山东大学耳鼻喉眼学报 ›› 2020, Vol. 34 ›› Issue (4): 69-74.doi: 10.6040/j.issn.1673-3770.1.2020.046

• 眼缺血综合征多学科精准诊疗 临床研究 • 上一篇    下一篇

视神经脊髓炎谱系疾病患者黄斑区及视盘周围视网膜血管参数变化特征

徐婧,瞿远珍,梁小芳,杨柳,汤洋   

  1. 徐婧, 瞿远珍, 梁小芳, 杨柳, 汤洋首都医科大学附属北京天坛医院 眼科, 北京 100070
  • 收稿日期:2020-05-22 出版日期:2020-07-20 发布日期:2020-08-28
  • 基金资助:
    北京天坛医院青年科研基金(2017-YQN-04)

Measurement of the parameters of the macular retinal and peripapillary vasculature in neuromyelitis optica spectrum disorder patientsXU Jing, QU Yuanzhen, LIANG Xiaofang, YANG Liu, TANG Yang Department of Ophthalmology,Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, ChinaAbstract: Objective〓

To evaluate the changes in the parameters of the macular and peripapillary vasculature in patients with neuromyelitis optica spectrum disorder(NMOSD). MethodsThis case-control study involved 40(76 eyes)aquaporin-4 antibody-positive NMOSD patients and 40(80 eyes)age- and gender-matched healthy controls(HCs). Of 76 eyes with NMOSD, 34 had a history of optic neuritis(ON); 40 had no history of ON. Macular superficial vessel density(MSVD), macular deep vessel density(MDVD), and radial peripapillary capillary(RPC)density were measured by OCT-A. The retinal nerve fiber layer(RNFL)and ganglion cell complex(GCC)thicknesses were measured by OCT. Comparisons of the retinal structural and microvascular parameters of the cohorts were performed using generalized estimating equation(GEE)models. The relationship between retinal vessel density and retinal thickness was also analyzed. ResultsRPC density and MSVD were significantly lower in eyes with NMOSD+ON than in those with NMOSD-ON and HC(P<0.05). The GCC and RNFL thicknesses were also significantly thinner in eyes with NMOSD+ON than in those with NMOSD-ON and HC(P<0.001 for both). MDVD was lower in eyes with NMOSD-ON than in those with HC(P<0.05); however, other vessel densities were not significantly different(P>0.05). In eyes with NMOSD, MSVD, whole image vessel density(WIVD)of RPC, and peripapillary vessel density(PPVD)were correlated with GCC and RNFL thicknesses(P<0.001). However, MDVD and inside disc vessel density(IDVD)were not correlated with GCC and RNFL thicknesses(P>0.05). ConclusionRetinal microvascular changes were present in eyes with NMOSD+ON. However, these changes, except those in MDVD, were not significant in eyes with NMOSD-ON. Thinner GCC and RNFL were associated with lower MSVD and RPC density.   

  1. Key words:Neuromyelitis optica spectrum disorder;
    Optic neuritis;
    Tomography, optical coherence;
    Angiography;
    Vessel density视神经脊髓炎谱系疾病(Neuromyelitis optica spectrum disorder, NMOSD)是一种视神经与脊髓相继或同时受累的自身免疫性脱髓鞘性疾病［1-2］, 占亚洲人群脱髓鞘疾病的20%~48%［3］, 水通道蛋白4抗体(aquaporin4-antibody, AQP4-Ab)是其特异性指标［4］, 可在60%~80%的NMOSD患者中检测到, 使我们对该疾病的免疫发病机制的理解得以迅速发展［5］。NMOSD患者中约50%以视神经炎(optic neuritis, ON)为首发表现, 其中大约50%表现为孤立的视神经炎, 持续且严重的视力损伤是NMO视神经炎的特征表现［1, 6］。然而, ON在NMOSD第一次发作的时间因患者而异, 在第一次发作之前眼底很少有明显的形态学改变。在临床NMOSD症状出现之前, 亚临床疾病活动通常不明显。在本研究中, 我们使用相干光层析成像术(optical coherence tomography, OCT)和相干光层析血管成像术(optical coherence tomography angiography, OCT-A)对AQP4-Ab阳性的NMOSD患者眼和正常人群眼的黄斑、视乳头血管情况进行对照研究, 以探索NMOSD的视网膜结构和微血管损伤以及两者之间关系。
  • Received:2020-05-22 Online:2020-07-20 Published:2020-08-28

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摘要： 目的 观察视神经脊髓炎谱系疾病(NMOSD)患者眼黄斑区及视盘周围血管参数的变化特征。 方法 回顾性病例对照研究。观察2019年1月至2020年2月于医院确诊为NMOSD且血清AQP4-Ab为阳性的患者40例(74眼),按照是否有ON病史分为NMOSD+ON组(34眼)和NMOSD-ON组(40眼)。选取同期健康对照组40例(80眼)。使用Avanti RTVue XR OCT对所有受检者进行黄斑区、视盘血管成像及神经节复合体(GCC)及神经纤维(RNFL)扫描。将NMOSD+ON组,NMOSD-ON组、健康对照组各区域视网膜血管密度、GCC和RNFL厚度进行比较,并分析血管密度与视网膜结构的相关性。 结果 NMOSD+ON组视盘放射状血管(RPC)血管密度、黄斑区浅层血管密度(MSVD)显著降低,GCC及RNFL明显变薄(P均<0.05)。NMOSD-ON组黄斑深层血管密度(MDVD)降低(P<0.05)。NMOSD患者MSVD、RPC整体血管密度(WIVD)、视乳头旁血管密度(PPVD)与GCC及RNFL厚度呈正相关(P均<0.001),而MDVD、视乳头内血管密度(IDVD)与GCC及RNFL厚度无相关性(P均>0.05)。 结论 有ON病史的NMOSD患者眼黄斑浅层及视盘周围血管密度显著减低,无ON病史NMOSD患者除MDVD外视网膜血管减少不明显。GCC及RNFL越薄,黄斑浅层毛细血管丛、视盘周围血管越稀疏。

关键词: 视神经脊髓炎, 视神经炎, 体层摄影术,光学相干, 血管密度,造影术

Abstract: Objective To evaluate the changes in the parameters of the macular and peripapillary vasculature in patients with neuromyelitis optica spectrum disorder(NMOSD). Methods This case-control study involved 40(76 eyes)aquaporin-4 antibody-positive NMOSD patients and 40(80 eyes)age- and gender-matched healthy controls(HCs). Of 76 eyes with NMOSD, 34 had a history of optic neuritis(ON); 40 had no history of ON. Macular superficial vessel density(MSVD), macular deep vessel density(MDVD), and radial peripapillary capillary(RPC)density were measured by OCT-A. The retinal nerve fiber layer(RNFL)and ganglion cell complex(GCC)thicknesses were measured by OCT. Comparisons of the retinal structural and microvascular parameters of the cohorts were performed using generalized estimating equation(GEE)models. The relationship between retinal vessel density and retinal thickness was also analyzed. Results RPC density and MSVD were significantly lower in eyes with NMOSD+ON than in those with NMOSD-ON and HC(P<0.05). The GCC and RNFL thicknesses were also significantly thinner in eyes with NMOSD+ON than in those with NMOSD-ON and HC(P<0.001 for both). MDVD was lower in eyes with NMOSD-ON than in those with HC(P<0.05); however, other vessel densities were not significantly different(P>0.05). In eyes with NMOSD, MSVD, whole image vessel density(WIVD)of RPC, and peripapillary vessel density(PPVD)were correlated with GCC and RNFL thicknesses(P<0.001). However, MDVD and inside disc vessel density(IDVD)were not correlated with GCC and RNFL thicknesses(P>0.05). Conclusion Retinal microvascular changes were present in eyes with NMOSD+ON. However, these changes, except those in MDVD, were not significant in eyes with NMOSD-ON. Thinner GCC and RNFL were associated with lower MSVD and RPC density.

Key words: Neuromyelitis optica spectrum disorder, Optic neuritis, Tomography, optical coherence, Angiography, Vessel density

中图分类号: 

  • R774.6+1
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