CAJ | 학술논문

目的应用OCT测量服用乙胺丁醇的结核患者的视网膜神经纤维层(RNFL)厚度,探讨乙胺丁醇对视神经纤维的影响,以及OCT在诊断中毒性视神经早期病变中的价值.方法横断面研究.分析眼科门诊收集的93例(185眼)服用乙胺丁醇的结核患者,其中短疗程组(服用乙胺丁醇2个月)共49例(97眼),长疗程组(服乙胺丁醇6个月以上)共44例(88眼),以未开始抗结核治疗的结核患者作为对照组,共46例(92眼),应用OCT测量3组各象限RNFL厚度,并进行单因素方差分析及两两比较,此外对所有患者进行眼科常规检查包括视力、眼压、色觉、裂隙灯、眼底、视野检查.结果短疗程组RNFL厚度:颞侧(90.35±12.58)μm,下方(145.91±17.18)μm,鼻侧(93.18±16.9)μm,上方(139.07±18.65)μm,平均厚度为(117.01±10.14)μm.长疗程组:颞侧(79.75±17.14)μm,下方(135.47±19.14)μm,鼻侧(91.17±20.23)μm,上方(130.44±21.50)μm,平均厚度(109.24±14.36)μm.对照组:颞侧(95.43±15.61)μm,下方(139.92±15.35)μm,鼻侧(90.06±15.61)μm,上方(140.71±19.02)μm,平均厚度为(116.49±11.49) μm.与对照组相比,短疗程组各象限RNFL厚度差异无统计学意义(P＞0.05),而长疗程组的颞侧(P＜0.01)、上方(P＜0.05)及平均RNFL值(P＜0.05)均较对照组薄,差异有统计学意义.在185眼中有6眼诊断为乙胺丁醇中毒性视神经病变,其各象限RNFL较对照组薄.结论短期服用乙胺丁醇(0.75 g·d-1)的患者未出现明显视神经纤维丢失及视功能损害,而长期服药者可出现RNFL的变薄,尤其是颞侧象限,这对诊断乙胺丁醇中毒性视神经早期病变有一定临床意义.
목적 응용OCT측량복용을알정순적결핵환자적시망막신경섬유층(RNFL)후도,탐토을알정순대시신경섬유적영향,이급OCT재진단중독성시신경조기병변중적개치.방법 횡단면연구.분석안과문진수집적93례(185안)복용을알정순적결핵환자,기중단료정조(복용을알정순2개월)공49례(97안),장료정조(복을알정순6개월이상)공44례(88안),이미개시항결핵치료적결핵환자작위대조조,공46례(92안),응용OCT측량3조각상한RNFL후도,병진행단인소방차분석급량량비교,차외대소유환자진행안과상규검사포괄시력、안압、색각、렬극등、안저、시야검사.결과 단료정조RNFL후도:섭측(90.35±12.58)μm,하방(145.91±17.18)μm,비측(93.18±16.9)μm,상방(139.07±18.65)μm,평균후도위(117.01±10.14)μm.장료정조:섭측(79.75±17.14)μm,하방(135.47±19.14)μm,비측(91.17±20.23)μm,상방(130.44±21.50)μm,평균후도(109.24±14.36)μm.대조조:섭측(95.43±15.61)μm,하방(139.92±15.35)μm,비측(90.06±15.61)μm,상방(140.71±19.02)μm,평균후도위(116.49±11.49) μm.여대조조상비,단료정조각상한RNFL후도차이무통계학의의(P＞0.05),이장료정조적섭측(P＜0.01)、상방(P＜0.05)급평균RNFL치(P＜0.05)균교대조조박,차이유통계학의의.재185안중유6안진단위을알정순중독성시신경병변,기각상한RNFL교대조조박.결론 단기복용을알정순(0.75 g·d-1)적환자미출현명현시신경섬유주실급시공능손해,이장기복약자가출현RNFL적변박,우기시섭측상한,저대진단을알정순중독성시신경조기병변유일정림상의의.
Objective To measure the changes in retinal nerve fiber layer (RNFL) thickness using OCT in patients treated with ethambutol,to detect the axonal loss caused by ethambutol,and to assess the value of OCT in the early diagnosis of toxic optic neuropathy.Methods This was a retrospective observation of 185 eyes of 93 patients collected in ophthalmology department,being treated with ethambutol.They were separated into short-time treatment group (2 months) and long-time treatment group (≥6 months),and 92 eyes of 46 age-matched TB infected patients who haven't started the treatment were chosen as the control group.The differences in RNFL thickness from the three groups were compared using ANOVA.All patients underwent a neuro-ophthalmologic examination including visual acuity,color vision,visual fields and fundus examination.Results RNFL thickness of short-time treatment group:temporal (90.35±12.58)μm,inferior (145.91±17.18)μm,nasal (93.18± 16.9)μm,superior (139.07±18.65)μm,average thickness (117.01±10.14)μm.RNFL thickness of long-time treatment group:temporal (79.75±17.14)μm,inferior (135.47±19.14)μm,nasal (91.17±20.23)μm,superior (130.44±21.50)μm,average thickness (109.24±14.36)μm.The control group:temporal (95.43± 15.61)μm,inferior (139.92±15.35)μm,nasal (90.06±15.61)μm,superior (140.71±19.02)μm,average thickness (116.49±11.49)μm.Compared with the control group,no significant changes of RNFL thickness were found in the short-term group (P＞0.05).There were statistically significant decrease in the mean RNFL thickness of the temporal and superior quadrants between the long-term medication group from the control group (P＜0.05).A prominent decrease in RNFL thickness was observed in all quadrants in 6 eyes diagnosed with ethambutol induced optic neuropathy.Conclusion The short-term administration of ethambutol (0.75 g·d-1) in most of the patients did not cause obvious axonal loss and visual damage,but in the long-term group the RNFL thinning could be found apparently in the temporal quadrant,which maybe of great importance for early diagnosis of ethambutol toxic optic neuropathy.