摘要
目的比较急性期、慢性期非动脉炎性前部缺血性视神经病变(NAION)患者与具有小视杯结构的健康人相同解剖结构下视盘周围血流变化及其相关因素.方法病例对照研究.收集2017年2月至2018年9月就诊于北京协和医院眼科的NAION单眼发病患者及同期具有小视杯结构的健康志愿者.病程≤3个月的患者归为NAION急性期组,病程>3个月的患者归为NAION慢性期组,健康志愿者为对照组.所有受检者行最佳矫正视力、眼压、裂隙灯联合前置镜检查并测量眼轴长度,采用相干光层析成像术测量视网膜神经纤维层(RNFL)及视网膜神经节细胞复合体(GCC)厚度,采用相干光层析血管成像术测量视盘血管密度;NAION患者行视野检查.采用方差分析、非参数Mann-Whitney U检验及Spearman相关性分析进行统计学分析.结果 NAION急性期组患者16例,年龄(57±9)岁,男性6例,女性10例;NAION慢性期组患者17例,年龄(56±10)岁,男性7例,女性10例;对照组15名,年龄(57±10)岁,男性6名,女性9名;3组受检者年龄、性别差异无统计学意义(均P>0.05).NAION慢性期组患眼RNFL厚度为(78±38)μm、GCC厚度为(75±19)μm,均小于急性期组患眼[(191±99)μm及(98±28)μm,t=4.389、2.758,均P<0.05];NAION慢性期组患眼中位杯盘面积比为0.18(0.11,0.31)、杯盘垂直直径比为0.45(0.39,0.56),杯盘水平直径比为0.39(0.28,0.54),均大于急性期组患眼[0.05(0.01,0.18)、0.22(0.11,0.41)、0.20(0.07,0.42),U=212.000、208.000、205.000,均P<0.05],差异均有统计学意义.NAION急性期组患眼视盘血管密度为45%±7%,慢性期组患眼视盘血管密度为41%±8%,均低于对照组(53%±6%),差异均有统计学意义(t=3.705,4.940;均P<0.01);视盘周围除鼻侧下方NAION慢性期组患眼毛细血管密度(36%±8%)低于急性期组患眼(42%±7%,P=0.039)外,其余区域毛细血管密度慢性期组患眼与急性期组患眼差异均无统计学意义(均P>0.05).NAION急性期组8/16的患眼可见毛细血管曲折及相对位置的片状血流密度降低、视野缺损.相关性分析显示NAION患者视盘血管密度与最佳矫正视力、视野平均缺损值、杯盘面积比、GCC局部丢失容积及GCC总体丢失容积均呈负相关(r=-0.510、-0.733、-0.372、-0.532、-0.648,均P<0.01),与GCC、RNFL厚度均呈正相关(r=0.604、0.508,均P<0.01).结论 NAION急性期和慢性期视盘血管密度均有显著的减少,其中NAION慢性期鼻侧下方毛细血管密度较急性期显著减少.NAION视盘血管密度与视力、视野平均缺损值、视盘结构、RNFL和GCC厚度变化相关.
Objective To compare the blood flow around the optic disc and related factors in patients with acute and chronic non-arteritic anterior ischemic optic neuropathy (NAION) and healthy volunteers with small disc cups under the same anatomical structure. Methods This was a prospective case-control study. NAION patients with unilateral onset and healthy volunteers of the same phase were included in the study conducted at the Department of Ophthalmology of Peking Union Medical College Hospital between February 2017 and September 2018. Patients with a course of ≤ 3 months were categorized in the acute phase of NAION, and those with a course of >3 months were in the chronic phase of NAION. Healthy volunteers were in the control group. All subjects underwent the examination of best corrected visual acuity converted to logarithm of the minimum angle of resolution (LogMAR), measurement of non-contact intraocular pressure, slit lamp examination, small pupil fundus examination, and axial measurement. Optical coherence tomography was used to measure the thickness of retinal nerve fiber layers (RNFL) and retinal ganglion cell complex (GCC). Optical coherence tomography angiography was used to measure the vessel density around the optic disc. NAION patients underwent the visual field examination. Analysis of variance, non-parametric Mann-Whitney U test and Spearman coefficient was used for statistical analysis. Results This study included 16 patients with acute phase of NAION, aged (57±9) years, 6 males and 10 females. There were 17 patients with chronic disease, aged (56 ± 10) years, 7 males and 10 females. There were 15 healthy controls, aged (57±10) years old, 6 males and 9 females. There were no significant differences in age and gender between the groups (both P>0.05). The RNFL and the GCC in the NAION chronic phase group were significantly thinner than those in the acute phase group [(78±38)μm vs.(191±99)μm,(75± 19)μm vs.(98±28)μm;t=4.389, 2.758;both P<0.05]. The cup/disc area ratio, cup/disc vertical diameter ratio and cup/disc horizontal diameter ratio in the chronic phase group were larger than those in the acute phase group [0.18 (0.11, 0.31) vs. 0.05 (0.01, 0.18), 0.45 (0.39, 0.56) vs. 0.22 (0.11, 0.41), 0.39 (0.28, 0.54) vs. 0.20 (0.07, 0.42)], and the difference was statistically significant (U=212.000, 208.000, 205.000;all P<0.05). Compared with the optic disc vessel density in the control group (53%±6%), there was a significant decrease in the acute phase group and the chronic phase group (45%±7%, 41%±8%;t=3.705, 4.940;both P<0.01). The blood vessel density in the nasal inferior of the chronic phase group was significantly lower than that in the acute phase group (36%±8% vs. 42%±7%, P=0.039), other sections didn't have significant difference (all P>0.05). There were tortuous capillaries in 8/16 of the acute phase cases, with a low blood flow density and visual field defect in relative positions. Correlation analysis showed that the whole density and peripapillary density in the NAION patients were negatively correlated with LogMAR, mean visual field defect, cup / disc area ratio, focal loss of volume of GCC and general loss of volume of GCC (r=- 0.510,-0.733,-0.372,-0.532,-0.648;all P<0.01), but positively correlated with GCC and RNFL thickness (r=0.604, 0.508;both P<0.01). Conclusions The optic disc vessel density in the acute phase and chronic phase of NAION is significantly reduced. The vessel density in the nasal area of the chronic phase is significantly reduced compared with the acute phase. The vessel density is correlated with visual acuity, visual field defect, disc indexes, thickness of RNFL and GCC.
作者
汪宇涵
马瑾
干霖洋
张夏
王旭倩
丑玉宇
王雪娇
孙子系
陶枳言
钟勇
Wang Yuhan;Ma Jin;Gan Linyang;Zhang Xia;Wang Xuqian;Chou Yuyu;Wang Xuejiao;Sun Zixi;Tao Zhiyan;Zhong Yong(Department of Ophthalmology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2019年第9期677-686,共10页
Chinese Journal of Ophthalmology
