中华眼科杂志
中華眼科雜誌
중화안과잡지
Chinese Journal of Ophthalmology
2012年
11期
1001-1004
,共4页
汤洋%瞿远珍%杨柳%王剑%王丽娜%方民%陆雯
湯洋%瞿遠珍%楊柳%王劍%王麗娜%方民%陸雯
탕양%구원진%양류%왕검%왕려나%방민%륙문
脑膜肿瘤%垂体肿瘤%视网膜神经节细胞%体层摄影术,光学相关%视野检查法
腦膜腫瘤%垂體腫瘤%視網膜神經節細胞%體層攝影術,光學相關%視野檢查法
뇌막종류%수체종류%시망막신경절세포%체층섭영술,광학상관%시야검사법
Meningeal neoplasms%Pituitary neoplasms%Retinal ganglion cells%Tomography,optical coherence%Perimetry
目的 分析相干光断层扫描(OCT)测量鞍区肿瘤患者黄斑区视网膜神经节细胞复合体(GCC)及视乳头周围视网膜神经纤维层(pRNFL)厚度的变化,并分析其与视野损伤指标视野平均缺损度(MD)及视野平均敏感度(MS)的相关性.方法 病例对照研究.对2010年11月至2011年6月在首都医科大学附属北京天坛医院神经外科就诊的279例不同类型鞍区肿瘤病例的540只眼和健康人188例376只眼(健康对照组)进行视野和OCT检查,测量神经纤维层厚度和GCC层厚度,比较垂体瘤组、颅咽管瘤组、鞍部脑膜瘤组和健康对照组pRNFL及GCC厚度的变化.利用Spearman等级相关系数(rs)评价其与MD、MS的相关性.结果 双眼的pRNFL平均厚度(有眼rs=0.369 ～0.735,左眼rs=0.369～0.691)及GCC平均厚度(右眼rs=0.357 ～0.797,左眼rs=0.375 ～0.681),分别与MD及MS相关(P＜0.01),且鞍部脑膜瘤组相关性更强.垂体瘤组[右眼:(101.25±19.95) μm和(91.08±13.19) μm；左眼:(99.96±20.95) μm和(89.82±15.47) μm]、颅咽管瘤组[右眼:(94.96±16.59) μm和(86.46±11.65)μm；左眼:(94.92±15.77) μm和(86.77±9.56) μm]、鞍部脑膜瘤组[右眼:(89.54±19.19) μm和(80.77±10.43) μm；左眼:(92.79±22.00)μm1和(80.43±10.09) μm]的pRNFL及GCC厚度较健康对照组[右眼:(113.60±9.13) μm和(98.04 ±6.85) μm;左眼:(114.06±8.99) μm和(97.70 ±5.83) μm]薄,鞍部脑膜瘤组的pRNFL及GCC厚度较健康对照组薄,鞍部脑膜瘤组pRNFL和GCC厚度较垂体瘤组、颅咽管瘤组更薄,差异有统计学意义(P＜0.05).结论 pRNFL和GCC厚度与视野损害相关,可定量地评估鞍区肿瘤患者的视神经损害程度,pRNFL和GCC厚度越薄,视功能损害越严重.3种肿瘤中,鞍部脑膜瘤对视路损伤更严重.在临床工作中,将视野检查和OCT检查结合起来,更有助于发现及评估患者的视路损害及预后.
目的 分析相榦光斷層掃描(OCT)測量鞍區腫瘤患者黃斑區視網膜神經節細胞複閤體(GCC)及視乳頭週圍視網膜神經纖維層(pRNFL)厚度的變化,併分析其與視野損傷指標視野平均缺損度(MD)及視野平均敏感度(MS)的相關性.方法 病例對照研究.對2010年11月至2011年6月在首都醫科大學附屬北京天罈醫院神經外科就診的279例不同類型鞍區腫瘤病例的540隻眼和健康人188例376隻眼(健康對照組)進行視野和OCT檢查,測量神經纖維層厚度和GCC層厚度,比較垂體瘤組、顱嚥管瘤組、鞍部腦膜瘤組和健康對照組pRNFL及GCC厚度的變化.利用Spearman等級相關繫數(rs)評價其與MD、MS的相關性.結果 雙眼的pRNFL平均厚度(有眼rs=0.369 ～0.735,左眼rs=0.369～0.691)及GCC平均厚度(右眼rs=0.357 ～0.797,左眼rs=0.375 ～0.681),分彆與MD及MS相關(P＜0.01),且鞍部腦膜瘤組相關性更彊.垂體瘤組[右眼:(101.25±19.95) μm和(91.08±13.19) μm；左眼:(99.96±20.95) μm和(89.82±15.47) μm]、顱嚥管瘤組[右眼:(94.96±16.59) μm和(86.46±11.65)μm；左眼:(94.92±15.77) μm和(86.77±9.56) μm]、鞍部腦膜瘤組[右眼:(89.54±19.19) μm和(80.77±10.43) μm；左眼:(92.79±22.00)μm1和(80.43±10.09) μm]的pRNFL及GCC厚度較健康對照組[右眼:(113.60±9.13) μm和(98.04 ±6.85) μm;左眼:(114.06±8.99) μm和(97.70 ±5.83) μm]薄,鞍部腦膜瘤組的pRNFL及GCC厚度較健康對照組薄,鞍部腦膜瘤組pRNFL和GCC厚度較垂體瘤組、顱嚥管瘤組更薄,差異有統計學意義(P＜0.05).結論 pRNFL和GCC厚度與視野損害相關,可定量地評估鞍區腫瘤患者的視神經損害程度,pRNFL和GCC厚度越薄,視功能損害越嚴重.3種腫瘤中,鞍部腦膜瘤對視路損傷更嚴重.在臨床工作中,將視野檢查和OCT檢查結閤起來,更有助于髮現及評估患者的視路損害及預後.
목적 분석상간광단층소묘(OCT)측량안구종류환자황반구시망막신경절세포복합체(GCC)급시유두주위시망막신경섬유층(pRNFL)후도적변화,병분석기여시야손상지표시야평균결손도(MD)급시야평균민감도(MS)적상관성.방법 병례대조연구.대2010년11월지2011년6월재수도의과대학부속북경천단의원신경외과취진적279례불동류형안구종류병례적540지안화건강인188례376지안(건강대조조)진행시야화OCT검사,측량신경섬유층후도화GCC층후도,비교수체류조、로인관류조、안부뇌막류조화건강대조조pRNFL급GCC후도적변화.이용Spearman등급상관계수(rs)평개기여MD、MS적상관성.결과 쌍안적pRNFL평균후도(유안rs=0.369 ～0.735,좌안rs=0.369～0.691)급GCC평균후도(우안rs=0.357 ～0.797,좌안rs=0.375 ～0.681),분별여MD급MS상관(P＜0.01),차안부뇌막류조상관성경강.수체류조[우안:(101.25±19.95) μm화(91.08±13.19) μm；좌안:(99.96±20.95) μm화(89.82±15.47) μm]、로인관류조[우안:(94.96±16.59) μm화(86.46±11.65)μm；좌안:(94.92±15.77) μm화(86.77±9.56) μm]、안부뇌막류조[우안:(89.54±19.19) μm화(80.77±10.43) μm；좌안:(92.79±22.00)μm1화(80.43±10.09) μm]적pRNFL급GCC후도교건강대조조[우안:(113.60±9.13) μm화(98.04 ±6.85) μm;좌안:(114.06±8.99) μm화(97.70 ±5.83) μm]박,안부뇌막류조적pRNFL급GCC후도교건강대조조박,안부뇌막류조pRNFL화GCC후도교수체류조、로인관류조경박,차이유통계학의의(P＜0.05).결론 pRNFL화GCC후도여시야손해상관,가정량지평고안구종류환자적시신경손해정도,pRNFL화GCC후도월박,시공능손해월엄중.3충종류중,안부뇌막류대시로손상경엄중.재림상공작중,장시야검사화OCT검사결합기래,경유조우발현급평고환자적시로손해급예후.
Objectives To analyze the differences and correlation between the ganglion cell complex (GCC),peripapillary retinal nerve fiber laver (pRNFL) and mean deviation (MD),mean sensitivity (MS) of saddle area tumor patients,and to evaluate the feasibility of using OCT to diagnose the visual pathway damage of saddle area tumor patients.Methods It was a case-control study.One hundred and eighty-eight normal persons and 279 saddle area tumor patients treated in Beijing Tiantan hospital,from November 2010 to June 2011,were recruited; the saddle area tumor patients were diagnosed by surgical sample pathological analysis.The recruits were divided into four groups,including the normal group,the pituitary gland tumours group,the meningiomas group and the craniopharynglomas group.All patients received the visual field (VF) test using the Octopus 900 automated perimeter with the central 30 degree program,and the mean thickness measurements of GCC and pRNFL were made by RTVue OCT.The Spearman rank correlation coefficient was used to assess the correlation between GCC,pRNFL and MD,MS.The differences between pRNFL and GCC among the four groups were compared.Results The averagethickness of the pRNFL (rsOD =0.369-0.735,rsOS =0.369-0.691) and GCC (rsOD =0.357-0.797,rsOS =0.375-0.681) were correlated with MD and MS (P ＜0.01),and the measurements from the meningiomas was the most significant.Comparing with the normal group's thickness of pRNFL and GCC [OD:(113.60 ±9.13) μm and (98.04 ± 6.85) μm;OS:(114.06 ± 8.99) μm and (97.70 ±5.83) tm],the pituitary gland tumours group [OD:(101.25 ± 19.95) μm and (91.08 ± 13.19) μm ; OS:(99.96±20.95) μm and (89.82 ± 15.47)μm],meningiomas group[OD:(89.54± 19.19) μm and (80.77 ± 10.43) μm ; OS:(92.79 ± 22.00) μm and (80.43 ± 10.09) μm] and craniopharynglomas group [OD:(94.96 ± 16.59) μm and (86.46 ± 11.65) μm; OS:(94.92 ± 15.77) μm and (86.77 ± 9.56) μm] were thinner.There was statistically significant difference of pRNFL and GCC,among the three tumor groups,and the thickness of pRNFL and GCC of the meningiomas group was the thinnest(P ＜ 0.05).Conclusions The average thickness of the pRNFL and GCC is correlated with vision field damage,which can be used to evaluate optic nerve damage of saddle area tumor patients quantitatively,where the meningiomas was thc most significant.The thickness of the pRNFL and GCC was thinner,and the damage to visual functions was more serious.In the three tumor groups,the meningiomas group was the most serious.In the clinic,visual field test combined with OCT were helpful to find and assess the damage to visual pathway and prognosis.
