目的：利用光学相干断层扫描血管成像(OCTA)评估妊娠期高血压和子痫前期患者视网膜表层黄斑区和视乳头区微血管的变化。

方法：回顾性研究。收集2020-09/2021-01就诊于山西医科大学第一医院产科的妊娠期高血压和子痫前期患者25例，其中妊娠期高血压10例、轻度子痫前期9例、重度子痫前期6例； 另收集同期就诊于我院的健康孕妇25例、健康未孕女性25例。应用OCTA测量视网膜黄斑区和视乳头区血管密度(VD)、灌注密度(PD)。分析比较各组受检者右眼视网膜微血管各参数的变化。

结果：妊娠期高血压和子痫前期患者黄斑区中心VD、内环VD、中心PD、内环PD均低于健康孕妇和健康未孕女性(均P<0.05)。妊娠期高血压和子痫前期患者视乳头内环PD低于健康孕妇和健康未孕女性(均P<0.05)。妊娠期高血压患者、轻度子痫前期患者、重度子痫前期患者黄斑区和视乳头VD、PD比较均无差异(均P>0.05)。健康孕妇和健康未孕女性黄斑区和视乳头VD、PD比较均无差异(均P>0.05)。

结论：OCTA可较好地显示妊娠期高血压和子痫前期患者视网膜表层微血管的变化，并在未出现明显视网膜病变前已经观察到妊娠期高血压和子痫前期患者黄斑区和视乳头VD、PD下降，OCTA可能对早期识别妊娠期高血压和子痫前期患者微血管变化提供一定帮助。

METHODS: Retrospective study. A total of 25 pregnant females diagnosed with gestational hypertension and preeclampsia in first hospital of Shanxi medical University between September 2020 and January 2021 were included in this study. The patients consisted of 10 cases with gestational hypertension, 9 cases with mild preeclampsia, and 6 cases with severe preeclampsia. Furthermore, a sample of 25 healthy pregnant females and 25 healthy non-pregnant females from our hospital during the same term was collected. OCTA was utilized to quantify the vascular density(VD)and perfusion density(PD)of the macular and optic nerve head in superficial retina. The changes of retinal microvascular parameters in the right eyes were analyzed and compared in each group.

RESULTS: Central VD, inner VD, central PD and inner PD of the macula were significantly lower in patients with gestational hypertension and preeclampsia compared to both healthy pregnant female and healthy non-pregnant female(all P<0.05). Inner PD of optic nerve head were significantly reduced in individuals with gestational hypertension and preeclampsia compared with healthy pregnant female and non-pregnant females(all P<0.05). There were no significant differences in VD and PD of the macula and optic nerve head among patients with gestational hypertension, mild preeclampsia and severe preeclampsia(all P>0.05). There were no significant differences in VD and PD of the macula and optic nerve head between healthy pregnant female and healthy non-pregnant female(all P>0.05).

CONCLUSION: OCTA is more effective in visualizing the alterations in superficial retinal microvasculature in patients with gestational hypertension and preeclampsia. It has been observed that there is a reduction in VD and PD in the macula and optic nerve head even before the development of noticeable retinopathy in patients with gestational hypertension and preeclampsia. OCTA can aid in the early detection of microvascular alterations in individuals with gestational hypertension and preeclampsia.