NAION患者RAPD检测与视功能及证候积分的相关性研究

发布时间：2018-11-27 07:08

【摘要】：相对性传入瞳孔障碍(RAPD)反映的是客观的视功能信息,能提供可能的病因学诊断依据,对于判断病情的发展变化亦有指导作用的一项体征,而国内有关RAPD的研究相对较少。RAPD的产生来自于双眼对光信号接受传递的不对称性,本文旨在尝试证明RAPD与各项视功能检查差值及中医证候积分之间的相关性。本论文主要包括文献综述和临床研究分析两大部分。文献综述部分包括"相对传入瞳孔障碍的现代研究概况"、"非动脉炎性前部缺血性视神经病变的现代研究进展"、"中医青盲相关理论概述"三个部分。在"相对传入瞳孔障碍(RAPD)的现代研究概况"中介绍了 RAPD的定义、原理、测量方法、相关疾病以及国内外对其与视功能之间的相关性研究;"非动脉炎性前部缺血性视神经病变的现代研究进展"中介绍了 NAION的发病机制、高危因素、相关检查、治疗及预后;"中医青盲相关理论概述"中介绍了青盲的定义、辨证分型、辨证治疗及特色治疗。临床研究分析部分:目的:研究RAPD值与各项视功能检查差值及中医证候积分之间的相关性;方法:入组45名由NAION引起的,中医辨证为肝肾不足型的视神经萎缩患者,对患者的性别、眼别、既往史等基本资料进行整理统计,并以RAPD的中性滤光镜片检查法定量RAPD值,搜集患者视力、视野、OCT、电生理等方面数据,完成中医证候积分量表,然后进行RAPD值与各项检查数据及证候积分之间的相关性研究,在此基础上,尝试以多元回归方程描述其间的关系。结果:本次入组的45例样本中,男性24人(53.3%),女性21人(46.7%);RAPD表现阳性的右眼有23例(51.1%),左眼22例(48.9%),在性别、眼别等方面无差异;最小发病年龄为34岁,最大发病年龄为77岁,发病平均年龄为54.09±9.596岁,50-55岁发病的人数最多。其中确诊有颈部动脉斑块的有16人(35.6%),动脉硬化或有内膜增厚等早期病变的有17人(37.8%),确诊有阻塞性睡眠呼吸暂停低通气综合症(OSAS)的25人(55.6%);而且此45例样本中,合并有高血压、糖尿病或高脂血症的患者过半数;RAPD值的大小与双眼的视力差值、视野MD差值、视野MS差值、RNFL厚度差值具有线性相关,与电生理VEP差值之间未见明显相关,与中医青盲的肝肾不足证候积分之间无统计学意义,得到了多元回归方程如下:RAPD 值=0.09+0.066 × 视野 MS 差值+0.003 × RNFL 差值+0.034 × 视力差值。结论:NAION的发病,在性别、眼别方面不存在偏向性,发病多集中在中老年人;高血压、糖尿病、高脂血症、OSAS、颈部动脉异常等都有可能是NAION的危险因素。RAPD值与视野的相关性最大,视力、平均RNFL厚度次之,四个变量之间存在方程关系,而电生理与RAPD值之间未发现明显相关性。中医证候积分与RAPD值的关联证据不充分。
[Abstract]:Relativistic afferent pupillary disorder (RAPD) reflects objective information of visual function, can provide possible etiological diagnosis basis, and has a guiding function in judging the development and change of the disease. However, there are relatively few studies on RAPD in China. The production of RAPD comes from the asymmetry of optical signal transmission in both eyes. This paper attempts to prove the correlation between RAPD and the difference of visual function examination and TCM syndromes integral. This paper mainly includes two parts: literature review and clinical research analysis. The literature review includes three parts: "A Survey of Modern Research on relative Afferent pupil Disorder", "Modern Research Progress of Non-Arterial inflammatory anterior Ischemic Optic Neuropathy", and "Overview of related theories of traditional Chinese Medicine and Blindness". The definition, principle, measurement method, related diseases and the correlation between RAPD and visual function of relative afferent pupillary disorder (RAPD) were introduced in "A Survey of Modern Research on relative Afferent pupillary Disorder". The pathogenesis, high risk factors, relevant examination, treatment and prognosis of NAION were introduced in the present study of anterior ischemic optic neuropathy of non-arterial inflammation. The definition, syndrome differentiation, syndrome differentiation and characteristic treatment of youth blindness are introduced in outline of related theories of youth blindness in traditional Chinese medicine. Part of clinical analysis: objective: to study the correlation between RAPD value and the difference of visual function and TCM syndromes. Methods: 45 patients with optic nerve atrophy caused by NAION with syndrome differentiation of liver and kidney deficiency were collected and analyzed. The basic data such as sex, eye differentiation, past history and so on were analyzed, and the RAPD value was measured by neutral filter of RAPD. Collect the patient's visual acuity, visual field, OCT, electrophysiology and other data, complete the TCM syndrome integral scale, and then carry on the research of the correlation between the RAPD value and the examination data and syndromes integral, on the basis of this, This paper attempts to describe the relationship with multivariate regression equation. Results: there were 24 males (53.3%) and 21 females (46.7%). There were 23 cases (51.1%) in right eye and 22 cases (48.9%) in left eye. The minimum age of onset was 34 years old, the maximum age of onset was 77 years old, the average age of onset was 54.09 卤9.596 years, and the number of patients aged 50-55 years was the highest. Among them, 16 cases (35.6%) were diagnosed with carotid artery plaque, 17 cases (37.8%) with early lesions such as atherosclerosis or intimal thickening. 25 patients (55.6%) were diagnosed with obstructive sleep apnea hypopnea syndrome (OSAS). And more than half of the 45 patients with hypertension, diabetes or hyperlipidemia; There was a linear correlation between RAPD value and visual acuity, visual field MD difference, visual field MS difference, RNFL thickness difference, there was no significant correlation between RAPD value and electrophysiological VEP difference, and there was no statistical significance between RAPD value and liver and kidney deficiency syndrome score of traditional Chinese medicine. The multivariate regression equation was obtained as follows: RAPD value = 0.09 0.066 脳 visual field MS difference 0.003 脳 RNFL difference 0.034 脳 visual acuity difference. Conclusion: the incidence of NAION is not biased in sex and eye sex. Hypertension, diabetes, hyperlipidemia and abnormal OSAS, cervical artery may all be risk factors of NAION. The correlation between RAPD value and visual field is the greatest, visual acuity, average RNFL thickness is the second, and there is an equation relationship among four variables. There was no significant correlation between electrophysiology and RAPD. The evidence of correlation between TCM syndromes integral and RAPD value is insufficient.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R276.7

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