摘要
目的研究原发性开角型青光眼(primary open angle glaucoma,POAG)患者的甲皱襞微循环情况。设计前瞻性比较性病例系列。研究对象POAG患者51例包括高眼压性青光眼(high tension glaucoma,HTG)34例、正常眼压性青光眼(normal tension glaucoma,NTG)17例;正常受试者70例(对照组)。方法用甲皱襞微循环检测仪(JH-1004显微镜)对受试者非主导手无名指行甲皱襞微循环检测。观察甲皱襞毛细血管出血情况,测量毛细血管密度、无血管区间距(两毛细血管近端平行距离),毛细血管动脉支及静脉支管径(管径最宽距离),计算无血管区>200μm、毛细血管扩张(动脉支管径>15μm或静脉支管径>20μm)存在的例数及评分。以血管扩张为例,0处、1处、2处、≥3处血管扩张分别评分为0、1、2、3。主要指标甲皱襞毛细血管密度,无血管区>200μm、毛细血管出血、毛细血管扩张存在例数及评分。结果 HTG组、NTG组和对照组甲皱襞毛细血管密度的中位数(四分位数间距)分别为9(9,10)、10(9,10)和10(9,10)(χ~2=4.123,P=0.127);出现无血管区>200μm者分别为20例(58.8%)、8例(47.1%)和27例(38.6%)(χ~2=3.894,P=0.143);出现毛细血管出血者分别为15例(44.1%)、6例(35.3%)和18例(25.7%)(χ~2=3.633,P=0.163);出现毛细血管扩张者分别为18例(52.9%)、7例(41.2%)和21例(30.0%)(χ~2=5.195,P=0.074),其中POAG组与对照组相比,χ~2=4.492,P=0.034。HTG组、NTG组和对照组无血管区评分的中位数(四分位数间距)分别为1(0,1.25)、0(0,1)和0(0,1)(χ~2=3.842,P=0.146);毛细血管出血评分的中位数(四分位数间距)分别为0(0,1)、0(0,1)和0(0,1)(χ~2=3.156,P=0.206);毛细血管扩张评分的中位数(四分位数间距)分别为1(0,2)、0(0,1)和0(0,1)(χ~2=8.125,P=0.017)。进一步行两组间比较,其中HTG组与对照组相比,差异存在统计学意义(Z=-2.904,P=0.004)。结论 POAG患者出现甲皱襞毛细血管异常扩张的情况较正常人明显增多,并且HTG患者出现甲皱襞毛细血管扩张的严重程度较正常人更重,提示POAG的发生可能和微循环异常相关;本研究显示的HTG和NTG患者甲皱襞微循环异常情况尚无显著差异,可能与NTG患者的样本量较少及甲皱襞微循环的检测指标局限有关。
Objective To investigate abnormalities of nailfold microcirculation in patients with primary open angle glaucoma(POAG). Design Prospective comparative case series. Participants 51 patients with POAG(POAG group) including 34 patients with high tension glaucoma(HTG group) and 17 patients with normal tension glaucoma(NTG group) diagnosed in Beijing Tongren Hopistal and 70 normal healthy subjects(control group). Methods Nailfold capillaroscope(JH-1004 microscope) was used to examine the fourth digit of nondominant hand of each subject. The hemorrhages of nail fold capillaries were observed. Capillary density, avascular zone(distance in proximal area of two capillaries), arterial limb diameter and venous limb diameter of capillaries(the widest diameter of limb) were measured. Case number and score of avascular zones>200 μm, capillary hemorrhages, dilated capillaries(a capillary with arterial limb wider than 15 μm or with venous limb wider than 20 μm) were analyzed. We coded nailfold microcirculation into 4 categories according to the severity respectively.(e.g., 0 for no dilated capillary, 1 for 1 dilated capillary category, 2 for 2 dilated capillary categories, 3 for 3 or more dilated capillary categories). Main Outcome Measures Nailfold capillary density, number of cases of avascular zones > 200 μm, hemorrhages, dilated capillaries and severity score of abnormal conditions. Results The capillary density of HTG group, NTG group and control group were 9(9,10),10(9,10) and 10(9,10)( X^2=4.123, P=0.127). The subjects with avascular zones in HTG group, NTG group and control group were 20(58.8%), 8(47.1%) and 27(38.6%)(χ^2=3.894, P=0.143). The subjects with hemorrhages in HTG group, NTG group and control group were 15(44.1%), 6(35.3%) and 18(25.7%)(χ^2=3.633, P=0.163). The subjects with dilated capillaries in HTG group, NTG group and control group were 18(52.9%),7(41.2%)and 21(30.0%)(χ^2=5.195, P=0.074). The difference between POAG and control group was significant(χ^2=4.492, P=0.034). The severity score of avascular zones in HTG group,NTG group and control group were 1(0,1.25), 0(0,1) and 0(0,1)(χ^2=3.842, P=0.146). The severity score of hemorrhages in HTG group,NTG group and control group were 0(0,1), 0(0,1) and 0(0,1)(χ^2=3.156, P=0.206). The severity score of dilated capillaries in HTG group,NTG group and control group were 1(0,2), 0(0,1) and 0(0,1)(χ^2=8.125, P=0.017). There is significant difference between HTG and control group(Z=-2.904, P=0.004). Conclusion The dilated capillaries in nailfold capillaroscopy are more frequent in POAG patients with the higher severity of dilated capillaries in HTG, which implied that microcirculation abnormalities may play a role in the pathogenesis of POAG. There is no significant difference of nailfold microcirculation between HTG and NTG. The reasons may involve the limited sample size and indicators about nailfold microcirculation.
作者
田佳鑫
李猛
辛晨
谢媛
石砚
桑景荭
王怀洲
王宁利
TIAN Jia-xin;LI Meng;XIN Chen;XIE Yuan;SHI Yah;SANG Jing-hong;WANG Huai-zhou;WANG Ning-li(Beijing Tongren Eye Center,Beijing Institute of Ophthalmology,Beijing Tongren Hospital,Capital Medical University,Beijing Key Laboratory of Ophthalmology and Visual Sciences,Beijing 100730,China)
出处
《眼科》
CAS
2019年第1期17-23,共7页
Ophthalmology in China
