原发性青光眼血流变与彩色多普勒测定

Evaluation of blood rheology and colour Doppler imaging in primary glaucoma

目的探讨原发性青光眼患者血黏度水平及彩色多普勒眼血流动力学变化的意义及两者间的关系。方法测定原发性开角型青光眼、急性闭角型青光眼、慢性闭角型青光眼和健康对照组(老年性白内障)各20例的全血比黏度、血浆比黏度、纤维蛋白原,彩色多普勒超声成像技术(color Doppler imaging,CDI)检测眼动脉和视网膜中央动脉的最大收缩速度(peak systolic relocity,PSV)、舒张末期血流速度(end diastolic ve-locity,EDV)、阻力指数、频谱形态和监听频声。比较各组间各参数的差异,并分析原发性青光眼患者血流变指标与CDI血流动力学各指标的相关性。结果3组青光眼与对照组比较除纤维蛋白原差异无统计学意义外,其余各项血流变指标均显著升高(P<0.05)。眼动脉和视网膜中央动脉的PSV和EDV明显下降,而阻力指数明显增高。3组青光眼的血黏度各项指标与眼动脉和视网膜中央动脉的PSV、EDV呈负相关,与阻力指数呈正相关;健康对照组血黏度水平与血流动力学各指标无相关性。结论原发性青光眼患者眼部存在不同程度血液循环障碍。CDI对球后血管血流改变有较高的敏感性,对青光眼的早期诊断有重要的参考价值。

Objective To investigate the blood viscosity level and the ocular hemodynamic changes by colour Doppler （CDI） imaging in patients with primary glaucoma and the relationship between them. Methods The blood rheology indices including blood viscosity, plasma viscosity and fibfinogen were determined in patients with primary open angle glaucoma （ n = 20）, acute angle-closure glaucoma （ n = 20）, chronic angle-closure glaucoma （ n = 20） and in 20 cases with senile cataract （control group）. The peak systolic velocity（ PSV）, end diastolic velocity （EDV）, resistant index, shape of spectra and frequency of monitor of ophthalmic artery and central retina artery was measured by CDL The correlation between the blood viscosity and CDI blood flow of the patients with primary glaucoma was analysed. Results The blood rheology indices in the three glaucoma groups were all significantly higher than those in the control group except fibrinogen. Either PSV or EDV of both ophthalnfic artery and central retina artery was significantly decreased while the resistant index was remarkably increased. All the targets levels of blood viscosity in glaucoma patients were negatively correlated with either PSV or EDV of both ophthalmic artery and central retina artery, but positively correlated with the resistant index. There were no significant correlations between the levels of blood viscosity and the parameters of ocular hemodynamics in the control. Conclusions There were varying degrees of ocular blood circulatory disorders in patients with primary glaucoma. CDI had a higher sensitivity to the change of optic blood flow which may be an important reference value in the early diagnosis of glaucoma.