Leber遗传性视神经病变视神经纤维层厚度及黄斑区神经节细胞复合体相关参数分析  

Measurement of retinal nerve fiber layer thickness and macular ganglion cell complex parameters in Leber hereditary optic neuropathy in patients

作　　者：邹文军[1] 田国红[2] 李梦玮 孙兴怀[2] 张洁[1] 武志峰[1] 

机构地区：[1]南京医科大学附属无锡第二医院眼科,214002 [2]复旦大学附属眼耳鼻喉科医院眼科卫生部近视眼研究重点实验室,上海200031

出　　处：《中华眼视光学与视觉科学杂志》2016年第8期473-477,共5页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的 观察Leber遗传性视神经病变（LHON）不同病变期患者的视网膜神经纤维层（RNFL）厚度和黄斑神经节细胞复合体（GCC）相关参数的变化特征。方法 回顾性病例对照研究。纳入经线粒体基因检测确诊的LHON患者32例（64眼），根据病变程度分为早期组18眼，进展期组22眼，晚期组24眼。选取眼部检查正常的健康志愿者60例（60眼）作为正常对照组。采用傅里叶频域光学相干断层扫描对所有受检者的视盘和黄斑区进行扫描，测量视盘平均、上方、下方、颞上、颞下、鼻上、鼻下、颞侧偏上、颞侧偏下、鼻侧偏上、鼻侧偏下象限的RNFL厚度等参数以及黄斑平均GCC、上方GCC、下方GCC厚度和局部丢失体积（FLV）、整体丢失体积（GLV）值。组间比较采用单因素方差分析。结果 LHON早期组颞上、颞侧偏上、颞侧偏下、颞下、鼻下、上方、下方及平均RNFL厚度较正常对照组厚（P〈0.05）；进展期组颞侧偏上、颞侧偏下、鼻侧偏下较正常对照组薄（P〈0.05）；晚期组各象限RNFL厚度分别较正常对照组、早期组、进展组明显薄（P〈0.05）。与正常对照组比较，LHON各期组平均GCC厚度、上方GCC厚度及下方GCC厚度均明显较薄（F=61.7、39.5、61.5，P〈0.01），FLV、GLV值均增大（F=29.6、40.8，P〈0.01）。结论 LHON发病早期，RNFL增厚，黄斑GCC明显变薄；病情进展期，颞侧和下方RNFL变薄，黄斑GCC进一步变薄；晚期各象限RNFL及黄斑GCC显著变薄。LHON发病存在慢性潜在性损害，且表现为急性发作的特征。Objective To evaluate the changes in retinal nerve fiber layer （RNFL） thickness and macular ganglion complex （GCC） parameters in patients with Leber hereditary optic neuropathy （LHON）. Methods This was a case-control study. Patients diagnosed with LHON were enrolled after the mitochondriaI DNA mutation test was shown to be positive （G11778A, G3460A, T14484C）. Thirty-two LHON patients （64 eyes） together with 60 normal volunteers were evaluated. Among them, 18, 22 and 24 eyes were found to be in the early, progressive, and late stages, respectively. The optic nerve head and macula of all patients were scanned by Fourier-domain optic coherence tomography （FD-OCT）. The following six parameters were measured, including RNFL, macular GCC, superior GCC, inferior GCC thickness, focal loss of volume （FLV） and global loss of volume （GLV）. Data were analyzed with one-way ANOVA and a Dunnettt-test when a pairwise comparison was needed. Results Early-stage patients had a thicker RNFL in the superior temporal （ST）, temporal upper （TU）, temporal lower （TL）, inferior temporal （IT）, inferior nasal （IN）, superior and inferior quadrants, as well as the 360° average compared to the normal controls （P〈0.05）. Progressive-stage patients had a thinner RNFL only in the TU, TL and NL quadrants （P〈0.05）. Late-stage patients had a thinner RNFL in each quadrant as well as the 360° average compared to normal controls and early-stage and advancing cases （P〈0.05）. For macular GCC parameters, three parameters were reduced in LHON patients （average GCC, superior and inferior GCC thickness） （F=61.7, 39.5, 61.5, P〈0.01） and there was an increase in two parameters （GLV and FLV） compared to the normal control group （F=29.6, 40.8, P〈0.01）. Conclusion RNFL thickness and macular GCC parameters in LHON patients show distinctive features at different disease stages as revealed by OCT parameters. These findings can improve the understanding of the pathogenic course

关 键 词：视神经萎缩 遗传性 Leber 视网膜神经节细胞 体层摄影术 光学相干 视网膜 神经纤维层 

分 类 号：R774[医药卫生—眼科]