相干光断层扫描评价多发性硬化患者视神经损伤程度的研究  

Clinical investigation of optic coherence tomography in evaluating the impairment of optic nerve secondary to multiple sclerosis

作　　者：黄剑锋[1] 戴虹[1] 张华[1] 王笑雄[1] 陈彤[1] 

机构地区：[1]卫生部北京医院眼科,100730

出　　处：《中华眼科杂志》2014年第12期900-905,共6页Chinese Journal of Ophthalmology

摘　　要：目的 利用OCT评价不同类型多发性硬化（MS）患者视神经损伤的程度.方法 横断面研究.符合2010 Mcdonald诊断标准的MS患者30例（52只眼）.其中MS患者根据有无视神经炎发作分为3个亚组：MS视神经炎组（MS-ON组）共22例（22只眼）,MS非视神经炎组（MS-NON组）共8例（16只眼）,MS视神经炎患眼的对侧眼（MS-ON Contra组）共14例（14只眼）.另外,性别、年龄匹配的健康对照组13例（13只眼）.应用傅立叶域OCT进行检查,检查程序包括黄斑部扫描,视网膜神经纤维层（RNFL）厚度,神经节细胞复合体（GCC）加视神经盘扫描,同时比较各组间视力、视野表现.主要测量指标为RNFL厚度及GCC厚度.采用单因素方差分析统计学方法比较4组各测量指标总体差异,采用LSD法完成两两组间比较.结果 MS-ON组的平均GCC、上方GCC和下方GCC分别为（80.65±16.03）、（81.50±14.56）、（79.83±17.65）μm,与MS-NON组[（99.65 ±9.35）、（99.26 ±9.73）、（100.06 ±9.31） μm],MS-ON Contra组[（99.36±8.25）、（100.39±8.97）、（98.34±7.88）μm]及健康对照组[（104.87 ±8.71） 、（105.36 ±8.21）、（103.96±10.33） μm]对比均明显变薄（P均＜0.05）,而其他3组之间GCC厚度无明显差异.MS-ON组的平均RNFL厚度为（83.68±29.91）tμm,与MS-NON组[（108.83±15.33） μm]及健康对照组[（111.60±14.90） μm]相比明显变薄（P＜0.05）,MS-ON组鼻下RNFL厚度（92.26±35.97） μm,与MS-NON[（120.85±35.96） μm]及健康对照组[（139.95±7.77） μm]相比明显变薄（P均＜0.05）,颞下[（109.63 ±44.54） μm]及颞侧[（60.47±26.94） μm] RNFL厚度较MS-NON组[（149.92±18.51）、（90.64±16.15） μm]及MS-ONContra组[（135.70 ±28.66）、（77.30±23.40） μm]和健康对照组[（172.72±15.29）、（90.90±6.15） μm]明显变薄（P均＜0.05）,且MS-ON Contra组鼻下、颞下及颞侧RNFL厚度[（106.60±44.07）、（135.70±28.66）、（77.30±23.40） μm],�Objective To evaluate the impairment of optic nerve of different types of multiple sclerosis （MS） by optic coherence tomography （OCT）.Methods Cross-sectional study.52 eyes of 30 patients who diagnosed as MS up to the 2010 Mcdonald criteria were included.13 eyes of 13 healthy people matched with sex and age were set as the control group.Patients with MS were divided into 3 subgroups based on the history of optic neuritis （ON）：22 eyes of MS patients with the history of ON were in MS-ON group,16 eyes of MS patients without ON were in MS-NON group and 14 contralateral eyes of MS-ON patients were in MS-ON Contra group.Fourier domain OCT was used to examine.The protocol included macula scanning,retinal nerve fiber layer （RNFL） analysis and ganglion cell complex （GCC） and optic nerve head （ONH） scanning.Visual acuity （VA） and visual field （VF） were also compared.The major measurements were RNFL and GCC thickness.ANOVA was used to compare the overall difference of RNFL and GCC thickness among all the groups.LSD method was used to compare the difference between every two groups.Results The thickness of average GCC,superior GCC and inferior GCC of MS-ON group is （80.65 ± 16.03） μm,（81.50 ± 14.56） μm,（79.83 ± 17.65） μm.Compared with the MS-NON group which is（99.65 ± 9.35） μm,（99.26 ± 9.73） μm,（100.06 ± 9.31） μm correspondingly,MS-ON contra group （99.36 ± 8.25） μm,（100.39 ± 8.97） μm,（98.34 ± 7.88） μm correspondingly and the control group （104.87 ± 8.71） μm,（105.36 ± 8.21） μm,（103.96 ± 10.33） μm correspondingly,they decreased significantly （P 〈 O.05）.While the GCC thickness has no significantly difference among the MS-NON,MSON Contra and the control group.The average RNFL thickness and nasal inferior quadrant RNFL thickness in MS-ON group was （83.68 ±29.91） μm,（92.26 ±35.97） μm.And they were significantly thinner than that in the MS-NON group which was （108.83 ± 15.33） μm,（120.85 ± 35.96） μm

关 键 词：多发性硬化 体层摄影术 光学相干 视神经炎 视网膜神经节细胞 神经纤维 

分 类 号：R774.6[医药卫生—眼科] R744.51[医药卫生—临床医学]