不同病程非动脉炎性前部缺血性视神经病变患眼视盘血流密度观察  

Observation of the optic disc vessel density in the affected eye with non-arteritic anterior ischemic optic neuropathy of different stages

作　　者：肖庆[1] 白海霞 胡江华 叶点 孙传宾[1] Xiao Qing;Bai Haixia;Hu Jianghua;Ye Dian;Sun Chuanbin(Eye Center,Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院眼科中心,杭州310009

出　　处：《中华眼底病杂志》2021年第10期763-768,共6页Chinese Journal of Ocular Fundus Diseases

基　　金：浙江省自然科学基金青年项目(LQ18H120002);浙江省医药科技计划项目(2020KY578、2020YK150)。

摘　　要：目的观察非动脉炎性前部缺血性视神经病变(NAION)患者连续病程不同阶段视盘周围放射状毛细血管(RPC)血流密度变化特征。方法前瞻性队列研究。2020年1~12月于浙江大学医学院附属第二医院眼科中心检查确诊的NAION患者29例29只眼纳入研究。其中,男性18例18只眼,女性11例11只眼;平均年龄为(53.62±6.67)岁。所有患眼均行视野检查获取视野平均缺损(MD)值。采用光相干断层扫描血管成像(OCTA)检查测量患眼视盘周围视网膜神经纤维层(pRNFL)厚度以及整体视盘血流密度(wiVD)、视盘内血流密度(diVD)、视盘周围RPC血流密度、黄斑神经节细胞复合体(GCC)厚度。将病程≤3周定义为急性期;4~12周定义为亚急性期;>12周定义为慢性期。观察急性期、亚急性期和慢性期病程(12~24、>24周)时患眼视野MD值、视盘RPC血流密度、pRNFL厚度和黄斑GCC厚度变化。采用完全随机设计的方差分析比较不同病程视野MD值、RPC血流密度及黄斑GCC、pRNFL厚度差异。采用Pearson相关性分析法分析pRNFL厚度、黄斑GCC厚度、视野MD值变化与视盘周围RPC血流密度的相关性。结果急性期、亚急性期以及慢性期病程(12~24周、>24周)患眼wiVD分别为(44.96±2.76)%、(41.50±3.49)%、(39.08±5.43)%、(38.56±6.48)%。不同病程患眼wiVD比较,差异有统计学意义(F=8.939,P<0.001)。慢性期病程12~24周、>24周患眼之间wiVD平均值差值为-0.984,差异无统计学意义(P>0.05)。不同病程患眼diVD比较,差异无统计学意义(F=1.079,P=0.365)。患眼视盘周围RPC血流密度除下方外,鼻侧、颞侧、上方象限血流密度均随病程进展明显降低,差异有统计学意义(F=8.816、6.069、8.943,P<0.05)。慢性期病程12~24周、>24周患眼之间鼻侧、颞侧、上方血流密度的平均值差值为-0.984、-0.230、-0.198,差异无统计学意义(P>0.05)。不同病程患眼视野MD值比较,差异无统计学意义(F=0.277,P=0.842);整体pRNFL厚度Objective To observe the changes in blood flow density of radial retinal peripapillary capillary(RPC)around the optic disc in patients with non-arteritic anterior ischemic optic neuropathy(NAION)at different stages of the continuous course of the disease.Methods A prospective cohort study.From January to December 2020,29 cases of 29 eyes of NAION patients diagnosed in the Eye Center of the Second Affiliated Hospital of Zhejiang University School of Medicine were included in the study.Among them,there were 18 males with 18 eyes and 11 females with 11 eyes.The average age was 53.62±6.67 years old.The affected eye underwent routine eye examination and visual field,optic cohenrence tomography angiography(OCTA)examination.Visual field inspection was performed to obtain the average visual mean defect(MD)value.OCTA was used to measure the thickness of the peripapillary retinal nerve flayer(pRNFL)around the optic disc,the whole en face image vessel density(wiVD),intro disc vessel density(diVD),RPC blood flow density around the optic disc,and macular ganglion cell complex(GCC).The course of disease≤3 weeks was defined as the acute phase;4-12 weeks was defined as the subacute phase;>12 weeks was defined as the chronic phase.The changes of visual field MD,optic disc RPC blood flow density,pRNFL thickness and macular GCC thickness were observed in the acute,subacute and chronic phases(12-24,>24 weeks).A completely randomized design of variance analysis was used to compare the differences in visual field MD,RPC blood flow density,GCC,and pRNFL thickness in different courses.Pearson correlation analysis was used to analyze the correlation between pRNFL thickness,macular GCC thickness,visual field MD changes and RPC blood flow density around the optic disc sex.Results The wiVD of the eyes in the acute phase,subacute phase,and chronic phase(12-24 weeks,>24 weeks)were(44.96±2.76)%,(41.50±3.49)%,(39.08±5.43)%,(38.56±6.48)%.There was a statistically significant difference in wiVD of eyes with different disease courses(F=8.93

关 键 词：视神经病变 缺血性 体层摄影术 光学相干 局部血流 

分 类 号：R774.6[医药卫生—眼科]