【摘要】：目的 使用Angio-OCT對視神經(jīng)炎(Optic neuritis, ON)患者的脈絡膜厚度(Choroidal thickness, CT)進行測量評估,探究患者的脈絡膜厚度與臨床特征的相關性。同時,比較患者的脈絡膜厚度與健康人之間是否具有差異,以協(xié)助診斷、評價治療效果及預測預后。方法我們對25位確診視神經(jīng)炎的患者的患眼、健眼進行視功能及OCT檢查；同時對年齡、性別相匹配的25位健康人進行視功能的基礎評估、脈絡膜的掃描及厚度的測量。利用Angio-OCT對黃斑區(qū)及視乳頭周圍的脈絡膜進行掃描,獲取脈絡膜厚度及視乳頭周圍神經(jīng)纖維層厚度的數(shù)據(jù)進行分析研究。脈絡膜厚度的測量包括黃斑區(qū)的17個位點及視乳頭周圍的8個位點,神經(jīng)纖維層的厚度由系統(tǒng)自動計算得出。我們比較視神經(jīng)炎組的健眼、患眼與對照組對應位點的脈絡膜厚度有無差異,并分析視乳頭周圍脈絡膜厚度與神經(jīng)纖維層厚度的相關性。數(shù)據(jù)使用SPSS20.0軟件進行多元線性回歸分析,秩檢驗等。結果視神經(jīng)炎患者患眼黃斑區(qū)中心凹下的脈絡膜厚度(Subfoveal choroidal thickness,SFCT)與眼軸長度呈負相關(P=0.003,相關系數(shù)B=-45.36),與眼球轉(zhuǎn)痛、相對性傳入性瞳孔障礙(relative afferent pupillary defect, RAPD)、杯盤比(C/D)、視杯容積(CV)、盤緣面積(Rim area)、視盤面積(Disc area)、視野平均缺損(MD)無顯著相關性(P0.05)。視乳頭周圍區(qū)域不同位點的脈絡膜厚度(peripapillary choroidal thickness, PPCT)與不同因素相關。視乳頭顳側(cè)(P=0.01),上顳側(cè)(P=0.000),上方(P=0.015),上鼻側(cè)(P=0.014),鼻側(cè)(P=0.035)的脈絡膜厚度均與性別呈正相關。視乳頭上顳側(cè)(P=0.021),下方(P=0.017),下顳側(cè)(P=0.013)的脈絡膜厚度均與年齡呈正相關。視乳頭鼻側(cè)(P=0.011),下鼻側(cè)(P=0.003)的脈絡膜厚度均與視杯容積呈正相關。視乳頭下方(P=0.005),下顳側(cè)(P=0.007)的脈絡膜厚度均與RAPD(+)呈正相關。在脈絡膜厚度的比較中,視神經(jīng)炎組的患眼、健眼及對照組的SFCT分別為307.56±61.95 μm,327.60±47.56 μm,315.48±84.29 μm。在校正年齡、性別、眼軸(Axial length, AL)、最佳矯正視力(Best Corrected Visual Acuity, BCVA)、非接觸眼壓(non-contact tonometer measurement of intraocular pressure, NCT)之后,比較視神經(jīng)炎組的患眼、健眼與對照組的黃斑區(qū)脈絡膜厚度及視乳頭周圍脈絡膜厚度,結果提示：視神經(jīng)炎患者的患眼、健眼分別與對照組在I1500 u m處有顯著差異,對照組視神經(jīng)炎祖的患眼健眼,其余黃斑區(qū)脈絡膜厚度均無顯著差異(P0.05)；視乳頭周圍脈絡膜厚度均無顯著性差異(P0.05)。視乳頭周圍脈絡膜厚度與神經(jīng)纖維層厚度的也無明顯相關性。結論視神經(jīng)炎患者不同位置的脈絡膜厚度與不同因素具有相關性。視神經(jīng)炎患者的患眼、健眼與對照組在黃斑區(qū)(除中心凹下方1500 μm處)和視乳頭周圍的脈絡膜厚度均無顯著性差異。視乳頭周圍脈絡膜厚度與神經(jīng)纖維層厚度無明顯相關性。我們推斷,視神經(jīng)炎患者的脈絡膜厚度在疾病中無明顯變化,是否能夠協(xié)助診斷、評價治療效果及預測預后,尚需進一步深入的研究。
[Abstract]:Objective To evaluate the choroidal thickness (choroid thickness, CT) of the patients with optic neuritis (ON) using the Angio-OCT, and to explore the correlation between the choroidal thickness and the clinical characteristics of the patients. At the same time, whether there is a difference between the choroid thickness of the patient and the healthy person is compared, so as to assist in the diagnosis, evaluate the therapeutic effect and predict the prognosis. Methods We performed the visual function and the OCT examination on the eyes and the eye of the 25 patients with the confirmed optic neuritis, and the basic assessment of the visual function, the scanning of the choroid and the measurement of the thickness of the 25 healthy controls matched with the age and the sex were performed. The choroidal thickness and the thickness of the nerve fiber layer around the papilla were analyzed by Anio-OCT, and the choroidal thickness and the thickness of the nerve fiber layer around the papilla were obtained. The measurement of the choroidal thickness included 17 sites in the macular region and 8 sites around the papilla, and the thickness of the nerve fiber layer was calculated automatically by the system. We compared the choroidal thickness of the corresponding sites in the eye of the optic neuritis group with the control group, and analyzed the correlation between the choroidal thickness around the papilla and the thickness of the nerve fiber layer. The data was subjected to multiple linear regression analysis, rank test and so on using the SPSS10.0 software. Results The foveal choroidal thickness (SFCT) in the central depression of the eye-related macular area in the patients with neuritis was negatively correlated with the length of the eye (P = 0.003, the correlation coefficient B =-45.36), the eye-to-eye pain, the relative afferent pupillary defect (RAPD), the cup-to-plate ratio (C/ D), the apparent cup volume (CV), There was no significant correlation between the area of the disc rim (Rim area), the disc area (Disc area) and the visual field average defect (MD) (P0.05). The choroidal thickness (PPCT) at different sites in the peripapillary region is associated with different factors. The choroidal thickness of the upper nasal side (P = 0.000), upper (P = 0.015), upper nasal side (P = 0.014) and nasal side (P = 0.035) was positively correlated with sex. The choroidal thickness of the inferior (P = 0.021), lower (P = 0.017) and lower (P = 0.013) was positively correlated with age. The choroidal thickness of the lower nasal side (P = 0.003) was positively correlated with the volume of the cup, depending on the nasal side of the nipple (P = 0.011). The choroidal thickness of the lower (P = 0.007) was positively correlated with RAPD (+) under the papilla (P = 0.005). In the comparison of the choroidal thickness, the SFCT in the eyes of the optic neuritis group, the healthy eye and the control group were 307.56, 61.95. m, 327.60, 47.56. m, 315.48 and 84.29. m After non-contact tonometer (NCT), the choroidal thickness and the choroidal thickness around the papilla in the eyes of the optic neuritis group, the eye and the control group were compared. There was no significant difference in the choroidal thickness of the other macular areas (P0.05), and there was no significant difference in the choroidal thickness around the papilla (P0.05). There was no significant correlation between the thickness of the choroid around the papilla and the thickness of the nerve fiber layer. Conclusion The choroidal thickness in different positions of patients with optic neuritis has a correlation with different factors. In the eyes of the patients with neuritis, there was no significant difference between the eye and the control group in the macular area (1500. mu.m below the central recess) and the choroid thickness around the optic nipple. There was no significant correlation between the thickness of the choroid around the papilla and the thickness of the nerve fiber layer. We conclude that the choroidal thickness of the patients with optic neuritis has no significant change in the disease, can assist in the diagnosis, evaluate the therapeutic effect and predict the prognosis, still needs to be further studied.
【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：博士
【學位授予年份】：2015
【分類號】：R774.6

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