水通道蛋白-4抗体阳性视神经脊髓炎谱系疾病患者光相干断层扫描血管成像特征及相关因素分析  

The characteristics of optical coherence tomography angiography in aquaporin-4 antibody positive neuromyelitis optica spectrum disorders

作　　者：余建 黃詠恒 全超 王敏 Yu Jian;Wong Wenghang;Quan Chao;Wang Min(Eye Institute and Department of Ophthalmology,Eye&ENT Hospital,Fudan University,Key Laboratory of Myopia of State Health Ministry,Shanghai Key Laboratory of Visual Impairment and Restoration,Shanghai 200031,China;Department of Ophthalmology,Kiang Wu Hospital,Macao Special Administration Region,China;Department of Neurology,Huashan Hospital,Shanghai Medical College,Fudan University,Shanghai 200030,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科,卫生部近视眼重点实验室,上海市视觉损害与重建重点实验室,200030 [2]澳门镜湖医院眼科 [3]复旦大学附属华山医院神经内科,上海200030

出　　处：《中华眼底病杂志》2021年第3期173-179,共7页Chinese Journal of Ocular Fundus Diseases

基　　金：国家自然科学基金青年科学基金(81700862);上海市科学技术委员会创新计划(19441900900)。

摘　　要：目的观察水通道蛋白-4(AQP-4)抗体阳性视神经脊髓炎谱系疾病(NMOSD)患者光相干断层扫描血管成像(OCTA)特征,分析其相关因素。方法病例对照研究。2015年9月至2017年8月在复旦大学附属眼耳鼻喉科医院眼科检查确诊的AQP-4抗体阳性NMOSD患者48例96只眼及同期年龄性别与之匹配的健康志愿者20名40只眼(正常对照组)纳入研究。均为双眼入组。根据视神经炎(ON)发作次数将NMOSD患者分为0 ON组、1 ON组、2 ON组、3+ON组,分别为30、22、31、13只眼。0 ON组为无ON发作史;1 ON组、2 ON组、3+ON组分别为ON发作1、2、≥3次。受检眼均行最佳矫正视力(BCVA)、视野、OCTA检查。BCVA检查采用国际标准Snellen视力表进行,并将结果转换成最小分辨角对数视力记录。采用Humphery视野计测量受检眼视野平均缺损值(MD)。采用OCTA仪对受检眼视盘区4.5 mm×4.5 mm和黄斑区6.0 mm×6.0 mm范围进行扫描,测量放射状视盘周围毛细血管(RPC)血流密度、黄斑旁中心凹视网膜浅层毛细血管丛血流密度(SVD)以及视盘旁神经纤维层(pRNFL)、黄斑旁中心凹神经节细胞-内丛状层(GCIPL)厚度。采用广义估计方程分析4组受检眼之间BCVA、视野MD、pRNFL与GCIPL厚度、RPC血流密度、SVD的差异,以及视网膜灌注与视网膜结构、视功能的关系。结果与正常对照组比较,0 ON组患眼RPC血管密度、SVD明显降低,差异有统计学意义(Waldχ^(2)=7.190、10.134,P<0.01);两组受检眼之间BCVA和pRNFL、GCIPL厚度比较,差异均无统计学意义(Waldχ^(2)=2.308、1.020、2.558,P>0.05)。与0 ON组比较,1 ON组、2 ON组、3+ON组患眼BCVA、视野MD、RPC血流密度、SVD和pRNFL、GCIPL厚度均明显降低,差异有统计学意义(Waldχ^(2)=12.390、11.346、38.860、18.040、45.418、26.608,P<0.01);1 ON组、2 ON组、3+ON组患眼之间上述各项指标比较,差异无统计学意义(P>0.05)。相关性分析结果显示,RPC血流密度与pRNFL厚度(β=0.372,标准误Objective To investigate the alteration of retinal perfusion in aquaporin-4 antibody(AQP4-ab)positive neuromyelitis optica spectrum disorders(NMOSD)patients by optical coherence tomography angiography(OCTA).Methods A case-control study.Forty-eight AQP4-ab positive NMOSD patients(96 eyes)and 20 age and gender matched healthy controls(40 eyes)were recruited from September 2015 to August 2017 at the Eye&ENT Hospital of Fudan University.Patients of both eyes were included in the groups.The patients were further divided into 4 subgroups(0 ON,1 ON,2 ON,3+ON group)according to the number of episodes of ON(0,1,2,or 3+)with respect to 30、22、31、13 eyes.0 ON group had no history of ON episodes;1 ON group,2 ON group,and 3+ON group had ON episodes 1,2,≥3 times,respectively.All patients underwent complete ophthalmological examinations including BCVA,visual field and OCTA examination.The BCVA was recorded for each eye using metric notation from the Snellen chart,and then converted to the logarithm of the minimum angle of resolution.The central visual field was assessed using a Humphrey Field Analyzer 750 and the mean deviation(MD)was determined.OCTA scans of the optic disc(4.5 mm×4.5 mm)and macula(6 mm×6 mm)were acquired.Radial peripapillary capillary(RPC)vessel density,superficial capillary plexus vessel density(SVD),the thickness of ganglion cell and inner plexiform layer(GCIPL)and peripapillary retinal nerve fiber layer(pRNFL)were determined.The generalized estimating equations was performed to compare the difference of BCVA,MD,pRNFL thickness,GCIPL thickness,RPC vessel density and SVD among the groups and the correlations between retinal perfusion and retinal structure,visual function were analyzed.Results The RPC vessel density and SVD were significant lower in the 0 ON group compared with healthy group(Waldχ^(2)=7.190,10.134;P<0.01),however,the BCVA,pRNFL and GCIPL thickness were not significant difference between the two groups(Waldχ^(2)=2.308,1.020,2.558;P>0.05).The BCVA,visual field MD,RPC vessel density,SV

关 键 词：视神经脊髓炎 视神经炎 水通道蛋白质4 体层摄影术 光学相干 局部血流 

分 类 号：R744.52[医药卫生—神经病学与精神病学]