306. doi:10.1167/iovs.18-24090.
[47]	LIEW G, XIE J, NGUYEN H, et al. Hypertensive retinopathy and cardiovascular disease risk: 6 population-based cohorts Meta-analysis[J]. Int J Cardiol Cardiovasc Risk Prev, 2023, 17:200180. doi:10.1016/j.ijcrp.2023.200180.
[48]	OSTRIN L A, HARB E, NICKLA D L, et al. IMI-The dynamic choroid:new insights,challenges,and potential significance for human myopia[J]. Invest Ophthalmol Vis Sci, 2023, 64(6):4. doi:10.1167/iovs.64.6.4.
[49]	KHALILIPUR E, MAHDIZAD Z, MOLAZADEH N, et al. Microvascular and structural analysis of the retina and choroid in heart failure patients with reduced ejection fraction[J]. Sci Rep, 2023, 13(1):5467. doi:10.1038/s41598-023-32751-w.
[50]	WANG J, JIANG J, ZHANG Y, et al. Retinal and choroidal vascular changes in coronary heart disease: an optical coherence tomography angiography study[J]. Biomed Opt Express, 2019, 10(4):1532-1544. doi:10.1364/BOE.10.001532.
[51]	JOO Y S, RIM T H, KOH H B, et al. Non-invasive chronic kidney disease risk stratification tool derived from retina-based deep learning and clinical factors[J]. NPJ Digit Med, 2023, 6(1):114. doi:10.1038/s41746-023-00860-5.
[52]	RUDNICKA A R, WELIKALA R, BARMAN S, et al. Artificial intelligence-enabled retinal vasculometry for prediction of circulatory mortality, myocardial infarction and stroke[J]. Br J Ophthalmol, 2022, 106(12):1722-1729. doi:10.1136/bjo-2022-321842.

光学相干断层扫描血管成像技术在慢性肾脏病临床评估中的应用进展

Application of optical coherence tomography angiography in clinical evaluation of chronic kidney disease

引用本文

RichHTML

PDF (PC)

可视化

摘要/Abstract

使用本文

参考文献 52

相关文章 15

编辑推荐

Metrics

本文评价

[1]	张文延, 李祖贵, 贾永春, 江伟, 甄雨生, 许亮. 成人Still病活动度及复发风险与¹⁸F-FDG PET/CT代谢参数的相关性研究[J]. 天津医药, 2026, 54(3): 283-288.
[2]	陈丽, 陈楠. COPD进展为Ⅱ型呼吸衰竭预警模型的建立与验证[J]. 天津医药, 2026, 54(2): 189-195.
[3]	庄瑞玲, 杨杰, 陈艳欣, 张雲. 基于转录组与代谢组学联合分析谷氨酰胺合成酶在慢性髓系白血病耐药中的作用机制[J]. 天津医药, 2026, 54(1): 1-7.
[4]	马良, 胡立影, 石羽, 赵永安, 孙雅斯, 孙广东. 不同血压水平糖尿病肾病患者黄斑区视网膜厚度特征分析[J]. 天津医药, 2025, 53(9): 923-926.
[5]	于晓猛, 索睿, 杜昕桃, 索莹, 阿亚拉·阿斯哈尔, 郝天旭, 赵晓赟. 人脐带来源的间充质干细胞对慢性间歇低氧小鼠的影响[J]. 天津医药, 2025, 53(8): 814-819.
[6]	王海诚, 赵一涵, 谢妹伊, 赵宇明. ¹⁸F-PSMA-1007 PET/CT的SUVmax和SUVmean参数对前列腺癌诊断及病情进展的预测价值[J]. 天津医药, 2025, 53(6): 614-618.
[7]	刘鑫, 马宇, 路凯, 张桂成, 吴悦, 胡方梅, 崔友祥, 孙云川. CTP、CTA联合血清NSE对脑卒中偏瘫患者侧支循环状态及预后的评估价值[J]. 天津医药, 2025, 53(6): 629-633.
[8]	李婉婷, 刘弘扬, 桑婧, 阮育凤, 徐丽, 李冬梅. 老年下肢骨折患者术后发生急性心脑血管意外的影响因素分析[J]. 天津医药, 2025, 53(6): 648-653.
[9]	孙鲁生, 张丽芳, 高俊杰, 汤秀英. CT定量左心结构参数与肥厚型心肌病并心房颤动射频消融术后复发的关系[J]. 天津医药, 2025, 53(5): 533-536.
[10]	冯华, 王魁, 徐文俊, 李能, 张恒喜. 床旁超声造影联合气水交替注射法在重症鼻肠管留置患者中的应用效果[J]. 天津医药, 2025, 53(5): 542-546.
[11]	邓子昊, 黄欣扬, 钟坤江, 赵博. 纳米材料在动脉粥样硬化性心血管疾病中的应用进展[J]. 天津医药, 2025, 53(5): 556-560.
[12]	李小硕, 韩子旭, 李洋, 李梦宁. 椎体CT参数对TLIF术后早期融合器沉降的预测价值[J]. 天津医药, 2025, 53(3): 301-306.
[13]	张小庆, 赵慧霞, 曹鄂洪, 张连霞, 宫秀娟. PIV、HCAR、PCT/PLT在老年COPD肺部感染中的应用价值[J]. 天津医药, 2025, 53(2): 170-175.
[14]	黄叶妮, 董扬洲, 胡苗青, 李卫, 刘杨. 肾安汤对慢性肾功能不全患者免疫、肾功能及脂代谢的影响[J]. 天津医药, 2025, 53(12): 1309-1314.
[15]	徐淑光, 管淑红, 张云凤. 集束化管理在慢性阻塞性肺疾病急性加重期患者围出院期中的应用效果[J]. 天津医药, 2025, 53(11): 1170-1175.