中华眼底病杂志
中華眼底病雜誌
중화안저병잡지
Chinese Journal of Ocular Fundus Diseases
2015年
6期
536-540
,共5页
彭春霞%曹珊珊%赵朔%康皓%周欢粉%杨沫%徐全刚%魏世辉
彭春霞%曹珊珊%趙朔%康皓%週歡粉%楊沫%徐全剛%魏世輝
팽춘하%조산산%조삭%강호%주환분%양말%서전강%위세휘
视神经炎/病理生理学%视神经炎/诊断%黄斑/病理生理学%水通道蛋白4%体层摄影术,光学相干
視神經炎/病理生理學%視神經炎/診斷%黃斑/病理生理學%水通道蛋白4%體層攝影術,光學相榦
시신경염/병리생이학%시신경염/진단%황반/병리생이학%수통도단백4%체층섭영술,광학상간
Optic neuritis/physiopathology%Optic neuritis/diagnosis%Macula lutea/physiopathology%Aquaporin 4%Tomography,optical coherence
目的 观察水通道蛋白-4抗体阳性视神经炎[AQP4-Ab(+)ON]患者盘周视网膜神经纤维层(pRNFL)厚度及黄斑区内层视网膜结构改变特点.方法 临床检查确诊的视神经炎(ON)患者60例84只眼(ON组)以及与患者无血缘关系的同期正常对照者40名80只眼(HC组)纳入研究.其中,ON组患者根据血清AQP4 Ab检查结果,分为AQP4-Ab(+)ON组、AQP4-Ab阴性ON组[AQP4-Ab(-)ON组].两组患者各30例42只眼.均行最佳矫正视力(BCVA)、眼前节、眼底及光相干断层扫描(OCT)检查.BCVA记录时换算为最小分辨角对数(logMAR)视力.3组受检者间性别(x2=0.568)、年龄(x2=1.472)比较,差异无统计学意义(P=0.753、0.497).AQP4-Ab(-)ON组、AQP4-Ab(+)ON组间不同病程眼数(x2=0.000)、平均logMAR BCVA(Z=-1.492)比较,差异无统计学意义(P=1.000、0.136).采用Spectralis-OCT仪行视盘及黄斑区扫描.应用标准视神经扫描模式的pRNFL程序,对盘周及其鼻侧、鼻下、颞下、颞侧、颞上、鼻上象限和盘斑束(PMB)厚度及鼻侧、颞侧pRNFL平均厚度比(N/T))进行分析.将黄斑部划分为以黄斑中心凹为中心,分别为直径1 mm的中心区,1 mm＜直径≤3 mm的内环区,3 mm＜直径≤6 mm的外环区等3个同心圆区域.应用黄斑程序对中心区外的内外环其他8个分区的黄斑容积及黄斑部RNFL(mRNFL)、神经节细胞层(mRGCL)、内丛状层(mIPL)、内核层(mINL)容积进行分析.结果 与HC组比较,ON组患眼pRNFL平均厚度及视盘各象限、PMB平均RNFL厚度均明显降低,差异有统计学意义(P=0.000);黄斑容积及mRNFL、mRGCL、mIPL容积明显减小,差异有统计学意义(P=0.000);mINL容积无明显变化,差异无统计学意义(P=0.700).AQP4-Ab(+)ON组pRNFL平均厚度,视盘各象限、PMB平均RNFL厚度均较AQP4-Ab(-)ON组降低,其中视盘鼻侧及鼻下象限pRNFL厚度差异有统计学意义(P=0.010、0.000);黄斑容积及mRNFL、mRGCL、mIPL容积较AQP4-Ab(-)ON组患眼减小,其中黄斑容积及mIPL容积减小程度差异有统计学意义(P=0.038、0.033).与AQP4-Ab(-)ON组患眼比较,AQP4-Ab(+)ON组患眼外环下方区域黄斑平均容积,外环上方、下方区域mIPL平均容积,内环鼻侧区域mRNFL平均容积减少更多,差异均有统计学意义(P＜0.05).结论 与AQP4-Ab(-)ON患眼比较,AQP4-Ab(+)ON患眼pRNFL厚度变薄,mIPL容积降低;pRNFL厚度变薄区域主要分布在视盘鼻侧及鼻下象限、mIPL容积减小区域主要位于黄斑外环上方和下方.
目的 觀察水通道蛋白-4抗體暘性視神經炎[AQP4-Ab(+)ON]患者盤週視網膜神經纖維層(pRNFL)厚度及黃斑區內層視網膜結構改變特點.方法 臨床檢查確診的視神經炎(ON)患者60例84隻眼(ON組)以及與患者無血緣關繫的同期正常對照者40名80隻眼(HC組)納入研究.其中,ON組患者根據血清AQP4 Ab檢查結果,分為AQP4-Ab(+)ON組、AQP4-Ab陰性ON組[AQP4-Ab(-)ON組].兩組患者各30例42隻眼.均行最佳矯正視力(BCVA)、眼前節、眼底及光相榦斷層掃描(OCT)檢查.BCVA記錄時換算為最小分辨角對數(logMAR)視力.3組受檢者間性彆(x2=0.568)、年齡(x2=1.472)比較,差異無統計學意義(P=0.753、0.497).AQP4-Ab(-)ON組、AQP4-Ab(+)ON組間不同病程眼數(x2=0.000)、平均logMAR BCVA(Z=-1.492)比較,差異無統計學意義(P=1.000、0.136).採用Spectralis-OCT儀行視盤及黃斑區掃描.應用標準視神經掃描模式的pRNFL程序,對盤週及其鼻側、鼻下、顳下、顳側、顳上、鼻上象限和盤斑束(PMB)厚度及鼻側、顳側pRNFL平均厚度比(N/T))進行分析.將黃斑部劃分為以黃斑中心凹為中心,分彆為直徑1 mm的中心區,1 mm＜直徑≤3 mm的內環區,3 mm＜直徑≤6 mm的外環區等3箇同心圓區域.應用黃斑程序對中心區外的內外環其他8箇分區的黃斑容積及黃斑部RNFL(mRNFL)、神經節細胞層(mRGCL)、內叢狀層(mIPL)、內覈層(mINL)容積進行分析.結果 與HC組比較,ON組患眼pRNFL平均厚度及視盤各象限、PMB平均RNFL厚度均明顯降低,差異有統計學意義(P=0.000);黃斑容積及mRNFL、mRGCL、mIPL容積明顯減小,差異有統計學意義(P=0.000);mINL容積無明顯變化,差異無統計學意義(P=0.700).AQP4-Ab(+)ON組pRNFL平均厚度,視盤各象限、PMB平均RNFL厚度均較AQP4-Ab(-)ON組降低,其中視盤鼻側及鼻下象限pRNFL厚度差異有統計學意義(P=0.010、0.000);黃斑容積及mRNFL、mRGCL、mIPL容積較AQP4-Ab(-)ON組患眼減小,其中黃斑容積及mIPL容積減小程度差異有統計學意義(P=0.038、0.033).與AQP4-Ab(-)ON組患眼比較,AQP4-Ab(+)ON組患眼外環下方區域黃斑平均容積,外環上方、下方區域mIPL平均容積,內環鼻側區域mRNFL平均容積減少更多,差異均有統計學意義(P＜0.05).結論 與AQP4-Ab(-)ON患眼比較,AQP4-Ab(+)ON患眼pRNFL厚度變薄,mIPL容積降低;pRNFL厚度變薄區域主要分佈在視盤鼻側及鼻下象限、mIPL容積減小區域主要位于黃斑外環上方和下方.
목적 관찰수통도단백-4항체양성시신경염[AQP4-Ab(+)ON]환자반주시망막신경섬유층(pRNFL)후도급황반구내층시망막결구개변특점.방법 림상검사학진적시신경염(ON)환자60례84지안(ON조)이급여환자무혈연관계적동기정상대조자40명80지안(HC조)납입연구.기중,ON조환자근거혈청AQP4 Ab검사결과,분위AQP4-Ab(+)ON조、AQP4-Ab음성ON조[AQP4-Ab(-)ON조].량조환자각30례42지안.균행최가교정시력(BCVA)、안전절、안저급광상간단층소묘(OCT)검사.BCVA기록시환산위최소분변각대수(logMAR)시력.3조수검자간성별(x2=0.568)、년령(x2=1.472)비교,차이무통계학의의(P=0.753、0.497).AQP4-Ab(-)ON조、AQP4-Ab(+)ON조간불동병정안수(x2=0.000)、평균logMAR BCVA(Z=-1.492)비교,차이무통계학의의(P=1.000、0.136).채용Spectralis-OCT의행시반급황반구소묘.응용표준시신경소묘모식적pRNFL정서,대반주급기비측、비하、섭하、섭측、섭상、비상상한화반반속(PMB)후도급비측、섭측pRNFL평균후도비(N/T))진행분석.장황반부화분위이황반중심요위중심,분별위직경1 mm적중심구,1 mm＜직경≤3 mm적내배구,3 mm＜직경≤6 mm적외배구등3개동심원구역.응용황반정서대중심구외적내외배기타8개분구적황반용적급황반부RNFL(mRNFL)、신경절세포층(mRGCL)、내총상층(mIPL)、내핵층(mINL)용적진행분석.결과 여HC조비교,ON조환안pRNFL평균후도급시반각상한、PMB평균RNFL후도균명현강저,차이유통계학의의(P=0.000);황반용적급mRNFL、mRGCL、mIPL용적명현감소,차이유통계학의의(P=0.000);mINL용적무명현변화,차이무통계학의의(P=0.700).AQP4-Ab(+)ON조pRNFL평균후도,시반각상한、PMB평균RNFL후도균교AQP4-Ab(-)ON조강저,기중시반비측급비하상한pRNFL후도차이유통계학의의(P=0.010、0.000);황반용적급mRNFL、mRGCL、mIPL용적교AQP4-Ab(-)ON조환안감소,기중황반용적급mIPL용적감소정도차이유통계학의의(P=0.038、0.033).여AQP4-Ab(-)ON조환안비교,AQP4-Ab(+)ON조환안외배하방구역황반평균용적,외배상방、하방구역mIPL평균용적,내배비측구역mRNFL평균용적감소경다,차이균유통계학의의(P＜0.05).결론 여AQP4-Ab(-)ON환안비교,AQP4-Ab(+)ON환안pRNFL후도변박,mIPL용적강저;pRNFL후도변박구역주요분포재시반비측급비하상한、mIPL용적감소구역주요위우황반외배상방화하방.
Objective To observe the thickness of per-papillary retinal fiber layer (pRNFL) and structural changes of inner macular segmented layers in optic neuritis (ON) patients with positive aquaporin4 antibody [AQP4-Ab(+)].Methods 60 ON patients (84 eyes) including 30 of AQP4 Ab(+) ON patients (42 eyes) and AQP4-Ab(-) ON patients (42 eyes), and 40 age-gender matched health controls(80 eyes) were recruited in present study.There was no statistical significance in gender (x2=0.568) and age (x2=1.472) between the three groups (P＞0.05).There was no statistical significance in the percentage of different course (x2 =0.000) and togMAR best corrected visual acuity (Z=-1.492) between AQP4-Ab (+) ON and AQP4-Ab(-) ON group (P =1.000,0.136).All subjects were examined by Spectralis-OCT.The thickness of per-papillary, nasal, nasal lower, temporal lower, temporal, temporal upper, nasal upper and papillomacular bundle (PMB) were analyzed as well as nasal pRNFL/temporal pRNFL (N/T).The macular area was divided into three concentric circles which including central region with 1 mm diameter, inner area with ＞1 mm but ≤3 mm diameter, and outer ring area with ＞3 mm but ≤6 mm diameter.The macular volume in each partition and volume in macular RNFL (mRNFL), macular ganglion cell layer (-nRGCL), macular inner plexiform layer (mIPL) and macular inner nuclear layer (mINL) were analyzed.Results Compared to HC group, the thickness of pRNFL, every quadrants and PMB were decreased significantly in ON group (P=0.000);the macular volume and the volume of mRNFL, mRGCL, mIPL were also decreased significantly in ON group (P=0.000);but there was no statistical difference in mINL volume between two groups (P=0.700).Compared to AQP4-Ab(-)ON group, the thickness of nasal and nasal lower were decreased significantly in AQP4-Ab(+) ON group (P=0.010, 0.000);the macular and mIPL volume were also decreased significantly in AQP4 Ab (+)ON group (P =0.038, 0.033);the thickness of inferior, superior and inferior mIPL in outer ring area and nasal mRNFL in inner area were decreased significantly in AQP4-Ab(+)ON group (P＜0.05).Conclusions Compared to AQP4 Ab(-) ON patients, the pRNFL thickness and mIPL volume decreased in AQP4-Ab(+-)ON patients.The thinner pRNFL area is mainly located in nasal, nasal lower quadrants, and inferior, superior mIPL.
