中华眼科杂志
中華眼科雜誌
중화안과잡지
Chinese Journal of Ophthalmology
2014年
12期
900-905
,共6页
黄剑锋%戴虹%张华%王笑雄%陈彤
黃劍鋒%戴虹%張華%王笑雄%陳彤
황검봉%대홍%장화%왕소웅%진동
多发性硬化%体层摄影术,光学相干%视神经炎%视网膜神经节细胞%神经纤维
多髮性硬化%體層攝影術,光學相榦%視神經炎%視網膜神經節細胞%神經纖維
다발성경화%체층섭영술,광학상간%시신경염%시망막신경절세포%신경섬유
Multiple sclerosis%Tomography,optical coherence%Optic Neuritis%Retinal ganglion cells%Nerve fibers
目的 利用OCT评价不同类型多发性硬化(MS)患者视神经损伤的程度.方法 横断面研究.符合2010 Mcdonald诊断标准的MS患者30例(52只眼).其中MS患者根据有无视神经炎发作分为3个亚组:MS视神经炎组(MS-ON组)共22例(22只眼),MS非视神经炎组(MS-NON组)共8例(16只眼),MS视神经炎患眼的对侧眼(MS-ON Contra组)共14例(14只眼).另外,性别、年龄匹配的健康对照组13例(13只眼).应用傅立叶域OCT进行检查,检查程序包括黄斑部扫描,视网膜神经纤维层(RNFL)厚度,神经节细胞复合体(GCC)加视神经盘扫描,同时比较各组间视力、视野表现.主要测量指标为RNFL厚度及GCC厚度.采用单因素方差分析统计学方法比较4组各测量指标总体差异,采用LSD法完成两两组间比较.结果 MS-ON组的平均GCC、上方GCC和下方GCC分别为(80.65±16.03)、(81.50±14.56)、(79.83±17.65)μm,与MS-NON组[(99.65 ±9.35)、(99.26 ±9.73)、(100.06 ±9.31) μm],MS-ON Contra组[(99.36±8.25)、(100.39±8.97)、(98.34±7.88)μm]及健康对照组[(104.87 ±8.71) 、(105.36 ±8.21)、(103.96±10.33) μm]对比均明显变薄(P均＜0.05),而其他3组之间GCC厚度无明显差异.MS-ON组的平均RNFL厚度为(83.68±29.91)tμm,与MS-NON组[(108.83±15.33) μm]及健康对照组[(111.60±14.90) μm]相比明显变薄(P＜0.05),MS-ON组鼻下RNFL厚度(92.26±35.97) μm,与MS-NON[(120.85±35.96) μm]及健康对照组[(139.95±7.77) μm]相比明显变薄(P均＜0.05),颞下[(109.63 ±44.54) μm]及颞侧[(60.47±26.94) μm] RNFL厚度较MS-NON组[(149.92±18.51)、(90.64±16.15) μm]及MS-ONContra组[(135.70 ±28.66)、(77.30±23.40) μm]和健康对照组[(172.72±15.29)、(90.90±6.15) μm]明显变薄(P均＜0.05),且MS-ON Contra组鼻下、颞下及颞侧RNFL厚度[(106.60±44.07)、(135.70±28.66)、(77.30±23.40) μm],与健康对照组[(139.95 ±7.77)、(172.72±15.29)、(90.90 ±6.15) μm]相比也明显变薄(P均＜0.05).结论 OCT检查GCC和RNFL厚度可用于评价MS患者的视神经损伤的程度,且RNFL厚度的检测可反映早期及潜在的MS视神经病变.
目的 利用OCT評價不同類型多髮性硬化(MS)患者視神經損傷的程度.方法 橫斷麵研究.符閤2010 Mcdonald診斷標準的MS患者30例(52隻眼).其中MS患者根據有無視神經炎髮作分為3箇亞組:MS視神經炎組(MS-ON組)共22例(22隻眼),MS非視神經炎組(MS-NON組)共8例(16隻眼),MS視神經炎患眼的對側眼(MS-ON Contra組)共14例(14隻眼).另外,性彆、年齡匹配的健康對照組13例(13隻眼).應用傅立葉域OCT進行檢查,檢查程序包括黃斑部掃描,視網膜神經纖維層(RNFL)厚度,神經節細胞複閤體(GCC)加視神經盤掃描,同時比較各組間視力、視野錶現.主要測量指標為RNFL厚度及GCC厚度.採用單因素方差分析統計學方法比較4組各測量指標總體差異,採用LSD法完成兩兩組間比較.結果 MS-ON組的平均GCC、上方GCC和下方GCC分彆為(80.65±16.03)、(81.50±14.56)、(79.83±17.65)μm,與MS-NON組[(99.65 ±9.35)、(99.26 ±9.73)、(100.06 ±9.31) μm],MS-ON Contra組[(99.36±8.25)、(100.39±8.97)、(98.34±7.88)μm]及健康對照組[(104.87 ±8.71) 、(105.36 ±8.21)、(103.96±10.33) μm]對比均明顯變薄(P均＜0.05),而其他3組之間GCC厚度無明顯差異.MS-ON組的平均RNFL厚度為(83.68±29.91)tμm,與MS-NON組[(108.83±15.33) μm]及健康對照組[(111.60±14.90) μm]相比明顯變薄(P＜0.05),MS-ON組鼻下RNFL厚度(92.26±35.97) μm,與MS-NON[(120.85±35.96) μm]及健康對照組[(139.95±7.77) μm]相比明顯變薄(P均＜0.05),顳下[(109.63 ±44.54) μm]及顳側[(60.47±26.94) μm] RNFL厚度較MS-NON組[(149.92±18.51)、(90.64±16.15) μm]及MS-ONContra組[(135.70 ±28.66)、(77.30±23.40) μm]和健康對照組[(172.72±15.29)、(90.90±6.15) μm]明顯變薄(P均＜0.05),且MS-ON Contra組鼻下、顳下及顳側RNFL厚度[(106.60±44.07)、(135.70±28.66)、(77.30±23.40) μm],與健康對照組[(139.95 ±7.77)、(172.72±15.29)、(90.90 ±6.15) μm]相比也明顯變薄(P均＜0.05).結論 OCT檢查GCC和RNFL厚度可用于評價MS患者的視神經損傷的程度,且RNFL厚度的檢測可反映早期及潛在的MS視神經病變.
목적 이용OCT평개불동류형다발성경화(MS)환자시신경손상적정도.방법 횡단면연구.부합2010 Mcdonald진단표준적MS환자30례(52지안).기중MS환자근거유무시신경염발작분위3개아조:MS시신경염조(MS-ON조)공22례(22지안),MS비시신경염조(MS-NON조)공8례(16지안),MS시신경염환안적대측안(MS-ON Contra조)공14례(14지안).령외,성별、년령필배적건강대조조13례(13지안).응용부립협역OCT진행검사,검사정서포괄황반부소묘,시망막신경섬유층(RNFL)후도,신경절세포복합체(GCC)가시신경반소묘,동시비교각조간시력、시야표현.주요측량지표위RNFL후도급GCC후도.채용단인소방차분석통계학방법비교4조각측량지표총체차이,채용LSD법완성량량조간비교.결과 MS-ON조적평균GCC、상방GCC화하방GCC분별위(80.65±16.03)、(81.50±14.56)、(79.83±17.65)μm,여MS-NON조[(99.65 ±9.35)、(99.26 ±9.73)、(100.06 ±9.31) μm],MS-ON Contra조[(99.36±8.25)、(100.39±8.97)、(98.34±7.88)μm]급건강대조조[(104.87 ±8.71) 、(105.36 ±8.21)、(103.96±10.33) μm]대비균명현변박(P균＜0.05),이기타3조지간GCC후도무명현차이.MS-ON조적평균RNFL후도위(83.68±29.91)tμm,여MS-NON조[(108.83±15.33) μm]급건강대조조[(111.60±14.90) μm]상비명현변박(P＜0.05),MS-ON조비하RNFL후도(92.26±35.97) μm,여MS-NON[(120.85±35.96) μm]급건강대조조[(139.95±7.77) μm]상비명현변박(P균＜0.05),섭하[(109.63 ±44.54) μm]급섭측[(60.47±26.94) μm] RNFL후도교MS-NON조[(149.92±18.51)、(90.64±16.15) μm]급MS-ONContra조[(135.70 ±28.66)、(77.30±23.40) μm]화건강대조조[(172.72±15.29)、(90.90±6.15) μm]명현변박(P균＜0.05),차MS-ON Contra조비하、섭하급섭측RNFL후도[(106.60±44.07)、(135.70±28.66)、(77.30±23.40) μm],여건강대조조[(139.95 ±7.77)、(172.72±15.29)、(90.90 ±6.15) μm]상비야명현변박(P균＜0.05).결론 OCT검사GCC화RNFL후도가용우평개MS환자적시신경손상적정도,차RNFL후도적검측가반영조기급잠재적MS시신경병변.
Objective To evaluate the impairment of optic nerve of different types of multiple sclerosis (MS) by optic coherence tomography (OCT).Methods Cross-sectional study.52 eyes of 30 patients who diagnosed as MS up to the 2010 Mcdonald criteria were included.13 eyes of 13 healthy people matched with sex and age were set as the control group.Patients with MS were divided into 3 subgroups based on the history of optic neuritis (ON):22 eyes of MS patients with the history of ON were in MS-ON group,16 eyes of MS patients without ON were in MS-NON group and 14 contralateral eyes of MS-ON patients were in MS-ON Contra group.Fourier domain OCT was used to examine.The protocol included macula scanning,retinal nerve fiber layer (RNFL) analysis and ganglion cell complex (GCC) and optic nerve head (ONH) scanning.Visual acuity (VA) and visual field (VF) were also compared.The major measurements were RNFL and GCC thickness.ANOVA was used to compare the overall difference of RNFL and GCC thickness among all the groups.LSD method was used to compare the difference between every two groups.Results The thickness of average GCC,superior GCC and inferior GCC of MS-ON group is (80.65 ± 16.03) μm,(81.50 ± 14.56) μm,(79.83 ± 17.65) μm.Compared with the MS-NON group which is(99.65 ± 9.35) μm,(99.26 ± 9.73) μm,(100.06 ± 9.31) μm correspondingly,MS-ON contra group (99.36 ± 8.25) μm,(100.39 ± 8.97) μm,(98.34 ± 7.88) μm correspondingly and the control group (104.87 ± 8.71) μm,(105.36 ± 8.21) μm,(103.96 ± 10.33) μm correspondingly,they decreased significantly (P ＜ O.05).While the GCC thickness has no significantly difference among the MS-NON,MSON Contra and the control group.The average RNFL thickness and nasal inferior quadrant RNFL thickness in MS-ON group was (83.68 ±29.91) μm,(92.26 ±35.97) μm.And they were significantly thinner than that in the MS-NON group which was (108.83 ± 15.33) μm,(120.85 ± 35.96) μm correspondingly and that in the control group which was (111.60 ± 14.90) μm,(139.95 ±7.77) μm correspondingly (P ＜ 0.05).The RNFL thickness in temporal inferior quadrant in MS-ON group was (109.63 ± 44.54) μm and it was (60.47 ± 26.94) μm in the temporal quadrant.And they decreased significantly compared with that in the MS-NON which was (149.92 ± 18.51) μm,(90.64 ± 16.15) μm correspondingly,and in the MSON Contra group which was (135.70± 28.66) μm,(77.30± 23.40) μm correspondingly and in the control group which was (172.72 ± 15.29) μm,(90.90 ± 6.15) μm correspondingly (P ＜ 0.05).The RNFL thickness in nasal inferior,temporal inferior and temporal quadrant in the MS-ON Contra group was (106.60 ±44.07) μm,(135.70 ±28.66) μm,(77.30 ±23.40) μm respectively which was significantly thinner than that in the control group which was (139.95 ±7.77) μm,(172.72 ± 15.29) μm,(90.90 ± 6.15) μm correspondingly (P ＜ 0.05).Conclusions GCC and RNFL thickness of OCT test can be used to evaluate the impairment of optic nerve of MS patients,and the RNFL scanning can reflect the early and latent lesion of optic nerve in MS.(Chin J Ophthalmol,2014,50:900-905)
