视神经纤维层厚度分析在利奈唑胺中毒性视神经病变中的应用价值  

Application of the analysis of retinal nerve fiber layer thickness in linezolid-induced optic neuropathy

作　　者：张彦坤[1] 关艳 田净净 翟静洁 ZHANG Yankun;GUAN Yan;TIAN Jingjing(Department of Ophthalmology,Hebei Chest Hospital,Hebei,Shijiazhuang 050047,China)

机构地区：[1]河北省胸科医院眼科,石家庄市050047

出　　处：《河北医药》2023年第6期893-896,共4页Hebei Medical Journal

基　　金：河北省医学科学研究重点课题计划(编号:20191029)。

摘　　要：目的 研究视神经纤维层(retinal nerve fiber layer, RNFL)厚度利奈唑胺抗结核治疗中发生的中毒性视神经病变的应用价值。方法 回顾性选择2018年9月至2020年9月我院发生视力下降及眼部体征变化的42例服用利奈唑胺的耐药肺结核患者作为病例组;同期纳入初治肺结核常规四联抗结核治疗患者42例作为对照组。用光学相干断层扫描技术(optical coherence tomography, OCT)检查测量对照组和病例组患者治疗前、治疗1个月、治疗6个月时的RNFL厚度。结果 对照组和病例组治疗前、治疗后1个月的RNFL厚度各象限差异无统计学意义(P>0.05);病例组患者治疗后6个月发生视力下降及眼部体征变化者的视盘颞侧、上方、下方、鼻侧及平均RNFL厚度均大于对照组(P<0.05);停药2个月时视盘颞侧、上方、下方、鼻侧及平均RNFL厚度均小于治疗后6个月的RNFL厚度(P<0.05)。结论 利奈唑胺中毒性视神经病变患者早期RNFL厚度出现增厚,以颞侧象限最明显,停药后恢复正常厚度,出现中毒性视神经病变后视神经纤维层厚度呈现正常增厚变薄的走势,结核科及眼科医生应加强对利奈唑胺服药者的眼部随访。Objective To evaluate the changes in the thickness of the retinal nerve fiber layer(RNFL)in linezolid-induced optic neuropathy.Methods From September 2018 to September 2020,42 cases of drug-resistant tuberculosis(TB)patients taking linezolid who had vision loss and eye signs changes admitted in our hospital were retrospectively selected as the case group.During the same period,42 newly diagnosed tuberculosis patients treated with the 4-drug regimen were included in the control group.RNFL thickness was measured before treatment and 1 month and 6 months after treatment by optical coherence tomography(OCT).Results There was no significant difference in RNFL thickness at each quadrant before treatment and 1 month after treatment between groups(P>0.05).The temporal side of the optic disc,superior quadrant,inferior quadrant,nasal quadrant of RNFL thickness,and the mean RNFL thickness at 6 months after treatment in patients of case group who had vision loss and changes in eye signs were significantly larger than those of control group(P<0.05).The temporal side of the optic disc,superior quadrant,inferior quadrant,nasal quadrant of RNFL thickness,and the mean RNFL thickness at 2 months after withdrawal were significantly lower than those at 6 months after treatment(P<0.05).Conclusion The thickness of RNFL in TB patients with linezolid-induced optic neuropathy increases in the early stage,especially in the temporal quadrant,which returns to normal after drug withdrawal.After the occurrence of toxic optic neuropathy,the thickness of RNFL increases first and decreases.Ophthalmologists should strengthen eye follow-up for linezolid users.

关 键 词：利奈唑胺中毒性视神经病变 视神经纤维层厚度 耐多药肺结核 光学相干断层扫描技术(OCT) 

分 类 号：R595.4[医药卫生—内科学]