CAJ | 학술논문

目的：探讨非动脉炎性前部缺血性视神经病变（NAION）的危险因素及诊断。方法收集2014年1月至2015年6月在山西医科大学第一医院眼科诊断为NAION的患者42例（44眼）行眼底荧光素血管造影（FFA）、视野、图形视觉诱发电位（VEP）、颈动脉多普勒超声检查及血压、血糖、血脂等检测，设对照组30例，年龄范围42～71岁，平均（55.43±8.03）岁。结果 NAION组与对照组比较，年龄、颈动脉病变、高血压病及高脂血症差异均有统计学意义（P＜0.05）；糖尿病、性别及吸烟差异均无统计学意义（P＞0.05）。FFA早期44患眼视盘均呈部分荧光充盈延迟或缺损，晚期表现多样；视野检查37眼（84.09%）表现为与生理盲点相连的象限或扇形缺损；VEP检查P 100波振幅异常的比例（92.50%）明显高于潜伏期异常的比例（67.50%），NAION患眼组与健眼组及对照组比较，P100波潜伏期延长及振幅降低（P＜0.05），而健眼组与对照组比较P100波潜伏期也有延长（P＜0.05）；颈动脉超声异常率（61.09%）较高，NAION患眼组与对照组比较，颈总动脉内膜中层厚度（IMT）增加，颈内动脉收缩期峰值血流速度（PSV）及舒张末期血流速度（EDV）降低（P＜0.05），阻力指数（RI）值升高（P＜0.05），患眼组与健眼组颈动脉各测量值无统计学差异（P＞0.05）。结论 NAION的发生与多种因素有关，尤其与颈动脉病变、高血压病、高脂血症明显相关。FFA和视野对NAION有较高的诊断价值，但表现复杂；颈动脉彩超及VEP也具有明显异常，可为临床早期诊断及提前干预提供新的方向。
목적：탐토비동맥염성전부결혈성시신경병변（NAION）적위험인소급진단。방법수집2014년1월지2015년6월재산서의과대학제일의원안과진단위NAION적환자42례（44안）행안저형광소혈관조영（FFA）、시야、도형시각유발전위（VEP）、경동맥다보륵초성검사급혈압、혈당、혈지등검측，설대조조30례，년령범위42～71세，평균（55.43±8.03）세。결과 NAION조여대조조비교，년령、경동맥병변、고혈압병급고지혈증차이균유통계학의의（P＜0.05）；당뇨병、성별급흡연차이균무통계학의의（P＞0.05）。FFA조기44환안시반균정부분형광충영연지혹결손，만기표현다양；시야검사37안（84.09%）표현위여생리맹점상련적상한혹선형결손；VEP검사P 100파진폭이상적비례（92.50%）명현고우잠복기이상적비례（67.50%），NAION환안조여건안조급대조조비교，P100파잠복기연장급진폭강저（P＜0.05），이건안조여대조조비교P100파잠복기야유연장（P＜0.05）；경동맥초성이상솔（61.09%）교고，NAION환안조여대조조비교，경총동맥내막중층후도（IMT）증가，경내동맥수축기봉치혈류속도（PSV）급서장말기혈류속도（EDV）강저（P＜0.05），조력지수（RI）치승고（P＜0.05），환안조여건안조경동맥각측량치무통계학차이（P＞0.05）。결론 NAION적발생여다충인소유관，우기여경동맥병변、고혈압병、고지혈증명현상관。FFA화시야대NAION유교고적진단개치，단표현복잡；경동맥채초급VEP야구유명현이상，가위림상조기진단급제전간예제공신적방향。
ObjectiveTo investigate the risk factors and diagnosis of nonarteritic anterior ischemic optic neuropathy.MethodsFor patients with NAION who presented to First Hospital of Shanxi Medical University between 2014 and 2015, FFA, visual field, VEP and colour Doppler ultrasonography examination, blood pressure, blood glucose and blood lipid examination were possible on 44 eyes of 42 patients, 30 patients were enrolled as control. Age of patients ranged from 42 to 71 years, mean(55.43±8.03) years.ResultsIn the NAION group compared with the control group, carotid artery diseases, age, hypertension, hyperlipidemia, the differences were statistically significant (P<0.05); there was no significant difference in gender, diabetes and smoking (P>0.05). In early FFA, all of 44 eyes showed fluorescence filling of the optic disc were delayed or defect, while advanced performances were different; In the examination of visual field 37 eyes (84.09%) were connected with the physiological blind spot scotoma; In VEP abnormal amplitude ratio (92.50%) of P100 was significantly higher than that of the incubation period (67.50%), NAION patients group compared with healthy eyes group and control group, incubation period of P100 was prolonged and the amplitude decreased (P<0.05), the healthy eyes group compared with the control group, the incubation period of P100was extended (P<0.05); carotid artery color Doppler ultrasound abnormality rate (61.09%) was higher, the NAION group compared with the control group, IMT increased, the internal carotid artery peak systolic velocity (PSV) and end diastolic velocity (EDV) decreased (P<0.05), but resistance index (RI) value was increased (P<0.05), while healthy eyes group and the NAION group had no statistical difference (P>0.05).ConclusionNAION is related to multiple factors, especially associated with carotid artery disease, hypertension and hyperlipidemia. FFA and visual field have high value in the diagnosis of NAION, but the performances are complex. Carotid artery color Doppler ultrasound and VEP also have obvious anomaly, so they can provide a new direction for clinical early diagnosis and intervention.