24 h眼灌注压与原发性开角型青光眼和正常眼压性青光眼的相关性研究  

Correlation research about 24-hour intraocular perfusion pressure with primary open-angle glaucoma and normal tension glaucoma

作　　者：邱思羽 孔祥梅 房召彬 陈旭 姜宪英 肖明 QIU Siyu;KONG Xiangmei;FANG Zhaobin;CHEN Xu;JIANG Xianying;XIAO Ming(Department of Ophthalmology,Shanghai Beizhan Hospital,Shanghai 200070,China;Department of Ophthalmology,Eye&ENT Hospital,Fudan University,Shanghai 200031,China)

机构地区：[1]上海市静安区北站医院眼科,上海200070 [2]复旦大学附属眼耳鼻喉科医院眼科,上海200031

出　　处：《中国眼耳鼻喉科杂志》2021年第5期335-340,共6页Chinese Journal of Ophthalmology and Otorhinolaryngology

基　　金：上海市静安区科委基金项目(2016MS12)。

摘　　要：目的深入探究原发性开角型青光眼(POAG)及正常眼压性青光眼(NTG)患者24 h眼内灌注压的昼夜变化及其与视功能损害的关系。方法选择眼科门诊筛选患者162例,分为2组:原发性开角型青光眼组(71例)、正常眼压性青光眼组(91例)。采集年龄、性别、屈光度、最佳矫正视力、眼轴、中央角膜厚度、杯盘比、中心视野等基本信息,并监测昼夜眼压、血压、眼内灌注压(OPP)。监测方法:用非接触性眼压计从8 am起每隔2 h测1次眼压(时间点分别为8 am、10 am、12 am、2 pm、4 pm、6 pm、8 pm、10 pm、12 pm、2 am、4 am、6 am),10 pm测完眼压后熄灯睡觉,12 pm~6 am为唤醒后即刻坐位眼压。将动态血压仪测定的间隔时间设定为每2 h测量1次,时间点与眼压测定的时间同步。夜晚10 pm后为测量完血压后再测眼压。根据以下公式计算所得OPP及波动值:平均OPP(MOPP)=2/3平均动脉压(MAP)-眼压(IOP)=2/3{舒张压(DBP)+1/3[收缩压(SBP)-DBP]}-IOP;MOPP波动值=MOPP日间平均值-MOPP夜间最低值。探究POAG及NTG患者的24 h眼压、血压和OPP的变化曲线,了解其波动规律,分析POAG及NTG患者的OPP昼夜变化与视野等功能损害的相关性。结果2组患者24 h眼压提示NTG低于POAG,两者比较差异有统计学意义(P<0.001)。2组患者DBP及SBP均呈昼高夜低趋势,2组比较差异没有统计学意义(P>0.05)。2组患者24 h的MOPP均呈昼高夜低趋势。峰值均在6 pm;谷值在12 pm。全天各时间点NTG组MOPP均高于POAG组,且差异有统计学意义(P<0.01)。POAG组MOPP波动值大于NTG组,两者比较差异有统计学意义(P<0.01)。POAG组的MOPP波动值与视野平均敏感度(MS)、平均缺损(MD)无相关性;NTG组的MOPP波动值与MS、MD存在相关性。结论POAG和NTG组的24 h MOPP均呈现出昼高夜低趋势,且NTG组的MOPP均值高于POAG、波动小于POAG患者,推测其视功能对波动的敏感性更高,对于NTG较小的波动就有可能造成不可逆的病理改变�Objective To investigate the diurnal variation of intraocular perfusion pressure in 24 hours and its relationship with visual impairment in patients with primary open-angle glaucoma(POAG)and normal tension glaucoma(NTG).Methods One hundred and sixty-two patients screened from the ophthalmology clinic were divided into POAG group(71 patients)and NTG group(91 patients).All patients’collected basic clinical data such as age,gender,refraction,best corrected visual acuity,eye axis,central corneal thickness,C/D ratio,central visual field,etc.were collected.Intraocular pressure(IOP),blood pressure and intraocular perfusion pressure were monitored day and night.Monitoring method:IOP was monitored with non-contact applanation tonometer every two hours from 8 am(time points are 8 am,10 am,12 am,2 pm,4 pm,6 pm,8 pm,10 pm,12 pm,2 am,4 am,6 am),of which,at 10 pm,patients turn off the lights to sleep after measuring the IOP,between 12 pm to 6 am,patients were awakened to monitor the sitting IOP immediately.Blood pressure was monitored with the ambulatory blood pressure instrument every two hours,of which the time points were synchronized with the time of the IOP monitoring.Between 12 pm to 6 am,the blood pressure was monitored after IOP.The intraocular perfusion pressure and its fluctuation were calculated according to the following formula:mean intraocular perfusion pressure(MOPP)=2/3 mean arterial pressure(MAP)-IOP=2/3{diastolic blood pressure(DBP)+1/3[systolic blood pressure(SBP)-DBP]}-IOP;MOPP fluctuation value=daytime average of MOPP-nighttime minimum value of MOPP.The study explored the curve and fluctuation of 24-hour IOP,blood pressure and intraocular perfusion pressure between POAG patients and NTG patients,and analyzed the correlation of the diurnal variation of intraocular perfusion pressure in 24 hours and its relationship with visual impairment in POAG and NTG patients.Results The 24-hour IOP of NTG group was lower than that of POAG group with significant difference(P<0.001).The diastolic and systolic blood pres

关 键 词：青光眼 24 h眼压 眼灌注压 动态血压 视功能 

分 类 号：R775[医药卫生—眼科]