非动脉炎性前部缺血性视神经病变的危险因素和远期变化

发布时间：2018-02-09 00:30

本文关键词： 缺血性视神经病变血压血糖血脂眼压光学相干断层扫描视网膜神经纤维层　出处：《眼科新进展》2014年07期 　论文类型：期刊论文

【摘要】：目的通过研究非动脉炎性前部缺血性视神经病变(nonarteritic anterior ischemic optic neuropathy,NAION)发病的危险因素和视网膜神经纤维层(retinal nerve fiber layer,RNFL)损伤的远期变化,提高对NAION的诊断和治疗效果。方法采用前瞻性对照研究的方法,收集50例(50眼)确诊为NAION的患者,同时选取50例(50眼)排除其他疾病的视疲劳患者作为对照,行血压、空腹血糖、血脂、眼压、视野及光学相干断层扫描(optical coherence tomography,OCT)检查,观察收缩压、舒张压、空腹血糖、总胆固醇、甘油三酯、眼压及视盘结构参数,并比较对照组和NAION患者发病后6个月、12个月、18个月上方、鼻侧、下方、颞侧、全周平均RNFL厚度的差异。结果与对照组比较,NAION患者收缩压、舒张压、空腹血糖、总胆固醇、眼压、盘沿面积差异均无统计学意义(均为P0.05),而甘油三酯为(2.14±1.46)mmol·L-1,较对照组的(1.56±0.86)mmol·L-1升高,差异有统计学意义(P0.05),视盘面积(1.99±0.34)mm2、视杯面积(0.32±0.31)mm2、杯/盘面积比(0.17±0.18)、水平杯盘比(0.32±0.16)、垂直杯盘比(0.28±0.12)均显著小于对照组,差异均有统计学意义(均为P0.05);与对照组比较,NAION患者发病后6个月、12个月、18个月上方、鼻侧、下方、颞侧、全周平均RNFL厚度均变薄,差异均有统计学意义(均为P0.05);但是,与NAION发病后6个月比较,发病后12个月、18个月上方、鼻侧、下方、颞侧、全周平均RNFL厚度均无明显变化,差异均无统计学意义(均为P0.05)。NAION发病后6个月、12个月、18个月的RNFL损伤百分比分别是29.8%、31.0%、32.3%,三组间差异均无统计学意义(均为P0.05)。结论甘油三酯、小视杯、浅视杯、小视盘是NAION发病的危险因素;一旦确诊为NAION,那么发病6个月后RNFL损伤将不再进一步加重;这对在NAION的诊断、早期治疗及后续治疗中采取相应措施具有重要意义。
[Abstract]:Objective to study the risk factors of nonarteritic anterior ischemic optic neuropathy (NAION) and the long-term changes of retinal nerve fiber layer (RNFL) injury in anterior ischemic optic neuropathy of non-arteritis. Methods 50 patients with NAION and 50 patients with visual fatigue who were excluded from other diseases were selected as control group. Fasting blood glucose, blood lipid, intraocular pressure, visual field and optical coherence tomography (Oct) were examined to observe systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol, triglyceride, intraocular pressure and optic disc structure parameters. The mean RNFL thickness in the nasal side, inferior temporal side, temporal side and whole week was compared between the control group and the patients with NAION 6 months, 12 months, 18 months after onset. Results compared with the control group, systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol, intraocular pressure were compared. There was no significant difference in disc edge area (P 0.05), but triglyceride was 2.14 卤1.46 mmol 路L -1, which was higher than that in control group (1.56 卤0.86 mmol 路L -1). The difference was statistically significant (P < 0.05), the optic disc area was 1.99 卤0.34 mm ~ 2, the cup area was 0.32 卤0.31 mm ~ 2, the cup / disc area ratio was 0.17 卤0.18 渭 m, the horizontal cup / disc ratio was 0.32 卤0.16 and the vertical cup / disc ratio was 0.28 卤0.12). Compared with the control group, the average thickness of RNFL in the nasal side, inferior side, temporal side, temporal side, and the whole week were all thinned (P 0.05), and the difference was statistically significant (P 0.05), however, compared with the control group, the mean thickness of RNFL in the nasal side, the inferior side, the temporal side and the whole week was thinner than that in the control group (P 0.05). Compared with NAION 6 months after onset, there was no significant change in mean RNFL thickness at 12 months, above 18 months, nasal side, inferior side, temporal side, and the whole week. There was no significant difference in the percentage of RNFL damage between the three groups (P 0.05, 12 months and 18 months after the onset of the disease). The percentage of RNFL damage was 29.810% and 31.0%, respectively. There was no significant difference among the three groups (all P0.050.Conclusion triglyceride, small vision cup, shallow vision cup, small vision cup, shallow vision cup, all of them have no significant difference between the three groups (P 0.05), and there is no significant difference between the three groups (P 0.05). Small optic disc is the risk factor of NAION. Once diagnosed as NAION, the RNFL damage will not be further aggravated 6 months after the onset, which is of great significance in the diagnosis, early treatment and subsequent treatment of NAION.
【作者单位】：中国中医科学院眼科医院;
【分类号】：R774.6

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