原发性闭角型青光眼眼压与眼球后血流动力学改变的相关研究

Correlation of intraocular pressure with retrobulbar hemodynamic changes in patients with primary angle-closure glaucoma

目的:研究原发性闭角型青光眼(PACG)眼动脉(OA)、视网膜中央动脉(CRA)血流动力学改变及眼压(IOP)对眼球后血流动力学的影响。方法:PACG患者45例(90眼),并根据IOP情况分为正常IOP组(52眼)与高IOP组(38眼)。应用彩色多普勒成像技术研究PACG眼球后OA、CRA血流动力学改变。观察指标:收缩期最大血流速度(PSV)、舒张末期血流速度(EDV)、搏动指数(PI)、阻力指数(RI)。彩色多普勒检查前采用非接触IOP计测量受检者IOP。结果:PACG患者CRA-EDV(P<0.01),CRA-RI(P<0.01)均显著不同于正常对照组,且患者正常IOP组与高IOP组之间亦有显著性差异(P<0.01)。CRA-EDV呈逐级降低趋势。CRA-RI的表现与CRA-EDV相反,呈逐级增高现象。无论是CRA还是OA,三组间PSV均无显著性差异。相关分析表明:PACGIOP与CRA-RI(r=0.51;P=0.001)及CRA-EDV(r=-0.396;P=0.014)显著相关。偏相关分析显示:IOP与CRA-RI显著相关(r=0.393;P<0.001),而与CRA-EDV无显著相关(r=-0.065;P=0.559)。其回归方程为:RI=58.82+0.47×IOP。结论:IOP对OA无显著影响。PACGIOP升高可导致CRA-RI增高,继而使EDV降低,视网膜血流量下降。

Objective： To investigate the hemodynamic changes of ophthalmic artery （OA） and central retinal artery （CRA） in patients with primary angle-closure glaucoma （PACG） and the effects of intraoc- ular pressure （lOP） on retrobulbar hemodynamics. Methods： Following the measurement of lOP by non-contact tonometry, hemodynamic changes of OA and CRA were examined by color Doppler imaging （CDI） in 45 patients （90 eyes） with PACG, who were divided according to lOP into a hypertension （38 eyes） and a normal tension group （52 eyes ）. Observations were made of the peak systolic velocity （ PSV）, end-diastolic velocity （ EDV ）, pulsatility index （ PI ） and resistance index （ RI ）. Results ： Significant differences were found between the PACG patients and the normal controls in CRA-EDV （ P 〈0.01 ） and CRA-RI （P 〈0.01 ）, as well as between the normal and the high IOP group （P 〈 0.01 ）. EDV had a tendency to decrease while RI to increase gradually. PSV exhibited no difference among the 3 groups either in CRA or in OA. Correlation analysis showed significant correlation of IOP with CRA-EDV （r = -0. 396,P =0.014 ） and RI （r =0.51. P =0. 001 ） in the PACG patients; partial correlation analysis revealed that IOP was significantly correlated with CRA-RI （r =0. 393 ,P 〈0. 001 ） but not with CRA-EDV （r= -0.065,P =0.559 ）. The regression equation was RI =58.82 ＋ 0.47 IOP. Conclusion： IOP has no remarkable effect on OA, but higher IOP may cause an increase in CRA-RI, a decrease in CRA-EDV and eventually a reduction in retinal blood flow.