前部缺血性视神经病变的危险因素及诊断分析  

Analysis of risk factors and diagnosis of anterior ischemic optic neuropathy

作　　者：关倩[1] 王春芳[2] 岳雪梅[2] 

机构地区：[1]山西医科大学 [2]山西医科大学第一医院眼科,太原030001

出　　处：《中华临床医师杂志（电子版）》2015年第17期61-65,共5页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的：探讨非动脉炎性前部缺血性视神经病变（NAION）的危险因素及诊断。方法收集2014年1月至2015年6月在山西医科大学第一医院眼科诊断为NAION的患者42例（44眼）行眼底荧光素血管造影（FFA）、视野、图形视觉诱发电位（VEP）、颈动脉多普勒超声检查及血压、血糖、血脂等检测，设对照组30例，年龄范围42～71岁，平均（55.43＆#177;8.03）岁。结果NAION组与对照组比较，年龄、颈动脉病变、高血压病及高脂血症差异均有统计学意义（P＜0.05）；糖尿病、性别及吸烟差异均无统计学意义（P＞0.05）。FFA早期44患眼视盘均呈部分荧光充盈延迟或缺损，晚期表现多样；视野检查37眼（84.09%）表现为与生理盲点相连的象限或扇形缺损；VEP检查P100波振幅异常的比例（92.50%）明显高于潜伏期异常的比例（67.50%），NAION患眼组与健眼组及对照组比较，P100波潜伏期延长及振幅降低（P＜0.05），而健眼组与对照组比较P100波潜伏期也有延长（P＜0.05）；颈动脉超声异常率（61.09%）较高，NAION患眼组与对照组比较，颈总动脉内膜中层厚度（IMT）增加，颈内动脉收缩期峰值血流速度（PSV）及舒张末期血流速度（EDV）降低（P＜0.05），阻力指数（RI）值升高（P＜0.05），患眼组与健眼组颈动脉各测量值无统计学差异（P＞0.05）。结论NAION的发生与多种因素有关，尤其与颈动脉病变、高血压病、高脂血症明显相关。FFA和视野对NAION有较高的诊断价值，但表现复杂；颈动脉彩超及VEP也具有明显异常，可为临床早期诊断及提前干预提供新的方向。ObjectiveTo investigate the risk factors and diagnosis of nonarteritic anterior ischemic optic neuropathy.MethodsFor patients with NAION who presented to First Hospital of Shanxi Medical University between 2014 and 2015, FFA, visual field, VEP and colour Doppler ultrasonography examination, blood pressure, blood glucose and blood lipid examination were possible on 44 eyes of 42 patients, 30 patients were enrolled as control. Age of patients ranged from 42 to 71 years, mean（55.43±8.03） years.ResultsIn the NAION group compared with the control group, carotid artery diseases, age, hypertension, hyperlipidemia, the differences were statistically significant （P〈0.05）; there was no significant difference in gender, diabetes and smoking （P〉0.05）. In early FFA, all of 44 eyes showed fluorescence filling of the optic disc were delayed or defect, while advanced performances were different; In the examination of visual field 37 eyes （84.09%） were connected with the physiological blind spot scotoma; In VEP abnormal amplitude ratio （92.50%） of P100 was significantly higher than that of the incubation period （67.50%）, NAION patients group compared with healthy eyes group and control group, incubation period of P100 was prolonged and the amplitude decreased （P〈0.05）, the healthy eyes group＆amp;nbsp;compared with the control group, the incubation period of P100was extended （P〈0.05）; carotid artery color Doppler ultrasound abnormality rate （61.09%） was higher, the NAION group compared with the control group, IMT increased, the internal carotid artery peak systolic velocity （PSV） and end diastolic velocity （EDV） decreased （P〈0.05）, but resistance index （RI） value was increased （P〈0.05）, while healthy eyes group and the NAION group had no statistical difference （P〉0.05）.ConclusionNAION is related to multiple factors, especially associated with carotid artery disease, hypertension and hyperlipidemia. FFA and visual field have high value in the diagnosis of

关 键 词：视神经病变 缺血性 危险因素 诊断 荧光素血管造影术 视野 诱发电位 视觉 颈动脉超声 

分 类 号：R774.6[医药卫生—眼科]