全身疾病致非动脉炎性前部缺血性视神经病变42例临床研究  

Clinical study of 42 cases of non-arteritic anterior ischemic optic neuropathy caused by systemic disease

作　　者：武炳慧[1] 陆慧琴[1] 吴惠琴[1] Wu Binghui;Lu Huiqin;Wu Huiqin(Xi＇an No.1 Hospital,Xi＇an Eye Hospital（Xi＇an 710001)

机构地区：[1]西安市第一医院西安市眼科医院,西安710001

出　　处：《陕西医学杂志》2018年第7期830-832,共3页Shaanxi Medical Journal

基　　金：陕西省科技厅社会发展科技攻关项目(2015SF081)

摘　　要：目的:分析非动脉炎性前部缺血性视神经病变(NAION)患者颈部血管彩超、经颅超声多普勒检查(TCD)、头颅磁共振成像(MRI)和磁共振血管成像(MRA)的特征。方法:总结分析明确诊断为NAION的42例患者颈部血管彩超、TCD、头颅MRI和MRA检查。既往体健14例(其中6例住院期间确诊高血压);高血压合并糖尿病3例;仅有糖尿病2例(其中1例住院期间诊断合并有高血压);仅有高血压22例;甲亢伴雷诺综合征1例。对患者进行颈部血管彩超、TCD、头颅MRI和MRA检查并进行总结。结果:42例患者的颈部血管彩超示颈动脉硬化34例,合并有斑块形成18例;动脉内膜毛糙2例;未见明显异常6例。TCD示未见明显异常16例,血管流速减慢26例。头颅MRI平扫示未见明显异常10例;双侧基底节区大脑白质多发腔梗18例,伴脱髓鞘改变12例;脑白质多发腔梗伴脱髓鞘5例;脑白质脱髓鞘5例;脑白质多发腔梗3例;T2WI和T2Flair双侧枕叶高信号,考虑髓鞘形成变异1例。MRA示单侧椎动脉纤细4例;大脑中动脉纤细2例;未见明显异常36例。结论:NAION患者常常合并高血压及动脉硬化等全身疾病,眼部症状为其全身疾病的预防敲响警钟,对此类患者应进行详细的相关检查,结合内科降脂固斑治疗,可以有效预防再发生。Objective：To analyze the distinction of carotid duplex ultrasound,transcranial color duplex sonography（TCD）,magnetic sonance maging（MRI）and magnetic resonance angiography（MRA）of head on non-arteritic anterior ischemic optic neuropathy（NAION）patients.Methods：This study recruited 42 subjects.All subjects accepted these checks including carotid duplex ultrasound,TCD,head MRI and MRA.14 patients were healthy before attracked by NAION（6 cases were diagnosised of hypertension during hositalization）,High blood pressure and diabetes mellitus were 3 cases,Only 2 cases of diabetes only（including 1 case diagnosed with high blood pressure in hospital）,22 cases of hypertension,Hyperthyroidism with Renault syndrome was 1 case.These above inspections were completed and summarized.Results：Carotid duplex ultrasound of 42 patients show that 34 cases of carotid artery sclerosis,18 cases with plaque formatio;Arterial intima coarse in 2 cases,No obvious abnormal 6 cases.TCD shows no obvious abnormality in 16 cases,slows down of blood vessels was 26 cases.10 cases were no obvious abnormal in Head MRI scan;Bilateral basal ganglia region of the brain white matter multiple cavity in18 patients,12 cases with demyelinating changes;Multiple cavity terrier with demyelinating brain white matter in 5 cases;Cerebral white matter demyelination in 5 cases;Cerebral white matter multiple cavity 3 cases;T2 WI and T2 Flair bilateral occipital high signal,considered myelination variation in 1 case.Unilateral vertebral artery slender can be seen in 4 cases of head MRA;Slim middle cerebral artery in 2 cases;No obvious abnormal 36 cases.Conclusion：Nalon patients often complicating hypertension and atherosclerosis and other systemic diseases,eye symptoms should be considered as the warning alarm of whole body disease,such patients should carry on the detailed inspections,combined with the treatment of related diseases,can effectively prevent the onset again.

关 键 词：视神经病变 缺血性 超声检查 多普勒 彩色 磁共振成像 

分 类 号：R744.6[医药卫生—神经病学与精神病学]