Quantitative study of vessel density in optic disc and macular region in patients with nonarteritic anterior ischemic optic neuropathy
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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。
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关键词:
- 非动脉炎性前部缺血性视神经病变 /
- 光学相干断层扫描 /
- 视盘血流 /
- 黄斑血流 /
- 血流密度
Abstract:ObjectiveTo 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).
MethodsThirteen 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.
ResultsCompared 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).
ConclusionThe 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.
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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 — — — — 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 — — — — 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 — — — — 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 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 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 -
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