原发性开角型青光眼与正常眼24小时眼压波动规律

Study on changes of intraocular pressure within 24 hours in primary open angle glaucoma and normal eyes

目的分析其眼压昼夜变化规律，以期为青光眼的个性化治疗提供参考依据。方法收集2006年4月至2009年4月上海市北站医院和复旦大学附属眼耳鼻喉科医院门诊的原发性开角型青光眼患者102例及正常志愿者83名，进行24h眼压测量，用非接触性眼压计从8am起每隔2h测1次眼压，零点至6am为唤醒后即刻坐位眼压。结果二组之间峰值眼压[正常组右眼（16．0±2．7）mlnHg，左眼（16．2±2．7）mm Hg；POAG组右眼（25．3±5．6）mm Hg，左眼（24．8±5．1）mmHg]、谷值眼压[正常组右眼（11．1±2．5）mmHg，左眼（11．0±2．3）mmHg；POAG组右眼（16．3±3．7）mmHg，左眼（16．2±3．3）mmHg]、平均眼压[正常组右眼（13．4±2．5）mmHg，左眼（13．4±2．5）mmHg；POAG组右眼（19．9±4．3）mmHg，左眼（19．8±3．8）mmHg]及眼压波动值[正常组右眼（5．0±1．6）mmHg，左眼（5．2±1，7）mmHg；POAG组右眼（9．1±3．6）nlmHg，左眼（8．6±3．8）mmHg]的差异均具有统计学意义（均P〈0．01），正常组59．6％，POAG组73．5％的峰值眼压位于门诊工作时间以外；尤其是在零点至早上6点这一时间段，正常组50％，POAG组64．7％的峰值位于凌晨0：00至06：00。结论通过对比分析，24h眼压可以为我们提供治疗前的基础状态，从而为个性化治疗提供详实的资料。建议有条件的话，应该将24h昼夜眼压监测作为开角型青光眼的榆杏常规。

Objective To analyze the discipline of intraocular pressure （IOP） variation, through circadian intraocular pressure monitoring in primary open-angle glaucoma （ POAG ） patients and normal controls, with a view to provide basis for individualized treatment of glaucoma. Methods Subjects were enrolled from the outpatients of Shanghai Beizhan Hospital and Eye and ENT Hospital of Fudan University, which were diagnosed as primary open angle glaucoma, from April 2006 to April 2009. Totally there were 102 cases of patients and 83 cases of normal volunteers. All the subjects accepted 24-hour lOP measurements using non-contact tonometer every two hours starting from 8：00 am. And the IOP between 00：00 to 06：00 am was measured in sitting position immediately after wake up. Results The differences of peak lOP[ （ 16. 0± 2. 7） mm Hgoffight eye and （16.2±2.7） mm Hgofleft eye in normal group; （25.3±5.6） mm Hg of right eye and （24. 8± 5.1 ）mm Hg of left eye in POAG group] , valley lOP （ 11.1 _＋ 2. 5） mm Hg of right eye and （ 11.0 ±2. 3） mm Hg of left eye in normal group; （ 16. 3 ±3.7） mm Hg of right eye and （ 16. 2± 3.3） mm Hg of left eye in POAG group, average lOP （ 13.4 ± 2. 5 ）mm Hg of right eye and （ 13.4± 2. 5 ） mm Hg of left eye in normal group; （ 19. 9±4. 3） mm Hg of right eye and （ 19. 8 ± 3.8） mm Hg of left eye in POAG group）, and lOP fluctuations （5.0 ± 1.6） mm Hg of right eye and （5.2± 1.7） mm Hg of left eye in normal group; （9. 1±3.6） mm Hg of fight eye and （8.6±3.8 ）mm Hg of left eye in POAG group between two groups were all of statistically significance （ P 〈 0. 01 ）. Notably, the peak 10P of 59. 6% innormal control group and 73.5% in POAG group were outside working hours, especially in the time period from 00：00 to 06：00 am. The peak value of 50% in normal group and 64. 7% in POAG group located between 00：00 to 06 ： 00 in the morning. Conclusions By comparison and analysis, 24-hour intraocular pressure measurement could provide us pre-treatment basic state, so as to provide detailed information for individualized treatment. If possible, it is suggested that 24-hour IOP monitoring should be added as a routine examination of primary open angle glaucoma.