垂体瘤患者神经眼科学检查分析72例  

Neuro-ophthalmic analysis in 72 cases of pituitary adenomas

作　　者：张蔚[1] 李惠玲[1] 李波[1] 张雪青[2] 韩彤[3] 

机构地区：[1]天津市环湖医院眼科,天津市300060 [2]天津市环湖医院电生理科,天津市300060 [3]天津市环湖医院影像科,天津市300060

出　　处：《眼科新进展》2013年第2期178-181,共4页Recent Advances in Ophthalmology

摘　　要：目的分析垂体瘤患者静态中心视野、视觉诱发电位及头磁共振成像(magnetic resonance imaging,MRI)检查结果的关系,探讨静态中心视野检查及视觉诱发电位检查在垂体瘤早期诊断及病情评估中的临床意义。方法选择2010年7月至2011年12月由我院神经外科确诊为垂体瘤的30～50岁患者72例(144眼),经头MRI强化检查显示瘤体均位于蝶鞍内或突破鞍隔向上生长。应用全自动视野分析仪24-2阈值程序进行静态中心视野检查,记录平均缺损(meandefect,MD)值,应用诱发电位仪进行图形翻转视觉诱发电位检查(pattern reserval visual evoked potential,PRVEP)。根据视野检查结果将患者分为4组:正常视野组9例;轻度缺损组13例(-5dB≤MD<0dB);中度缺损组38例(-15dB<MD<-5dB);重度缺损组12例(MD≤-15dB),采用单因素方差分析及q检验分析比较各组患者MRI正中矢状位、冠状位肿瘤的相对高度及PRVEPP100波潜伏期。结果患者视野异常以颞侧偏盲最多,此外可见不典型视野缺损。随着视野缺损程度的增加,MRI正中矢状位及冠状位肿瘤相对高度均增大(F=125.1,P<0.05;F=109.8,P<0.05),正常视野组为(0.9±0.3)cm/(0.7±0.2)cm,轻度缺损组为(1.1±0.4)cm/(0.8±0.2)cm,中度缺损组为(2.6±0.5)cm/(2.4±0.6)cm,重度缺损组为(3.9±0.4)cm/(3.8±0.4)cm。其中正常视野组与轻度缺损组比较,差异无统计学意义(q=1.49,P>0.05)。随着视野缺损程度的增加,PRVEPP100波潜伏期也呈逐渐延长趋势(F=23.5,P<0.05),正常视野组为(102.2±4.3)ms,轻度缺损组为(109.4±5.4)ms,中度缺损组为(114.5±4.8),至重度缺损组达(118.1±3.9)ms。根据MRI结果,垂体微腺瘤共11例,其中行静态中心视野检查异常率为27.3%,行PRVEP检查异常率达72.7%,差异具有统计学意义(χ2=4.55,P<0.05)。结论静态中心视野检查结果有助于垂体瘤的定性、定位诊断。视野缺损程度与垂体瘤所致视神经功能受损程度一致,且与头MRI所示瘤体大小相对应�Objective To analyze the correlation of central static visual field,pattern reserval visual evoked potential （ PRVEP ） and magnetic resonance imaging （MRI） findings with pituitary adenomas,and investigate the value of central static visual field and PRVEP in early diagnosis and pathogenetic condition evaluation for pituitary adenomas.Methods Retrospective nested case-control study.A total of 72 cases （ 144 eyes） with 30 - 50 years old of pituitary adenomas in our hospital from July 2010 to December 2011 were selected in the study.MRI showed that the tumors were all in Sella or grew upward out of Saddle compartment.All cases underwent static visual field perimetry using the central 24 - 2 threshold program.The values of mean defect were recorded.According to the findings of central static visual field,all cases were divided into four groups： normal visual field group （ 9 cases） ,mild defect group （ 13 cases） ,moderate defect group （ 38 cases） and severe defect group （ 12 cases） .ANOVA and q test were used for the relative heights of the tumor on the median sagittal and coronal MR images.They were also used for the P100 latency of PRVEP.Results Atypical visual field defected just like the typical temporal visual field.Though the median sagittal or coronal MR images were measured,the relative heights of tumors increased accompanied by the serious defecting in visual field（ F = 125.1,P 0.05; F = 109.8,P 0.05） ,the relative height of tumors were （ 0.9±0.3） cm / （ 0.7±0.2） cm in normal visual field group,（ 1.1±0.4） cm / （ 0.8±0.2 ） cm in mild defect group,（ 2.6±0.5） cm / （ 2.4±0.6） cm in moderate defect group,（ 3.9±0.4） cm / （ 3.8±0.4） cm in severe defect group.There was no significant difference between the normal visual field group and mild defect group（ q = 1.49,P 0.05） .The P100 latency became longer when the visual field became serious （ F = 20.19,P 0.05） ,which was （ 102.2±4.3） ms in normal visual field group,（ 109.4±5.4）

关 键 词：垂体瘤 视功能 静态中心视野 图形翻转视觉诱发电位 磁共振成像 

分 类 号：R135.12[医药卫生—劳动卫生]