摘要
目的:总结原发性开角型青光眼(POAG)和高眼压症(OHT)患者24h眼压和饮水试验(WDT)的临床特点并分析其相关性。方法:收集2019-12/2022-03于深圳大学总医院眼科行24h眼压(每2h测量1次)和WDT(按1000mL饮水量,5min内饮完,之后1h内每15min测量1次)的POAG和OHT患者87例174眼,共分为三组:高眼压性开角型青光眼(HTG组)33例66眼,正常眼压性青光眼(NTG组)28例56眼,OHT组26例52眼。总结三组患者24h眼压和WDT临床特点,并对各组眼压峰值、波动值进行Spearman相关分析。结果:三组患者临床特点:(1)24h眼压HTG组、NTG组、OHT组眼压峰值比例:凌晨(2∶00~6∶00):40.9%、23.2%、26.9%;上午(8∶00~12∶00):34.8%、46.4%、55.8%;下午(14∶00~18∶00):18.2%、21.4%、11.5%;夜间(20∶00~24∶00):6.1%、8.9%、5.8%。各组谷值比例:凌晨:21.2%、25.0%、30.8%;上午:22.7%、10.7%、13.5%;下午:19.7%、17.9%、17.3%;夜间:36.4%、46.4%、38.5%。各组24h眼压波动<6mmHg的比例:9.1%、62.5%、17.3%;6~<8mmHg:24.2%、32.1%、40.4%;≥8mmHg:66.7%、5.4%、42.3%。(2)WDT:三组30min内可达到眼压高峰比例分别为81.8%、76.8%、80.8%。三组WDT眼压波动<6mmHg的比例:10.6%、78.6%、38.5%;6~<8mmHg:22.7%、16.1%、28.8%;≥8mmHg:66.7%、5.4%、32.7%。(3)三组WDT峰值高于24h眼压峰值的比例分别为:80.3%、80.4%、80.8%。相关性:三组24h眼压峰值与WDT峰值存在显著正相关(均P<0.01),HTG组和OHT组24h眼压波动值与WDT波动值存在正相关(P<0.01,P<0.05),NTG组二者眼压波动值无明显相关(P>0.05)。结论:仅在工作时间(08∶00~18∶00)监测眼压可能会遗漏峰值,低估眼压波动值,24h眼压波动值≥8mmHg中HTG组>OHT组>NTG组。超过75%患者WDT在30min内达峰值,大于80%患者WDT峰值高于24h眼压峰值。HTG和OHT患者24h眼压波动值与WDT波动值存在正相关性。WDT在评估患者眼压的波动有一定临床意义。
AIM:To summarize the clinical features of the 24h intraocular pressure data and the water drinking test(WDT)results in patients with primary open angle glaucoma(POAG)and ocular hypertension(OHT),and analyze the correlation.METHODS:To collect the data of 87 cases(174 eyes)with POAG and OHT,who had completed 24h intraocular pressure(IOP)(measured every 2h)and WDT(drink 1000mL water off within 5min and then measure every 15min within 1h)in the ophthalmology department of Shenzhen University General Hospital from December 2019 to March 2022.They were divided into three groups,with 33 cases(66 eyes)in high tension glaucoma(HTG)group,28 cases(56 eyes)in normal tension glaucoma(NTG)group and 26 cases(52 eyes)in OHT group.The clinical features of 24h IOP and WDT among the patients in three groups were summarized,and Spearman correlation was used to analyze the peak and fluctuation values of IOP.RESULTS:Clinical features among the patients in three groups:(1)the proportion of peak IOP of HTG,NTG and OHT group:(2∶00-6∶00 a.m.):40.9%,23.2%and 26.9%;(8∶00-12∶00 a.m.):34.8%,46.4%and 55.8%;(14∶00-18∶00 p.m.):18.2%,21.4%and 11.5%;(20∶00-24∶00 p.m.):6.1%,8.9%and 5.8%.Valley proportion among groups:early morning:21.2%,25.0%and 30.8%;morning:22.7%,10.7%and 13.5%;afternoon:19.7%,17.9%and 17.3%;evening:36.4%,46.4%and 38.5%.The proportion of 24h IOP fluctuation<6mmHg:9.1%,62.5%and 17.3%;6-<8mmHg:24.2%,32.1%and 40.4%;≥8mmHg:66.7%,5.4%and 42.3%.(2)WDT:The proportion of the three groups that could reach peak IOP within 30min was 81.8%,76.8%and 80.8%,respectively.The proportion of IOP fluctuations in the three groups<6mmHg:10.6%,78.6%and 38.5%;6-<8mmHg:22.7%,16.1%and 28.8%;≥8mmHg:66.7%,5.4%and 32.7%.(3)the proportions of WDT peak higher than 24h peak IOP in the three groups were 80.3%,80.4%and 80.8%.Correlation:the peak values of 24h IOP were positively correlated with the peak values of WDT(all P<0.01),the fluctuation of 24h IOP was positively correlated with the fluctuation of WDT in HTG and OHT group(P<0.01,P<0.05),while it showed no significant correlation in NTG group(P>0.05).CONCLUSION:Diurnal measurements of IOP during office hours(08∶00 a.m.-18∶00 p.m.)may fail to capture the peak values and underestimate IOP fluctuations.The 24h IOP fluctuation≥HTG group of 8mmHg>OHT group>NTG group.The peak WDT in over 75%patients could be achieved within 30min,and it was higher than 24h peak IOP of over 80%patients.There was a positive correlation between the 24h IOP fluctuations and the WDT fluctuations in HTG and OHT patients.Therefore,WDT has clinical significance in assessing fluctuations in patients’IOP.
作者
冯骅
张怡
韩银萍
程芸
黎婵玉
蔡莉
Hua Feng;Yi Zhang;Yin-Ping Han;Yun Cheng;Chan-Yu Li;Li Cai(Department of Ophthalmology,Shenzhen University General Hospital,Shenzhen 518055,Guangdong Province,China)
出处
《国际眼科杂志》
CAS
北大核心
2023年第2期278-282,共5页
International Eye Science
基金
深圳市科创委基础研究自由探索项目(No.JCYJ20180305124320418)
深圳市科创委国际科技合作项目(No.GJHZ20200731095005016)。
