青光眼视路改变应用磁共振成像评估的临床研究

发布时间：2018-03-03 02:23

本文选题：青光眼　切入点：视路　出处：《大连医科大学》2011年硕士论文　论文类型：学位论文

【摘要】：目的:利用磁共振成像(MRI)评估原发性开角型青光眼(POAG)和慢性闭角型青光眼(CACG)的视觉通路改变及差异,探索青光眼患者视野损害与视路改变的相关性,探讨MRI成像技术作为青光眼诊断的辅助检查的准确性和可行性。方法:选择2010年5月至2011年2月间于大连医科大学附属第一医院眼科就诊的符合入选标准的12名原发性开角型青光眼患者(24眼)和8名原发性慢性闭角型青光眼患者(16眼)进行视觉通路的MRI(1.5T磁共振仪器)分析,质子密度加权成像(PDWI)测量外侧膝状体的体积,弥散张量成像(DTI)测量视神经、视束、视放射的各向异性分数(FA)和平均弥散率(MD)。病例组所有患者病史均为三至五年内,具有青光眼的临床表现及体征,所有患者用非接触性眼压计测量24小时眼压,利用Humphrey视野计记录视野缺损的分贝值,查房角,眼底照相记录C/D值。对照组18人(36眼)要求无眼科其他疾病及高血压,糖尿病等全身疾病的正常健康成年人(25——69岁)。开青组、闭青组和对照组均行t检验,年龄差异均无统计学意义。根据外侧膝状体的体积和所得FA和MD值来评估原发性开角型青光眼和慢性闭角型青光眼患者视路改变及其差异。通过Humphrey视野计记录视野缺损的分贝值,视野损害与各参数间进行Pearson相关性分析。将青光眼患者分为前期、早期、中期、晚期,检测四组患者的年龄、视力(矫正)、C/D、外侧膝状体体积,视神经、视束、视放射的FA值和MD值并进行单因素方差分析。结果:开青组、闭青组分别与对照组相比较,青光眼患者外侧膝状体的体积明显减小(72.91±15.81),p0.01,差异均具有统计学意义,视神经,视束及视放射的FA值明显减小,p0.01,差异均具有统计学意义,闭青组与对照组相比较,视神经、视束及视放射MD值明显升高,p0.01,差异有统计学意义,开青组与对照组相比较,视神经、视束的MD值明显升高,P0.01,差异有统计学意义;原发性开角型青光眼患者与慢性闭角型青光眼患者相比较,外侧膝状体体积、视神经、视束及视辐射的FA值和MD值均无明显差异,P0.05,差异无统计学意义。视野损害程度与各参数在α=0.05上具有相关性。根据视野损害程度分组,组间各参数进行单因素方差分析,视束FA值、视神经MD值及外侧膝状体组间差异具有统计学意义。结论:青光眼是一种复杂的神经系统疾病,影响不同层次的视神经纤维。MRI作为青光眼诊断的辅助检查对整个视觉通路改变提供量化依据,为青光眼患者的病情评估及随访提供影像学支持。原发性开角型青光眼患者与慢性闭角型青光眼患者病程进展过程相似,视路改变无明显差异。
[Abstract]:Objective: to evaluate the changes and differences of visual pathways between primary open-angle glaucoma (Poag) and chronic angle-closure glaucoma (CACGG) by magnetic resonance imaging (MRI), and to explore the correlation between visual field damage and visual pathway change in patients with glaucoma. To investigate the accuracy and feasibility of MRI imaging as auxiliary examination for glaucoma diagnosis. Methods: from May 2010 to February 2011, 12 patients (24 eyes) with primary open angle glaucoma and 8 patients with primary chronic angle-closed light were selected from the first affiliated Hospital of Dalian Medical University. The visual pathway was analyzed by MRI(1.5T magnetic resonance instrument (MRI(1.5T). The volume of lateral geniculate body was measured by proton density weighted imaging (PDWI), the volume of lateral geniculate body was measured by diffusion Zhang Liang imaging (DTI), the optic nerve, optic bundle, anisotropic fraction of visual radiation (FAA) and the mean diffusion rate (MDD) were measured. The history of all patients in the case group was within three to five years. All patients were measured with non-contact intraocular pressure (IOP) for 24 hours. The Humphrey visual field meter was used to record the decibels of visual field defect and the angle of inspection. C / D value recorded by fundus photography. Control group (18 eyes, 36 eyes). Normal healthy adults without other diseases of ophthalmology, hypertension, diabetes mellitus and other systemic diseases were required to undergo t test in Kaiqing group, closed green group and control group. According to the volume of lateral geniculate body and the values of FA and MD, the changes of visual pathway in patients with primary open-angle glaucoma and chronic angle-closure glaucoma were evaluated. The visual changes were recorded by Humphrey visual field meter. The decibel value of the field defect, The correlation between visual field damage and parameters was analyzed by Pearson. The patients with glaucoma were divided into three groups: pre, early, middle and late stage. The age, visual acuity (corrected C / D, lateral geniculate body volume, optic nerve, optic tract) were measured in the four groups. FA value and MD value of visual radiation were analyzed by single factor ANOVA. Results: compared with the control group, the volume of the lateral geniculate body in the Kaiqing group and the closed green group was significantly reduced by 72.91 卤15.81% (P 0.01), and the difference was statistically significant. The FA value of optic tract and visual radiation decreased significantly (P 0.01), and the difference was statistically significant. Compared with control group, the value of optic nerve, visual bundle and apparent radiation MD in closed green group was significantly higher than that in control group (P 0.01), the difference was statistically significant, and that in Kaiqing group was higher than that in control group, the optic nerve was higher in open green group than in control group. Compared with chronic angle closure glaucoma patients, the volume of lateral geniculate body, optic nerve, the volume of lateral geniculate body, and optic nerve in patients with primary open-angle glaucoma were significantly higher than those in patients with chronic angle closure glaucoma. There was no significant difference between FA value and MD value of visual beam and apparent radiation (P 0.05), but there was no statistical significance. The degree of visual field damage was correlated with each parameter on 伪 -0.05. According to the degree of visual field damage, single factor variance analysis was carried out among the parameters. There were significant differences in FA value, MD value of optic nerve and lateral geniculate body. Conclusion: glaucoma is a complex nervous system disease. MRI can provide quantitative evidence for the changes of the whole visual pathway. The clinical course of primary open-angle glaucoma was similar to that of chronic angle-closure glaucoma, but there was no significant difference in visual changes between patients with primary open-angle glaucoma and patients with chronic angle-closure glaucoma.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R775

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