垂体无功能腺瘤视交叉受压患者视网膜神经节细胞层改变与视野缺损的相关性研究  

The correlation of ganglion cell layer thickness with visual field defect in non-functional pituitary adenoma with chiasm compression

作　　者：张夏 马瑾[1] 汪宇涵[1] 干霖洋 李略[1] 王旭倩[1] 李东辉[1] 幸兵[2] 冯铭[2] 朱慧娟[3] 卢琳[3] 冯逢[4] 有慧[4] 张竹花[4] 钟勇[1] Zhang Xia;Ma Jin;Wang Yuhan;Gan Linyang;Li Lue;Wang Xuqian;Li Donghui;Xing Bing;Feng Ming;Zhu Huijuan;Lu Lin;Feng Feng;You Hui;Zhang Zhuhua;Zhong Yong(Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China;Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China;Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China;Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院眼科,100730 [2]中国医学科学院北京协和医学院北京协和医院神经外科,100730 [3]中国医学科学院北京协和医学院北京协和医院内分泌科,100730 [4]中国医学科学院北京协和医学院北京协和医院放射科,100730

出　　处：《中华眼科杂志》2019年第3期186-194,共9页Chinese Journal of Ophthalmology

摘　　要：目的研究伴有视交叉压迫的垂体无功能腺瘤患者视网膜神经节细胞层(GCL)厚度变化与视野缺损发生的相关性。方法病例对照研究。纳入2015年3月至2017年2月就诊于北京协和医院的垂体无功能腺瘤患者40例(80只眼),其中包括垂体无功能腺瘤导致视交叉受压但视野无明显异常者(视野正常组)20例(40只眼)以及与其性别、年龄匹配的典型垂体无功能腺瘤压迫视交叉导致双颞侧偏盲患者(颞侧偏盲组)20例(40只眼);同时纳入性别、年龄匹配的健康对照(健康对照组)20名(40只眼)。采用频域相干光层析成像术测量各组视盘旁鼻侧、颞侧、鼻上、颞上、鼻下、颞下6个象限视网膜神经纤维层(RNFL)厚度,黄斑区鼻上、鼻下、颞上、颞下4个象限GCL及神经节细胞-内丛状层(GCIPL)厚度。采用非参数检验对3组受试者RNFL、GCL及GCIPL厚度进行比较。结果3组受试者年龄(46±10)岁,男女比例为9∶11,眼轴长度为(23.22±0.90)mm,3组间差异均无统计学意义(均P>0.05)。颞侧偏盲组视盘旁颞上、颞侧、鼻上、鼻侧、鼻下5个象限及全周RNFL厚度均低于健康对照组[(129.88±28.64)μm、(63.63±26.84)μm、(88.08±32.16)μm、(50.68±19.99)μm、(92.48±25.06)μm、(85.00±20.65)μm分别与(141.10±18.95)μm、(79.12±16.78)μm、(113.68±21.28)μm、(69.67±14.23)μm、(117.80±31.32)μm、(102.80±9.68)μm比较],差异均有统计学意义(Dunnett=2.26、3.06、4.14、4.84、4.25、4.88,均P<0.05),视野正常组仅鼻侧象限RNFL厚度低于健康对照组,差异有统计学意义[(61.45±9.83)μm与(69.67±14.23)μm比较,Dunnett=2.97,P<0.05]。颞侧偏盲组及视野正常组患者黄斑区GCL总体厚度分别为(30.48±5.42)μm、(31.35±2.77)μm,均低于健康对照组[(33.32±2.92)μm,Dunnett=2.92、3.62,均P<0.05];而3组间黄斑区GCIPL总体厚度差异无统计学意义(P=0.07)。在后极部颞侧(颞上及颞下象限)3组间GCL厚度及GCIPL厚度差异均无统计学意义(均Objective To investigate the consequences of the thickness of ganglion cell layer (GCL) and visual field defect of non-functional pituitary adenoma with chiasm compression. Methods A case control study. The study included 40 (80 eyes) non-functional pituitary adenoma patients in Peking Union Medical College Hospital from March 2015 to February 2017. Twenty patients (no visual field defect group, 40 eyes) of them were detected to be chiasm compressed or touched by the adenoma with no visual field defect detected, and the other 20 patients (visual field defect group, 40 eyes) were the sex-and-age matched pituitary adenoma patients with bitemporal heminopsia. This study also included 20 (control group, 40 eyes) sex-and-age matched healthy controls. The para-papillary retinal nerve fiber layer (RNFL) thickness in 6 quadrants including nasal, temporal, nasal superior, temporal superior, nasal inferior and temporal inferior as well as the macular GCL thickness and ganglion cell-inner plexiform layer (GCIPL) thickness in 4 quadrants including nasal superior, nasal inferior, temporal superior and temporal inferior were measured. The non-parametric test was used to compare the RNFL, GCL and GCIPL thickness among the three groups. Results The mean age among the three groups was (46±10) years and the difference among the three groups was not significant (P=0.88). The sex ratio of the three groups was 9∶11 (male∶female) and the difference among the three groups was not significant. The mean axial length among the three groups was (23.22±0.90) mm and the difference among the three groups was not significant (P=0.51). The thickness of para-papillary RNFL of temporal superior, temporal, nasal superior, nasal, nasal inferior quadrants and whole circumference was significantly thinner in the visual field defect group than the control group [(129.88±28.64)μm,(63.63±26.84)μm,(88.08±32.16)μm,(50.68±19.99)μm,(92.48±25.06)μm, and (85.00±20.65)μm vs.(141.10±18.95)μm,(79.12±16.78)μm,(113.68±21.28)μm,(69.67±14.23

关 键 词：垂体肿瘤 腺瘤 偏盲 视网膜神经节细胞 神经纤维 

分 类 号：R736.4[医药卫生—肿瘤] R774[医药卫生—临床医学]