中华眼视光学与视觉科学杂志
中華眼視光學與視覺科學雜誌
중화안시광학여시각과학잡지
CHINESE JOURNAL OF OPTOMETRY OPHTHALMOLOGY AND VISUAL SCIENCE
2011年
3期
218-222
,共5页
王莉莉%刘堃%凌振芬%许迅
王莉莉%劉堃%凌振芬%許迅
왕리리%류곤%릉진분%허신
多发性硬化%神经纤维层,视网膜%体层摄影术,光学相干%诱发电位,视觉%视网膜电描记术%EDSS评分
多髮性硬化%神經纖維層,視網膜%體層攝影術,光學相榦%誘髮電位,視覺%視網膜電描記術%EDSS評分
다발성경화%신경섬유층,시망막%체층섭영술,광학상간%유발전위,시각%시망막전묘기술%EDSS평분
Multiple sclerosis%Nerve fiber layer,retinal%Tomography,optical coherence%Evoked potential,visual%Electroretinography%EDSS score
目的 研究多发性硬化(MS)患者视网膜神经纤维层(RNFL)厚度与视功能、疾病病程及系统功能障碍之间的联系,评估RNFL厚度作为衡量MS病程中轴突缺失的生物学指标的意义.方法 横断面研究.MS患者17例(32眼),平均年龄(45.0±15.9)岁,及年龄、性别相匹配的健康对照者17例(17眼),平均年龄(43.3±14.9)岁.对所有患者和对照者均行全面的眼科检查,包括最佳矫正视力、光学相干断层扫描(OCT)测量RNFL厚度、图形视觉诱发电位(PVEP)及视网膜电图(ERG)检查.患者还进行了神经系统评估(以EDSS评分表示).根据有无视神经炎(ON)发作史将MS患者分为MS-ON组(16眼)和MS-NON组(16眼).采用单冈素方差分析对MS-ON组、MS-NON组和对照组的RNFL厚度、PVEP及ERG结果的差异进行分析,采用Spearman相关分析RNFL厚度与EDSS评分、病程及电生理结果之间的相关性.结果 MS-ON组的平均、上方、下方、颞侧、鼻侧RNFL厚度分别为(72.4±16.6)、(80.5±26.3)、(84.2±29.5)、(65.8±14.0)、(54.2±16.4)μm,与对照组[(105.6±10.8)、(119.7±18.2)、(123.5±17.9)、(91.1±21.2)、(88.2±13.0)μm]相比均较薄(P均=0.000).MS-ON组与MS-NON组[(98.3±12.0)、(115.5±18.2)、(117.7±21.5)、(72.0±15.0)、(68.1±16.1)μm]相比,平均、上方、下方及颞侧的RNFL厚度差异有统计学意义(P均＜0.05),而鼻侧的RNFL厚度差异则无统计学意义.MS-NON组与对照组相比,颞侧和鼻侧的RNFL厚度较薄(P均＜0.05),而平均、上方、下方的厚度相比差异均无统计学意义.MS-ON组患者的平均RNFL厚度与MS病程[(8.8±9.8)年]、EDSS评分(2.9±2.2)均呈负相关(r=-0.659、-0.741,P均＜0.05).而MS-NON患者的平均RNFL厚度与MS病程、EDSS评分的相关性无统计学意义.MS组平均RNFL厚度与60'和15'视角的P100波潜伏期和振幅均有相关性(r=-0.416、0.332、-0.317、0.265,P均＜0.05);与ERG最大反应的a波潜伏期、振幅及b波潜伏期都有相关性(r=-0.471、0.415、-0.360,P均＜0.05),而与b波振幅的相关性无统计学意义.结论 OCT测量的RNFL厚度可以作为MS患者轴突损伤的一项生物结构学指标用于临床.
目的 研究多髮性硬化(MS)患者視網膜神經纖維層(RNFL)厚度與視功能、疾病病程及繫統功能障礙之間的聯繫,評估RNFL厚度作為衡量MS病程中軸突缺失的生物學指標的意義.方法 橫斷麵研究.MS患者17例(32眼),平均年齡(45.0±15.9)歲,及年齡、性彆相匹配的健康對照者17例(17眼),平均年齡(43.3±14.9)歲.對所有患者和對照者均行全麵的眼科檢查,包括最佳矯正視力、光學相榦斷層掃描(OCT)測量RNFL厚度、圖形視覺誘髮電位(PVEP)及視網膜電圖(ERG)檢查.患者還進行瞭神經繫統評估(以EDSS評分錶示).根據有無視神經炎(ON)髮作史將MS患者分為MS-ON組(16眼)和MS-NON組(16眼).採用單岡素方差分析對MS-ON組、MS-NON組和對照組的RNFL厚度、PVEP及ERG結果的差異進行分析,採用Spearman相關分析RNFL厚度與EDSS評分、病程及電生理結果之間的相關性.結果 MS-ON組的平均、上方、下方、顳側、鼻側RNFL厚度分彆為(72.4±16.6)、(80.5±26.3)、(84.2±29.5)、(65.8±14.0)、(54.2±16.4)μm,與對照組[(105.6±10.8)、(119.7±18.2)、(123.5±17.9)、(91.1±21.2)、(88.2±13.0)μm]相比均較薄(P均=0.000).MS-ON組與MS-NON組[(98.3±12.0)、(115.5±18.2)、(117.7±21.5)、(72.0±15.0)、(68.1±16.1)μm]相比,平均、上方、下方及顳側的RNFL厚度差異有統計學意義(P均＜0.05),而鼻側的RNFL厚度差異則無統計學意義.MS-NON組與對照組相比,顳側和鼻側的RNFL厚度較薄(P均＜0.05),而平均、上方、下方的厚度相比差異均無統計學意義.MS-ON組患者的平均RNFL厚度與MS病程[(8.8±9.8)年]、EDSS評分(2.9±2.2)均呈負相關(r=-0.659、-0.741,P均＜0.05).而MS-NON患者的平均RNFL厚度與MS病程、EDSS評分的相關性無統計學意義.MS組平均RNFL厚度與60'和15'視角的P100波潛伏期和振幅均有相關性(r=-0.416、0.332、-0.317、0.265,P均＜0.05);與ERG最大反應的a波潛伏期、振幅及b波潛伏期都有相關性(r=-0.471、0.415、-0.360,P均＜0.05),而與b波振幅的相關性無統計學意義.結論 OCT測量的RNFL厚度可以作為MS患者軸突損傷的一項生物結構學指標用于臨床.
목적 연구다발성경화(MS)환자시망막신경섬유층(RNFL)후도여시공능、질병병정급계통공능장애지간적련계,평고RNFL후도작위형량MS병정중축돌결실적생물학지표적의의.방법 횡단면연구.MS환자17례(32안),평균년령(45.0±15.9)세,급년령、성별상필배적건강대조자17례(17안),평균년령(43.3±14.9)세.대소유환자화대조자균행전면적안과검사,포괄최가교정시력、광학상간단층소묘(OCT)측량RNFL후도、도형시각유발전위(PVEP)급시망막전도(ERG)검사.환자환진행료신경계통평고(이EDSS평분표시).근거유무시신경염(ON)발작사장MS환자분위MS-ON조(16안)화MS-NON조(16안).채용단강소방차분석대MS-ON조、MS-NON조화대조조적RNFL후도、PVEP급ERG결과적차이진행분석,채용Spearman상관분석RNFL후도여EDSS평분、병정급전생리결과지간적상관성.결과 MS-ON조적평균、상방、하방、섭측、비측RNFL후도분별위(72.4±16.6)、(80.5±26.3)、(84.2±29.5)、(65.8±14.0)、(54.2±16.4)μm,여대조조[(105.6±10.8)、(119.7±18.2)、(123.5±17.9)、(91.1±21.2)、(88.2±13.0)μm]상비균교박(P균=0.000).MS-ON조여MS-NON조[(98.3±12.0)、(115.5±18.2)、(117.7±21.5)、(72.0±15.0)、(68.1±16.1)μm]상비,평균、상방、하방급섭측적RNFL후도차이유통계학의의(P균＜0.05),이비측적RNFL후도차이칙무통계학의의.MS-NON조여대조조상비,섭측화비측적RNFL후도교박(P균＜0.05),이평균、상방、하방적후도상비차이균무통계학의의.MS-ON조환자적평균RNFL후도여MS병정[(8.8±9.8)년]、EDSS평분(2.9±2.2)균정부상관(r=-0.659、-0.741,P균＜0.05).이MS-NON환자적평균RNFL후도여MS병정、EDSS평분적상관성무통계학의의.MS조평균RNFL후도여60'화15'시각적P100파잠복기화진폭균유상관성(r=-0.416、0.332、-0.317、0.265,P균＜0.05);여ERG최대반응적a파잠복기、진폭급b파잠복기도유상관성(r=-0.471、0.415、-0.360,P균＜0.05),이여b파진폭적상관성무통계학의의.결론 OCT측량적RNFL후도가이작위MS환자축돌손상적일항생물결구학지표용우림상.
Objective To study the relationship between retinal nerve fiber layer (RNFL) thickness measured by optical coherence tomography (OCT) and visual function, disease course and system dysfunction in patients with multiple sclerosis (MS); to evaluate the significance of RNFL thickness as a biological marker for axonal loss in the course of MS disease. Methods This was a cross-sectional study. Seventeen MS patients (32 eyes) and 17 healthy people (17 eyes) were matched by age and sex. All participants received a neurological evaluation and a complete ophthalmological examination, including visual acuity, OCT measurement of RNFL thickness, pattern visual evoked potentials (PVEP) and electroretinography (ERG) examinations. Patients were divided into three groups: MS patients with a history of optic neuritis (MS-ON group), MS patients without a history of optic neuritis (MS-NON group) and the control group. The results of OCT measurement of RNFL thickness, and PVEP and ERG examinations of the three groups were compared by ANOVA. The relationship between RNFL thickness and the score on the expanded disability status scale (EDSS), and disease course, and electrophysiology results were analyzed by Spearman correlation analysis. Results The MS-ON eyes showed RNFL thinning in the average, superior, inferior, nasal, and temporal quadrants [(72.4±16.6), (80.5±26.3), (84.2±29.5), (65.8±14.0), (54.2±16.4)μm] compared to the control eyes [(105.6±10.8), (119.7±18.2), (123.5±17.9), (91.1 ±21.2), (88.2±13.0)μm] (P=0.000 each). The differences in RNFL thickness in the average, superior, inferior, and temporal quadrants between MS-ON eyes and MS-NON eyes [(98.3±12.0), (115.5±18.2), (117.7±21.5), (72.0±15.0), (68.1 ±16.1 )μm] were significant (P＜0.05 each), while the nasal quadrant did not show significant differences. Compared to control eyes, RNFL in the nasal and temporal quadrants in MS-NON eyes showed a significant reduction (P＜0.05 each), while the average, superior and inferior quadrants did not show significant thinning. RNFL thickness in MS-ON eyes was significantly correlated with the disease course of MS [(8.8±9.8)year] (r=-0.659, P=0.028) and EDSS scores (2.9±2.2) (r=-0.741, P=0.046). In this research, no significant relationships were found between RNFL thickness and disease course or EDSS scores in the MS-NON group. RNFL thickness in MS eyes showed a significant relationship to the latency and amplitude of P100 wave of both the 60' and 15' angles (r=-0.416, 0.332,-0.317, 0.265, P＜0.05 each), and the latency and amplitude of the a wave and latency of the b wave in the ERG maximum response (r=-0.471, 0.415,-0.360, P＜0.05 each), while no relationship was found between RNFL thickness and the amplitude of the b wave. Conclusion RNFL thickness measured by OCT can be used for clinical application as a structural biomarker of axonal loss in MS patients.
