摘要
目的分析HELLP综合征患者发生渗出性视网膜脱离的危险因素,并观察其光相干断层扫描(OCT)特征。方法回顾性临床研究。2015年1月至2021年3月于天津市第三中心医院住院治疗的HELLP综合征患者84例168只眼纳入研究。患者平均年龄(30.96±4.09)岁。收集患者一般临床资料,包括年龄、分娩孕周、HELLP综合征分型和发病时间、胎次、怀孕次数、收缩压和舒张压、糖皮质激素(以下简称为激素)总使用量及使用时间、是否入住重症监护病房;实验室指标,包括血小板计数及血清白蛋白、血清尿酸、24 h尿蛋白、天门冬氨酸氨基转移酶、乳酸脱氢酶、总胆红素(TBIL)水平。全身情况允许者行OCT检查;全身情况不允许但有视力下降主诉或直接检眼镜检查可疑视网膜脱离者,行B型超声检查辅助诊断。根据有无渗出性视网膜脱离将患者分为视网膜脱离组(网脱组)和非视网膜脱离组(非网脱组),分别为31(36.90%,31/84)、53(63.10%,53/84)例。网脱组31例患者中,行OCT检查17例34只眼。组间正态分布的计量资料比较行两独立样本t检验,偏态分布者比较行Wilcoxon秩和检验;计数资料比较行χ^(2)检验。筛选单因素分析有统计学差异的变量为自变量,行二元logistic回归分析。结果84例患者中,HELLP综合征分型为部分型、完全型分别为41(48.81%,41/84)、43(51.19%,43/84)例。与非网脱组比较,网脱组患者分娩孕周短(t=2.51),舒张压更高(t=-2.61),激素总使用量更大(Z=-2.14)、使用时间更长(Z=-2.75),差异有统计学意义(P<0.05);TBIL(Z=-2.49)、血清白蛋白水平降低(t=2.06),24 h尿蛋白定量水平升高(Z=-4.35),差异有统计学意义(P<0.05)。Logistic回归分析结果显示,24 h尿蛋白定量水平升高增加渗出性视网膜脱离发生风险(P<0.05)(比值比=1.20,95%可信区间1.06~1.37)。行OCT检查的34只眼中,表现为视网膜色素上皮(RPE)层不光滑、增厚、与脱离的视网膜似有粘连者18只眼。视网膜脱离复位后,RPE上述改变仍然存在,但有所缩小;椭圆体带仍有不连续、局部断裂、甚至广泛缺失16只眼。结论24 h尿蛋白定量水平升高是HELLP综合征渗出性视网膜脱离发生的危险因素;部分患者渗出性视网膜脱离复位后椭圆体带仍有缺失。
Objective To observe and analyze the risk factors and optical coherence tomography(OCT)characteristics of exudative retinal detachment in patients with HELLP syndrome.Methods A retrospective clinical study.From January 2015 to March 2021,168 eyes of 84 patients with HELLP syndrome who were hospitalized in The Third Central Hospital of Tianjin were included in the study.The average age of the patients was 30.96±4.09 years old.The patient’s general clinical data which included age,gestational week of delivery,type of HELLP syndrome,onset time of HELLP syndrome,parity,number of pregnancy,systolic and diastolic blood pressure,total amount and duration of glucocorticoid,whether been admitted to intensive care unit;laboratory indicators,which included platelet count,serum albumin,serum uric acid,24-hour urine protein quantification,aspartate aminotransferase,lactate dehydrogenase,total bilirubin(TBIL)were collected.Whose the general condition was not allowed,however patients had a complaint of vision loss or suspected retinal detachment under direct ophthalmoscope examination,B-mode ultrasound was used to assist in the diagnosis.According to the presence or absence of exudative retinal detachment,patients were divided into retinal detachment group(net detachment group)and non-retinal detachment group(non-retinal detachment group),respectively 31(36.90%,31/84),53(63.10%,53/84)cases.Among the 31 cases in the network disconnection group,34 eyes in 17 cases underwent OCT.Two independent sample t tests were used to compare the measurement data of normal distribution between groups,Wilcoxon rank sum test was used to compare skewed distributions;theχ^(2) test was used to compare count data.The variables with statistical differences in univariate analysis were selected as independent variables,and binary logistic regression analysis was performed.Results Among 84 patients,HELLP syndrome was classified into partial type and complete type,41(48.81%,41/84)and 43(51.19%,43/84)cases,respectively.Compared with the non-net-off group,the patients in the off-line group had shorter gestational weeks(t=2.51),higher diastolic blood pressure(t=-2.61),greater total glucocorticoid use(Z=-2.14),and longer use time of glucocorticoid(Z=-2.75),the difference were statistically significant(P<0.05);TBIL(Z=-2.49),serum albumin(t=2.06)levels decreased,and 24-hour urine protein quantitative(Z=-4.35)levels increased,the difference were statistically significant(P<0.05).Logistic regression analysis showed that the increase of 24-hour urine protein level increased the risk of exudative retinal detachment(P<0.05)(odds ratio=1.20,95%confidence interval 1.06-1.37).Among the 34 eyes that underwent OCT examination,18 eyes showed that the retinal pigment epithelium(RPE)layer was not smooth,thickened,and seemed to have adhesion to the detached retina.After the reattachment of retinal detachment,the abovementioned changes of RPE still existed,but reduced;the ellipsoid zone still has discontinuity,partial rupture,and even extensive loss in 16 eyes.Conclusion The quantitative increase of 24-hour urine protein is a risk factor for the occurrence of exudative retinal detachment in HELLP syndrome;some patients with exudative retinal detachment are still missing the ellipsoid zone after reattachment.
作者
徐文君
魏丹
安喜艳
谈宗雯
高军
苏九妹
Xu Wenjun;Wei Dan;An Xiyan;Tan Zongwen;Gao Jun;Su Jiumei(Department of Ophthalmology,The Third Central Hospital of Tianjin,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases,Artificial Cell Engineering Technology Research Center,Tianjin Institute of Hepatobiliary Disease,Tianjin 300170,China)
出处
《中华眼底病杂志》
CAS
CSCD
北大核心
2021年第12期942-948,共7页
Chinese Journal of Ocular Fundus Diseases
