视网膜色素变性患者脉络膜厚度和血管密度与视功能的相关性分析

发布时间：2018-09-17 20:24

【摘要】：第一部分视网膜色素变性患者脉络膜厚度和血管密度与视功能的相关性分析目的:应用Cirrus HD-OCT对视网膜色素变性(RP)患者脉络膜厚度和血管密度进行分析,并探讨其与视功能的相关性。方法:从2014年9月至2017年3月,分别收集60例散发型RP患者(120眼)和与其年龄、屈光度相匹配的健康对照者60(120眼)入选本研究。采用Cirrus HD-OCT的增强深部成像技术(enhanced depth imaging,EDI)测量所有受检眼的黄斑中心凹脉络膜厚度及血管密度。RP组患眼同时行视网膜电图(ERG)检查,并采用OCTOPUS自动视野计T32或LVC程序行30°视野检查,对两组检查结果进行比较分析,并探讨RP患者的脉络膜厚度、血管密度与视功能的相关性。结果:RP组黄斑中心凹脉络膜厚度和黄斑脉络膜血管密度之间存在明显的正相关性(r=0.398,P0.001);在31-40岁年龄组,RP组的黄斑中心凹脉络膜厚度和黄斑血管密度存在明显的正相关性(r=0.647,P0.001)。在31～40岁年龄组,RP组的黄斑中心凹脉络膜厚度和黄斑脉络膜血管密度明显低于正常组(P0.001)。RP组的黄斑中心凹脉络膜厚度和黄斑脉络膜血管密度与其发现年龄有一定的相关性(P0.05)。RP患者黄斑中心凹脉络膜厚度、黄斑脉络膜血管密度分别与视功能分析均无明显相关性(P0.05)。结论:RP的脉络膜厚度及血管密度仅能在一定程度上反映患眼的病变程度,并与其发现年龄关系密切。RP患者黄斑中心凹脉络膜厚度、黄斑脉络膜血管密度与视功能无明显相关性。第二部分Angio-OCT与HD-OCT对RP患者检测分析目的:比较两种OCT(光学相干断层扫描血流成像术(Angio-optical coherence tomography,Angio-OCT)和Cirrus HD-OCT)对RP患者检测的差异性和相关性。方法:从已入组观察例中共选取RP患者30例(60眼)与年龄、屈光度相匹配的健康对照者30人(60眼),分别应用Angio-OCT和HD-OCT测量所有眼黄斑中心凹视网膜、脉络膜厚度,黄斑视网膜血流密度、脉络膜血流面积和血流密度,对两组人群的测量指标进行差异性和相关性分析,并对Angio-OCT与HD-OCT的视网膜、脉络膜厚度测量值进行差异性和相关性分析。结果:1.视网膜厚度:两种OCT所测黄斑中心凹视网膜厚度差异无统计学意义(P0.05)。RP组黄斑中心凹视网膜厚度、黄斑视网膜血流密度均较正常组明显降低(P0.001)。RP组黄斑中心凹视网膜厚度与黄斑视网膜血流密度无明显相关性(r=0.051,P=0.697)。2.脉络膜厚度:Angio-OCT所测两组人群的黄斑中心凹脉络膜厚度均较HD-OCT所测升高,差异有统计学意义(P0.05);RP组黄斑中心凹脉络膜厚度较正常组降低(P0.05),而两组人群的黄斑脉络膜血流面积和血流密度差异均无统计学意义(P0.05)。两组人群的黄斑中心凹脉络膜厚度与黄斑脉络膜血流面积、血流密度均无明显相关性(P0.05)。3.两种OCT所测黄斑中心凹视网膜、脉络膜厚度测量值均有明显的正相关性(P0.001)。结论:两种设备成像原理和技术不同,在黄斑中心凹视网膜脉络膜厚度测量中有一定的相关性,临床中均可以应用。第三部分RP患者中西医结合治疗前后Angio-OCT分析目的:探索性应用Angio-OCT观察RP患者中西医结合治疗前后眼底变化及视功能的改变。方法:从2016年1月至2017年3月,共纳入13例符合纳入标准和排除标准的散发型RP患者(26眼)入选本研究。应用Angio-OCT检测RP患者中西医结合治疗前后眼底视网膜和脉络膜的血流变化,并与最佳矫正视力和视野改变进行分析。结果:RP患者13例(26眼)中西医结合治疗后的视网膜血流密度、脉络膜的血流面积、血流密度较治疗前均升高,但差异均无统计学意义(P0.05),治疗后最佳矫正视力和视敏度均较治疗前提高(P0.05)。结论:中西医结合治疗在改善RP患者视功能有明显的疗效,而眼底视网膜、脉络膜血流方面改变不明显,还有待进一步研究。
[Abstract]:Part I Correlation between Choroidal Thickness, Vascular Density and Visual Function in Patients with Retinopathy Objective: To analyze the choroidal thickness and vascular density in patients with retinitis pigmentosa (RP) by Cirrus HD-OCT, and to explore the correlation between choroidal thickness and vascular density and visual function. Type I RP patients (120 eyes) and 60 healthy controls (120 eyes) matched with their age and diopter were enrolled in the study. The thickness of choroidal fovea and vascular density were measured by enhanced depth imaging (EDI) with Cirrus HD-OCT. The eyes in RP group underwent electroretinogram (ERG) and OC simultaneously. TOPUS automatic perimeter T32 or LVC program for 30 degree visual field examination, the results of the two groups were compared and analyzed, and to explore the RP patients with choroidal thickness, vascular density and visual function correlation. Results: RP group macular fovea choroidal thickness and macular choroidal vascular density between the obvious positive correlation (r = 0.398, P 0.001); There was a significant positive correlation between macular foveal choroidal thickness and macular vascular density in RP group (r = 0.647, P 0.001). In 31-40 years old group, macular foveal choroidal thickness and macular choroidal vascular density in RP group were significantly lower than those in normal group (P 0.001). There was no significant correlation between macular foveal choroidal thickness, macular choroidal vascular density and visual function analysis in RP patients (P There was no significant correlation between macular foveal choroidal thickness, macular choroidal vascular density and visual function in RP patients. Part 2 Angio-OCT and HD-OCT were used to detect RP patients. Objective: To compare the difference between two kinds of OCT (Angio-optical coherence tomography, Angio-OCT) and CIRRUS HD-OCT) in detecting RP patients. Methods: Angio-OCT and HD-OCT were used to measure the foveal retina, choroidal thickness, macular retinal blood flow density, choroidal blood flow area and blood flow density in 30 RP patients (60 eyes) and 30 healthy controls (60 eyes) matched with age and diopter. Results: 1. Retinal thickness: There was no significant difference in macular fovea retinal thickness between the two OCTs (P 0.05). There was no significant difference in macular fovea retinal thickness between RP group and HD-OCT group (P 0.05). There was no significant correlation between foveal retinal thickness and macular retinal blood flow density in RP group (r = 0.051, P = 0.697). 2. Choroidal thickness: Choroidal thickness in both groups measured by Angio-OCT was higher than that measured by HD-OCT, the difference was statistically significant (P 0.05). Fovea choroidal thickness was lower than normal group (P 0.05), but there was no significant difference in macular choroidal blood flow area and density between the two groups (P 0.05). There was no significant correlation between fovea choroidal thickness and macular choroidal blood flow area, blood flow density (P 0.05). 3. Retinal and choroidal thickness measurements have significant positive correlation (P 0.001). Conclusion: The imaging principles and techniques of the two devices are different, and they have a certain correlation in the measurement of retinal and choroidal thickness in macular fovea, and can be used in clinical practice. Methods: From January 2016 to March 2017, 13 patients (26 eyes) with sporadic RP who met the inclusion criteria and exclusion criteria were enrolled in this study. Angio-OCT was used to detect the retinal and choroidal blood of RP patients before and after treatment. Result: The retinal blood flow density, choroidal blood flow area and blood flow density of 13 patients (26 eyes) with RP were higher than those before treatment, but the difference was not statistically significant (P 0.05). After treatment, the best corrected visual acuity and visual acuity were improved (P 0.05). 05). Conclusion: The treatment of integrated traditional Chinese and Western medicine has obvious effect on improving the visual function of RP patients, but the changes of fundus retina and choroidal blood flow are not obvious.
【学位授予单位】：中国中医科学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R774.1

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