颅内压下降所致眼颅压力梯度增大对视盘血流密度影响的临床研究  

Effect of increasing trans lamina cribrosa pressure difference due to lowering intracranial pressure on optic blood flow density

作　　者：刘祥祥[1] 林丹婷 孙云晓[1] 甘嘉禾 金杉杉 玛依努尔·于苏甫 王宁利[1] Liu Xiangxiang;Lin Danting;Sun Yunxiao;Gan Jiahe;Jin Shanshan;MayinuerYusufu;Wang Ningli(Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Institute of Ophthalmology,Beijing Ophthalmology & Visual Sciences Key Lab,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院眼科中心北京市眼科研究所北京市眼科学与视觉科学重点实验室

出　　处：《中华眼科医学杂志（电子版）》2019年第5期273-280,共8页Chinese Journal of Ophthalmologic Medicine(Electronic Edition)

基　　金：国家自然科学基金(GZR-2012-009);北京市自然科学基金(BJZR-2011-004);国家科技支撑计划(KJB-KJZC-2011-001)

摘　　要：目的探讨颅内压(ICP)下降所致眼颅压力梯度(TLPD)增大与视盘血流密度改变的相关关系。方法前瞻性病例对照研究。收集2018年9月至2018年12月北京同仁医院神经内科行腰椎穿刺(LP)收集脑脊液后ICP降低的患者20例(26只眼)为实验组。其中,男性8例(12只眼),女性12例(14只眼);年龄23~61岁,平均年龄(41.7±2.8)岁;收集健康志愿者13例(26只眼)为对照组。其中,男性5例(10只眼),女性8例(16只眼);年龄21~62岁,年龄(46.9±2.7)岁。检测实验组患者的眼内压(IOP)、ICP、脑脊液压力(CSFP)、TLPD、眼灌注压(OPP)及血压;检测对照组健康志愿者的IOP、OPP及血压;根据CSFP计算ICP下降程度(△CSFP)。实验组,根据△CSFP分为亚组A(15 mmH2O<△CSFP≤30 mmH2O,6只眼)、亚组B(30 mmH2O<△CSFP≤45 mmH2O,5只眼)及亚组C(△CSFP>45 mmH2O,15只眼)等三个亚组。实验组患者记录脑脊液初压与末压,并于LP前和LP后15 min进行眼底相干光层析血管成像(OCTA)检查,测量视盘区血流密度;对照组,检查其在与LP患者相同体位改变前后的视盘区血流密度。应用配对t检验分别评估两组组内IOP、血压、OPP及视盘区血流密度变化情况和实验组各亚组内视盘区血流密度在不同程度ICP改变后的变化情况。结果对照组在体位改变后IOP、OPP、视盘区及各象限血流密度均未发现明显改变,差异无统计学意义(t=0.061,-0.361;P>0.05)。实验组LP后ICP由(11.8±2.2)mmHg下降至(7.8±2.0)mmHg,差异有统计学意义(t=13.061,P<0.05);TLPD由(5.2±3.2)mmHg升高至(9.3±2.9)mmHg,差异有统计学意义(t=-8.621,P<0.05);视盘内、视盘周及视盘周毛细血管血流密度均明显下降,差异有统计学意义(t=2.502, 3.848, 3.389;P<0.05)。在ICP下降超过45 mmH2O时,视盘周平均血流密度及视盘周毛细血管血流密度改变最明显,差异有统计学意义(t=4.043, 4.332;P<0.05)。结论 ICP下降所致的TLPD增大可导致视盘区血供减少,同时引起视盘周毛细�Objective To investigate the relationship between the increasing trans lamina cribrosa pressure difference(TLPD) due to lowering intracranial pressure(ICP) and optic disc blood flow density. Methods Prospective case-control study. From September 2018 to December 2018, the study group recruited 20 patients(26 eyes) with an average age of(41.7±2.8) years old ranging from 37.8 years old to 67.2 years old, including 8 males(12 eyes) and 12 females(14 eyes), who admitted to the Department of Neurology of Beijing Tongren Hospital and underwent lumbar puncture(LP) with reduced intracranial pressure after collecting cerebrospinal fluid. The control group recruited 13 healthy volunteers(26 eyes) with an average age of(46.9±2.7) years old ranging from 34.5 years old to 69.4 years old and included 5 males(10 eyes) and 8 females(16 eyes). The study group were divided into three subgroups according to the reduction degree of cerebrospinal fluid pressure(△CSFP) including sub-group A(15 mmH2O<△CSFP≤30 mmH2O, 6 eyes), sub-group B(30 mmH2O<△CSFP≤45 mmH2O, 5 eyes), sub-group C ( CSFP > 45 mm H2O,15 eyes). OCTA scans,IOP and BP were acquired before and 15 minutes after in patients undergoing lumbar puncture( LP) and collecting cerebrospinal fluid samples and leading to a lower ICP level in the study group,respectively. Same parameters measurements were taken in the control group when the subjects performed the same body position change with LP procedure. The paired t-test was used to evaluate the changes of intraocular pressure,blood pressure,intraocular pressure and optic disc blood flow density within the two groups,and the flow density differences of the optic disc area among subgroups after varied reduction of intracranial pressure. Results In the control group,after body position changing,there was no significant changes in the intraocular pressure,optic blood flow density( t = 0. 061,-0. 361;P >0. 05). In the study group,ICP was significantly decreased from( 11. 8 ± 2. 2) mm Hg to( 7. 8 ± 2. 0)mm Hg( t = 13.

关 键 词：颅内压 眼颅压力梯度 视盘血流密度 微循环障碍 

分 类 号：R775[医药卫生—眼科]