光学相干断层扫描血管成像联合彩超对眼前部缺血性视神经病变的诊断作用研究

doi:10.7517/issn.1674-0475.210103

摘要/Abstract

摘要： 本文探讨非动脉炎性前部缺血性视神经病变（NAIOA）采用光学相干断层扫描血管成像（OCTA）联合彩超诊断的应用价值。选取78例单眼NAIOA患者作为研究对象，分别接受OCTA、彩超检查。经OCTA检查，患侧的上部黄斑部神经节细胞复合体（GCC）厚度、下部GCC厚度及平均GCC厚度测定值均低于健侧，差异具有统计学意义（P<0.05）；上方视盘周围视网膜神经纤维层（RNFL）厚度、下方RNFL厚度及平均RNFL厚度对比，患侧均低于健侧，差异显著（P<0.05）；经彩超检查，患侧眼动脉（OA）的PSV、EDV、RI测定值与健侧比较，差异均不具有统计学意义（P>0.05）；患侧与健侧视网膜中央动脉（CRA）的EDV、RI测定值对比，差异无统计学意义（P>0.05），患侧眼CRA的PSV值低于健侧且差异显著（P<0.05）。CRA-PSV联合平均RNFL厚度以及平均GCC厚度诊断NAIOA患者的灵敏度为95.27%、特异度为83.90%、ROC曲线下面积（AUC）为0.930。研究结果发现OCTA联合彩超在NAIOA患者的诊断中较单一诊断方式更有利于提高诊断的灵敏度。

关键词: 光学相干断层扫描, 彩超, 非动脉炎性前部缺血性视神经病变

Abstract: The application value of optical coherence tomography angiography (OCTA) and color Doppler ultrasound in the diagnosis of non-arteritic anterior ischemic optic neuropathy (NAIOA) were explored in this study. A total of 78 monocular NAIOA patients admitted to our hospital were selected as the research subjects, and they received OCTA and color Doppler ultrasound examinations. After OCTA examination, the upper GCC thickness, lower GCC thickness and average macular ganglion cell complex (GCC) thickness of the affected side were all lower than those of the healthy side, and the difference was statistically significant (P<0.05). Compared with the thickness of the retinal nerve fiber layer (RNFL) around the upper optic disc, the thickness of the lower RNFL and the average RNFL thickness of the affected side was lower than those of the healthy side (P<0.05). After color Doppler ultrasound examination, the PSV, EDV and RI of OA on the affected side were compared with those of the healthy side (P>0.05). The EDV and RI of CRA were compared between the affected side and the healthy side, and the difference was not statistically significant (P>0.05). The PSV of CRA of the affected eye was lower than that of the healthy side (P<0.05). The sensitivity of CRA-PSV combined with average RNFL thickness and average GCC thickness for diagnosis of NAIOA patients was 95.27%, the specificity was 83.90%, and the AUC value of the area under the ROC curve was 0.930. The results of the study showed that OCTA combined with color Doppler ultrasound is more conducive to improve the sensitivity of diagnostic indicators in the diagnosis of NAIOA patients.

Key words: optical coherence tomography, color ultrasound, non-arteritic anterior ischemic optic neuropathy

钱劲, 陈洁, 李宾毅, 邓成瑜. 光学相干断层扫描血管成像联合彩超对眼前部缺血性视神经病变的诊断作用研究[J]. 影像科学与光化学, 2021, 39(5): 637-641.

QIAN Jin, CHEN Jie, LI Binyi, DENG Chengyu. Study on the Diagnostic Effect of Optical Coherence Tomography Angiography Combined with Color Doppler Ultrasound on Anterior Ischemic Optic Neuropathy[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2021, 39(5): 637-641.

参考文献

[1] 陈凯, 周洪伟. 神经生长因子治疗非动脉炎性前部缺血性视神经病变的临床效果[J]. 中华眼视光学与视觉科学杂志, 2020, 22(10):781-785.
[2] 陶枳言, 马瑾, 钟勇. OCTA在非动脉炎性前部缺血性视神经病变诊断中的应用和研究现状[J]. 中华眼科杂志, 2019, 55(4):306-310.
[3] 中华医学会眼科学分会神经眼科学组. 我国非动脉炎性前部缺血性视神经病变诊断和治疗专家共识(2015年)[J]. 中华眼科杂志, 2015, 51(5):323-326.
[4] 邹文军, 武志峰, 张洁, 等. 非动脉炎性前部缺血性视神经病变患眼视盘周围及黄斑区视网膜血流参数变化特征[J]. 中华眼视光学与视觉科学杂志, 2018, 20(12):737-742.
[5] 吴子旭, 郑东萍, 潘陆平, 等. 非动脉炎性前部缺血性视神经病变患者临床特征和视盘形态分析[J]. 中国药物与临床, 2018, 18(9):1490-1492.
[6] Baek M S, Seo Y S, Kyung S E. The function of the fellow eye in patients with unilateral nonarteritic anterior ischemic optic neuropathy[J]. Journal of the Korean Ophthalmological Society, 2019, 60(9):881.
[7] Rizzo J F. Unraveling the Enigma of nonarteritic anterior ischemic optic neuropathy[J]. Journal of Neuro-Ophthalmology, 2019, 39(4):529-544.
[8] Augstburger E, Zéboulon P, Keilani C, et al. Retinal and choroidal microvasculature in nonarteritic anterior ischemic optic neuropathy:an optical coherence tomography angiography study[J]. Investigative Ophthalmology & Visual Science, 2018, 59(2):870-877.
[9] Distefano A G, Lam B L. Non-arteritic anterior ischemic optic neuropathy in pilots[J]. Aerospace Medicine and Human Performance, 2018, 89(11):1005-1007.
[10] Kim J H, Kang M H, Seong M, et al. Anomalous coagulation factors in non-arteritic anterior ischemic optic neuropathy with central retinal vein occlusion:a case report[J]. Medicine, 2018, 97(15):e0437.
[11] 李梦洋, 钱彤, 黎晓新, 等. 急性黄斑旁中心中层视网膜病变患眼临床特征及多模式影像特征观察[J]. 中华眼底病杂志, 2019, 35(4):322-326.
[12] 巩鸿霞, 王兰惠. 光相干断层扫描及其血管成像在非动脉炎性前部缺血性视神经病变中的应用研究现状及进展[J]. 中华眼底病杂志, 2018, 34(1):80-82.
[13] 汪宇涵, 马瑾, 干霖洋, 等. 不同病程非动脉炎性前部缺血性视神经病变视盘结构及血管密度的初步观察[J]. 中华眼科杂志, 2019, 55(9):677-686.
[14] 刘珏君, 陈长征, 李璐, 等. 非动脉炎性前部缺血性视神经病变视盘及黄斑血流灌注变化的观察[J]. 中华眼底病杂志, 2019, 35(3):219-225.
[15] 仲妍, 车慧欣. 光学相干断层扫描血管成像(OCTA)在原发性青光眼患者中的检测价值[J]. 眼科新进展, 2018, 38(4):352-356.