特发性脱髓鞘性视神经炎视网膜神经纤维层厚度和黄斑厚度的变化特点  

Characteristics of retinal nerve fiber layer and macular thickness changes in idiopathic demyelinating optic neuritis

作　　者：张译心[1] 巩琰[1] 戴艳丽[1] 黄厚斌[1] 魏世辉[1] 

机构地区：[1]中国人民解放军总医院眼科,北京市100853

出　　处：《眼科新进展》2013年第2期139-142,146,共5页Recent Advances in Ophthalmology

基　　金："十二五"国家科技支撑计划项目(编号:2012BAI08B06)~~

摘　　要：目的分析特发性脱髓鞘性视神经炎(idiopathic demyelinating optic neuritis,IDON)患者视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度和黄斑厚度的变化特点。方法回顾性分析解放军总医院眼科2011年10月至2012年3月诊治的49例(64眼)IDON患者病例资料,按照患眼病程分为4组(第一组:病程≤1个月;第二组:1个月<病程≤3个月;第三组:3个月<病程≤6个月;第四组:病程>6个月),选取性别、年龄匹配的健康对照组32人(32眼)。统计分析平均(360°)和颞、上、鼻、下侧象限RNFL厚度以及黄斑容积平均厚度、ETDRS分区九个子区黄斑厚度的变化特点。结果第一组平均和颞、上、鼻、下侧象限RNFL厚度与对照组相比差异均无统计学意义(均为P>0.05)。第二组和第三组除鼻侧象限外,平均和颞、上、下侧象限RNFL均显著变薄(P=0.001、P=0.001、P=0.010、P=0.001;P=0.002、P<0.001、P=0.003、P=0.012)。第四组所有象限RNFL测量值均显著变薄(P<0.001、P<0.001、P=0.003、P<0.001、P<0.001)。各组中心子区黄斑厚度与对照组相比差异均无统计学意义(均为P>0.05)。第一组外子区鼻侧黄斑厚度显著增厚(P=0.015),其余测量值与对照组相比差异均无统计学意义(均为P>0.05)。第二、三、四组黄斑容积平均厚度及内子区颞、上、鼻、下侧和外子区颞、上、鼻、下侧黄斑厚度与对照组相比均显著变薄(均为P<0.05)。RNFL厚度和黄斑容积平均厚度与BCVA和视野MD值均无直线相关关系。结论 IDON患者RNFL厚度1个月内无显著水肿,2-3个月开始萎缩变薄,鼻侧象限RNFL萎缩速度最慢,程度最轻。IDON患者中心子区黄斑厚度不萎缩变薄,所有内子区和外子区黄斑厚度均在发病1个月后显著萎缩变薄。Objective To analyze the characteristics of retinal nerve fiber layer （ RNFL） and macular thickness changes in patients with idiopathic demyelinating optic neuritis （ IDON） .Methods Retrospective analyses of clinical data of IDON patients from October 2011 to March 2012 in PLA General Hospital was conducted.A total of 49 cases （ 64 eyes） were divided into 4 groups according to disease duration （ group 1： 0 - 1 months; group 2： 2 - 3 months; group 3： 4 - 6 months; group 4： longer than 6 months） .32 healthy subjects （ 32 eyes） with matched age and gender were selected as control group.The average （ 360° ） and temporal,superior,nasal and inferior quadrant RNFL thickness as well as cube average and nine ETDRS sub-area macular thickness were compared between each IDON group and control group.Results Compared with the control group,eyes in group 1 didn’t have significant changes in all the measurements of RNFL thickness（ all P 0.05） ; Eyes in group 2 and group 3 showed a significantly thinner RNFL in average,superior,inferior and temporal quadrants（ P = 0.001,P = 0.001,P = 0.010,P = 0.001; P = 0.002,P 0.001,P = 0.003,P = 0.012） ,except for the nasal quadrant; Eyes in group 4 showed a significantly thinner RNFL in all the measurements（ P 0.001,P 0.001,P = 0.003,P 0.001,P 0.001） .Compared with the control group,all the central sub-area macular thickness didn’t show significant changes （ all P 0.05） ; Eyes in group 1 only showed a significantly thicker macular thickness in the nasal side of lateral sub-area（ P = 0.015） .Eyes in group 2,3 and 4 showed a significantly thinner macular thickness in the cube average,all the medial and lateral sub-areas （ all P 0.05 ） .No linear correlation was present between RNFL thickness,cube average thickness and BCVA,MD value.Conclusion RNFL with IDON has no significant edema within one month,and then gradually become thinner within 2 - 3 months.The nasal quadrant RNFL shows the least and slowest atrophy.Central sub-area macular

关 键 词：特发性脱髓鞘性视神经炎 光学相干断层扫描 视网膜神经纤维层 黄斑厚度 

分 类 号：R779.63[医药卫生—眼科]