非动脉炎性前部缺血性视神经病变患者视盘及黄斑区血流密度的定量研究

任一舟, 刘晓蓉, 李喆, 徐敏, 陈放, 甘春兰

任一舟, 刘晓蓉, 李喆, 徐敏, 陈放, 甘春兰. 非动脉炎性前部缺血性视神经病变患者视盘及黄斑区血流密度的定量研究[J]. 实用临床医药杂志, 2023, 27(4): 70-75, 79. DOI: 10.7619/jcmp.20222588
引用本文: 任一舟, 刘晓蓉, 李喆, 徐敏, 陈放, 甘春兰. 非动脉炎性前部缺血性视神经病变患者视盘及黄斑区血流密度的定量研究[J]. 实用临床医药杂志, 2023, 27(4): 70-75, 79. DOI: 10.7619/jcmp.20222588
REN Yizhou, LIU Xiaorong, LI Zhe, XU Min, CHEN Fang, GAN Chunlan. Quantitative study of vessel density in optic disc and macular region in patients with nonarteritic anterior ischemic optic neuropathy[J]. Journal of Clinical Medicine in Practice, 2023, 27(4): 70-75, 79. DOI: 10.7619/jcmp.20222588
Citation: REN Yizhou, LIU Xiaorong, LI Zhe, XU Min, CHEN Fang, GAN Chunlan. Quantitative study of vessel density in optic disc and macular region in patients with nonarteritic anterior ischemic optic neuropathy[J]. Journal of Clinical Medicine in Practice, 2023, 27(4): 70-75, 79. DOI: 10.7619/jcmp.20222588

非动脉炎性前部缺血性视神经病变患者视盘及黄斑区血流密度的定量研究

基金项目: 

江苏省扬州市社会发展计划项目 YZ2020112

详细信息
    通讯作者:

    甘春兰, E-mail: chunlan88239@163.com

  • 中图分类号: R774.6;R770.42

Quantitative study of vessel density in optic disc and macular region in patients with nonarteritic anterior ischemic optic neuropathy

  • 摘要:
    目的 

    基于光学相干断层扫描血管成像(OCTA)评估非动脉炎性前部缺血性视神经病变(NAION)患者双眼的视盘及黄斑区的血流密度改变。

    方法 

    选取初次发病且病程 < 3个月的13例单眼NAION患者作为研究对象(共26眼,分为患眼组13眼与对侧眼组13眼),同时筛选性别、年龄与其相匹配的17例健康志愿者的17眼作为健康对照组。对所有眼行OCTA、最佳矫正视力及眼压检查,比较3组视盘全部血管及毛细血管血流密度、黄斑区浅层毛细血管网(SCP)与深层毛细血管网(DCP)血流密度。

    结果 

    与对侧眼组、健康对照组相比,患眼组视盘全区域及各分区的毛细血管、全部血管血流密度均降低,差异有统计学意义(P < 0.05); 对侧眼组视盘血流密度与健康对照组比较,差异无统计学意义(P>0.05)。患眼组黄斑区中心凹周围上侧分区SCP血流密度低于对侧眼组,且黄斑区旁中心凹上半侧、颞侧、鼻侧分区DCP血流密度低于对侧眼组,差异有统计学意义(P < 0.05); 患眼组黄斑区中心凹周围整体及上半侧、鼻侧分区SCP血流密度低于健康对照组,差异有统计学意义(P < 0.05); 对侧眼组黄斑区血流密度与健康对照组比较,差异无统计学意义(P>0.05)。

    结论 

    病程 < 3个月的NAION患者患眼黄斑区及视盘血流密度均明显降低,未累及的对侧眼血流密度则无明显改变。在NAION患者的诊治和随访过程中,临床医师应同时关注患眼的视盘血流变化和黄斑区微循环情况。

    Abstract:
    Objective 

    To evaluate the changes of vessel density in optic disc and macular in nonarteritic anterior ischemic optic neuropathy (NAION) patients based on optical coherence tomography angiography (OCTA).

    Methods 

    Thirteen monocular NAION patients with initial onset and disease course < 3 months were selected as the study objects [26 eyes in total, which were divided into affected eye group (n=13) and contralateral eye group (n=13)]. At the same time, 17 eyes of 17 healthy volunteers with matching gender and age were selected as healthy control group. All eyes were examined by OCTA, best corrected visual acuity and intraocular pressure. The density of all vessels and capillaries in the optic disc and the density of superficial capillary plexuses (SCP) and deep capillary plexuses (DCP) in macular were compared among the three groups.

    Results 

    Compared with the healthy control group and the contralateral eye group, the density of capillary and all vessels in the whole area and all sectors of optic disc in the affected eye group was decreased (P < 0.05). There was no significant difference in blood flow density between contralateral eye group and healthy control group (P>0.05). Compared with the contralateral eye group, the SCP density decreased in the affected eye group in the superior sector of perifoveal area, and DCP density was decreased in the superior, temporal and nasal sectors of paramacular fovea (P < 0.05). Compared with the healthy control group, the SCP density in the superior hemi-and nasal sectors in perifovea was decreased in the affected eye group(P < 0.05). There was no significant difference in blood flow density between contralateral eye group and healthy control group (P>0.05).

    Conclusion 

    The blood vessel density of macula and optic disc of NAION eyes decreases significantly, while the blood vessel density of contralateral eyes has no significant change. During the diagnosis, treatment and follow-up of NAION patients, clinicians should pay attention to the changes in optic disc blood flow and macular microcirculation in the affected eye.

  • 图  1   视盘分区示意图

    A: 视盘内、视盘周围上半侧、下半侧分区; B: 视盘周围颞侧、上侧、鼻侧、下侧4个分区。

    图  2   黄斑区血流密度示意图

    A: OCTA黄斑区血管成像及分区(A1示浅层, A2示深层); B: 黄斑区浅层及深层视网膜检测范围(B1示浅层, B2示深层); C: 黄斑区血流密度测量结果(C1示浅层, C2示深层)。

    表  1   患眼组与对侧眼组视盘血流密度比较(x±s)  %

    检测区域 分类 毛细血管 全部血管
    患眼组(n=13) 对侧眼组(n=13) t/z P 患眼组(n=13) 对侧眼组(n=13) t/z P
    视盘全区域 40.18±3.60 47.59±6.00 -2.412 0.016 47.05±3.50 54.06±6.28 -2.447 0.014
    视盘内 40.92±4.64 48.88±5.14 -6.811 < 0.001 50.92±4.84 58.86±5.83 -5.931 < 0.001
    视盘周围 整体 40.96±3.97 50.04±6.78 -2.691 0.007 47.86±4.09 56.22±7.07 -2.517 0.012
    上半侧 39.17±4.39 49.38±8.46 -2.271 0.023 46.61±4.49 55.79±8.61 -2.272 0.023
    下半侧 42.91±4.53 50.75±5.29 -4.089 < 0.001 49.27±4.40 56.72±5.64 -4.936 < 0.001
    颞侧 41.46±7.94 51.54±8.79 -3.126 0.009
    上侧 36.23±5.04 50.46±9.47 -2.762 0.006
    鼻侧 41.69±4.27 45.08±7.65 -3.041 0.011
    下侧 43.85±5.51 54.69±3.59 -7.905 < 0.001
    下载: 导出CSV

    表  2   患眼组与健康对照组视盘血流密度比较(x±s)  %

    检测区域 分类 毛细血管 全部血管
    患眼组(n=13) 健康对照组(n=17) t/U P 患眼组(n=13) 健康对照组(n=17) t/U P
    视盘全区域 40.18±3.60 49.28±2.73 -7.873 < 0.001 47.05±3.50 55.42±2.65 -7.467 < 0.001
    视盘内 40.92±4.64 46.31±5.04 57.500 0.025 50.92±4.84 56.91±4.81 -3.371 0.002
    视盘周围 整体 40.96±3.97 52.65±3.29 -8.817 < 0.001 47.86±4.09 58.49±3.32 -7.858 < 0.001
    上半侧 39.17±4.39 53.07±3.36 -9.845 < 0.001 46.61±4.49 59.02±3.37 -8.665 < 0.001
    下半侧 42.91±4.53 52.23±3.46 -6.402 < 0.001 49.27±4.40 57.89±3.39 -6.074 < 0.001
    颞侧 41.46±7.94 55.41±2.24 12.000 < 0.001
    上侧 36.23±5.04 54.24±4.40 -10.441 < 0.001
    鼻侧 41.69±4.27 47.35±4.24 39.000 0.002
    下侧 43.85±5.51 55.53±4.24 -6.572 < 0.001
    下载: 导出CSV

    表  3   对侧眼组与健康对照组视盘血流密度比较(x±s)  %

    检测区域 分类 毛细血管 全部血管
    对侧眼组(n=13) 健康对照组(n=17) t/U P 对侧眼组(n=13) 健康对照组(n=17) t/U P
    视盘全区域 47.59±6.00 49.28±2.73 108.000 0.902 54.06±6.28 55.42±2.65 -0.808 0.426
    视盘内 48.88±5.14 46.31±5.04 76.000 0.157 58.86±5.83 56.91±4.81 77.500 0.170
    视盘周围 整体 50.04±6.78 52.65±3.29 92.000 0.457 56.22±7.07 58.49±3.32 97.50 0.592
    上半侧 49.38±8.46 53.07±3.36 91.000 0.432 55.79±8.61 59.02±3.37 95.50 0.536
    下半侧 50.75±5.29 52.23±3.46 -0.928 0.361 56.72±5.64 57.89±3.39 109.500 0.967
    颞侧 51.54±8.79 55.41±2.24 -1.753 0.091
    上侧 50.46±9.47 54.24±4.40 83.500 0.263
    鼻侧 45.08±7.65 47.35±4.24 107.000 0.902
    下侧 54.69±3.59 55.53±4.24 -0.571 0.572
    下载: 导出CSV

    表  4   患眼组与对侧眼组黄斑区血流密度比较(x±s)  %

    检测区域 分类 浅层毛细血管网 深层毛细血管网
    患眼组(n=13) 对侧眼组(n=13) t/z P 患眼组(n=13) 对侧眼组(n=13) t/z P
    黄斑全区域 整体 42.12±5.72 44.15±2.98 -1.595 0.137 44.54±3.37 46.69±5.85 -1.643 0.100
    上半侧 41.99±5.93 44.24±2.99 -1.853 0.064 44.44±3.24 47.83±6.85 -1.783 0.075
    下半侧 42.25±5.80 44.06±3.22 -1.375 0.194 44.60±4.16 45.65±5.39 -0.820 0.428
    旁中心凹 整体 45.92±5.01 44.81±3.81 1.110 0.289 50.08±3.92 54.02±5.72 -2.148 0.053
    上半侧 46.22±4.54 45.95±3.96 0.307 0.764 50.04±3.18 54.25±5.67 -2.291 0.041
    下半侧 45.63±6.13 43.68±4.22 1.404 0.186 50.13±4.91 53.76±6.34 -1.888 0.083
    颞侧 45.08±6.20 45.25±3.73 -0.118 0.908 50.63±4.14 54.13±5.47 -2.257 0.043
    上侧 47.39±4.49 46.91±5.40 0.361 0.725 49.52±3.86 53.99±6.57 -1.740 0.107
    鼻侧 45.97±5.46 43.74±5.33 1.397 0.188 51.30±4.73 56.16±4.75 -3.572 0.004
    下侧 45.28±6.63 43.36±4.76 1.169 0.265 48.91±6.15 51.68±8.12 -0.992 0.341
    中心凹周围 整体 42.26±5.70 44.59±3.05 -1.801 0.097 45.28±3.70 47.88±7.37 -1.389 0.190
    上半侧 41.95±6.30 44.68±3.42 -2.009 0.068 45.20±3.25 48.64±8.10 -1.485 0.163
    下半侧 42.59±5.55 44.52±3.04 -1.442 0.180 45.33±4.97 47.15±7.09 -1.177 0.262
    颞侧 40.75±3.75 39.54±2.88 1.102 0.292 48.38±3.23 51.53±5.15 -1.924 0.054
    上侧 41.22±6.68 45.04±3.91 -2.340 0.037 42.82±3.99 46.66±8.95 -1.504 0.158
    鼻侧 45.46±7.57 48.78±3.34 -1.672 0.123 45.37±4.63 48.91±8.96 -1.570 0.117
    下侧 42.32±5.77 45.16±3.85 -2.007 0.068 44.12±5.98 44.54±7.69 -0.291 0.776
    下载: 导出CSV

    表  5   患眼组与健康对照组黄斑区血流密度比较(x±s)  %

    检测区域 分类 浅层毛细血管网 深层毛细血管网
    患眼组(n=13) 健康对照组(n=17) t/z P 患眼组(n=13) 健康对照组(n=17) t/z P
    黄斑全区域 整体 42.12±5.72 44.77±3.58 74.000 0.133 44.54±3.37 45.29±5.33 -0.447 0.659
    上半侧 41.99±5.93 44.89±4.04 72.000 0.113 44.44±3.24 46.13±5.16 -1.034 0.310
    下半侧 42.25±5.80 44.65±3.25 -1.340 0.197 44.60±4.16 44.55±5.72 0.025 0.980
    旁中心凹 整体 45.92±5.01 45.48±5.58 0.224 0.825 50.08±3.92 52.21±5.12 -1.248 0.222
    上半侧 46.22±4.54 45.45±6.30 0.375 0.710 50.04±3.18 52.37±5.08 -1.449 0.158
    下半侧 45.63±6.13 45.52±5.24 0.052 0.959 50.13±4.91 52.01±5.33 -0.990 0.331
    颞侧 45.08±6.20 46.43±5.50 95.000 0.536 50.63±4.14 53.86±3.73 73.500 0.123
    上侧 47.39±4.49 45.12±7.29 0.988 0.331 49.52±3.86 50.36±6.38 -0.423 0.675
    鼻侧 45.97±5.46 44.96±5.31 0.510 0.641 51.30±4.73 53.92±5.57 -1.362 0.184
    下侧 45.28±6.63 45.485.79 -0.084 0.933 48.91±6.15 50.62±6.60 -0.726 0.474
    中心凹周围 整体 42.26±5.70 45.44±3.34 59.000 0.031 45.28±3.70 46.58±6.28 -0.708 0.485
    上半侧 41.95±6.30 45.28±3.86 62.50 0.043 45.20±3.25 46.92±5.84 -1.026 0.314
    下半侧 42.59±5.55 45.58±2.98 -1.758 0.096 45.33±4.97 46.21±6.96 -0.387 0.702
    颞侧 40.75±3.75 41.60±3.82 -0.611 0.546 48.38±3.23 50.42±5.50 -1.183 0.247
    上侧 41.22±6.68 44.89±4.11 67.500 0.072 42.82±3.99 45.04±6.35 -1.102 0.280
    鼻侧 44.69±7.75 49.04±3.49 -2.061 0.049 45.37±4.63 46.13±7.23 99.000 0.650
    下侧 42.32±5.77 45.98±3.35 -2.042 0.056 44.12±5.98 44.84±7.61 -0.283 0.779
    下载: 导出CSV

    表  6   对侧眼组与健康对照组黄斑区血流密度比较(x±s)  %

    检测区域 分类 浅层毛细血管网 深层毛细血管网
    对侧眼组(n=13) 健康对照组(n=17) t/z P 对侧眼组(n=13) 健康对照组(n=17) t/z P
    黄斑全区域 整体 44.15±2.98 44.77±3.58 -0.501 0.620 46.69±5.85 45.29±5.33 0.683 0.500
    上半侧 44.24±2.99 44.89±4.04 -0.491 0.627 47.83±6.85 46.13±5.16 0.777 0.443
    下半侧 44.06±3.22 44.65±3.25 -0.491 0.627 45.65±5.39 44.55±5.72 0.532 0.599
    旁中心凹 整体 44.81±3.81 45.48±5.58 -0.374 0.711 54.02±5.72 52.21±5.12 0.913 0.369
    上半侧 45.95±3.96 45.45±6.30 0.250 0.805 54.25±5.67 52.37±5.08 0.953 0.349
    下半侧 43.68±4.22 45.52±5.24 -1.033 0.310 53.76±6.34 52.01±5.33 0.821 0.418
    颞侧 45.25±3.73 46.43±5.50 85.000 0.300 54.13±5.47 53.86±3.73 0.162 0.873
    上侧 46.91±5.40 45.12±7.29 0.742 0.464 53.99±6.57 50.36±6.38 1.523 0.139
    鼻侧 43.74±5.33 44.96±5.31 -0.623 0.538 56.16±4.75 53.92±5.57 1.160 0.256
    下侧 43.36±4.76 45.48±5.79 -1.068 0.295 51.68±8.12 50.62±6.60 0.395 0.696
    中心凹周围 整体 44.59±3.05 45.44±3.34 -0.710 0.484 47.88±7.37 46.58±6.28 0.522 0.606
    上半侧 44.68±3.42 45.28±3.86 -0.441 0.663 48.64±8.10 46.92±5.84 0.674 0.506
    下半侧 44.52±3.04 45.58±2.98 88.000 0.363 47.15±7.09 46.21±6.96 0.365 0.718
    颞侧 39.54±2.88 41.60±3.82 -1.621 0.116 51.53±5.15 50.42±5.50 0.564 0.577
    上侧 45.04±3.91 44.89±4.11 0.097 0.923 46.66±8.95 45.04±6.35 0.581 0.566
    鼻侧 48.48±3.37 49.04±3.49 -0.435 0.667 48.91±8.96 46.13±7.23 0.941 0.355
    下侧 45.16±3.85 45.98±3.35 -0.624 0.538 44.54±7.69 44.84±7.61 -0.107 0.915
    下载: 导出CSV
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出版历程
  • 收稿日期:  2022-08-20
  • 网络出版日期:  2023-03-14
  • 刊出日期:  2023-02-27

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