非动脉炎性前部缺血性视神经病变相关因素分析

发布时间：2018-07-23 20:28

【摘要】：目的探讨非动脉炎性前部缺血性视神经病变(non-arteritic anterior ischemic optic neuropathy,NAION)患者的病因、发病机制、相关危险因素、临床特征、治疗方法、治疗效果和预防措施,以期为临床医生提供更有力的证据指导临床诊断和治疗。方法采用回顾性病例分析研究。自2011年4月至2016年11月间,收集天津市第四中心医院眼科连续收治的NAION患者66例(74眼)作为研究对象,分析其临床表现、眼部及全身危险因素、视力、视野、眼底荧光素血管造影(fundus fluorescein angiography,FFA)、光学相干断层扫描(optical coherence tomography,OCT)结果,积极治疗全身病,同时全身应用糖皮质激素、血管扩张剂和神经营养剂等综合治疗,比较治疗前后矫正视力和视野的变化。结果本组66例患者中,男女之比为1.6:1,发病年龄平均为(58.6±10.4)岁。所有患者均表现有不同程度的中心视力下降和视野改变,71眼中与生理盲点相连的绕过中心注视点的象限性或下方视野缺损36眼(50.7%),眼底检查可见患眼视乳头缺血水肿66眼(89.2%),FFA检查早期可见视乳头血管充盈迟缓和晚期荧光增强者45眼(60.8%)。伴有高血压病者46例(69.7%)、糖尿病者26例(39.4%)、高脂血症者37例(56.0%),有吸烟史者19例(28.8%),其中高血压、糖尿病与NAION初诊视力低下(0.3)和治疗有效率无直接相关。经血管扩张剂和营养神经药物综合治疗后患眼视力提高者38眼,有效率为51.4%;视野缺损改善者为34眼,有效率为47.9%。FFA显示早期视乳头充盈时间较发病初期缩短者19眼,缺血范围较发病初期缩小者31眼。结论NAION是一种与全身及眼局部多种疾病和因素有关的眼部病变,高血压病、糖尿病、高脂血症或动脉硬化、无视杯或小视杯、显著眼内压升高及吸烟均是其危险因素。临床诊治过程中应注意完善各项检查措施,明确诊断,经积极综合治疗后,部分患者的中心视力和视野可有一定改善。
[Abstract]:Objective to investigate the etiology, pathogenesis, risk factors, clinical features, treatment methods, therapeutic effects and preventive measures of non-arteritic anterior ischemic optic neuropathy in patients with non-arterial inflammatory anterior ischemic optic neuropathy. In order to provide clinicians with more powerful evidence to guide clinical diagnosis and treatment. Methods retrospective case analysis was used. From April 2011 to November 2016, 66 patients (74 eyes) with NAION admitted to the fourth Central Hospital of Tianjin were collected and analyzed their clinical manifestations, ocular and systemic risk factors, visual acuity and visual field. The results of fundus fluorescein angiography (fundus fluorescein) and optical coherence tomography (Oct) were used to treat systemic diseases, and the patients were treated with glucocorticoids, vasodilators and neurotrophic agents. The changes of corrected visual acuity and visual field before and after treatment were compared. Results the ratio of male to female was 1.6: 1, and the mean age of onset was (58.6 卤10.4) years. All the patients showed different degrees of central visual acuity decline and visual field change. In 71 eyes, the quadrant or inferior visual field defect around the central fixation point was connected with the physiological blind spot, 36 eyes (50.7%). The ocular fundus examination showed ischemic water in the optic papilla. In 66 eyes (89.2%) with FFA, 45 eyes (60.8%) showed delayed filling and late fluorescence enhancement of optic papilla. There were 46 cases (69.7%) with hypertension, 26 cases (39.4%) with diabetes, 37 cases (56.0%) with hyperlipidemia and 19 cases (28.8%) with smoking history. The visual acuity was improved in 38 eyes, the effective rate was 51.4, and the visual field defect was improved in 34 eyes, the effective rate was that 47.9%.FFA showed that the filling time of early optic nipple was shorter in 19 eyes than that in the early stage. The ischemic area was smaller in 31 eyes than in the early stage. Conclusion NAION is a kind of ocular disease related to various diseases and factors of the whole body and local eye. Hypertension diabetes hyperlipidemia or arteriosclerosis ignoring cup or cup raising intraocular pressure and smoking are the risk factors. In the course of clinical diagnosis and treatment, attention should be paid to the improvement of examination measures and definite diagnosis. After active comprehensive treatment, the central visual acuity and visual field of some patients can be improved to some extent.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R774.6

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