阿尔茨海默病视网膜神经纤维丢失的临床观察

The investigation of retinal nerve fiber loss in Alzheimer＇s disease

目的研究阿尔茨海默病（AD）患者视觉异常是否与视网膜神经纤维层改变有关。方法病例对照研究。对12例AD患者和17例正常对照者进行眼部检查、简易智能精神状态量表检查评分及相干光断层扫描检查，测量视网膜神经纤维层（RNFL）厚度、黄斑厚度、黄斑容积等，两组间检查指标比较采用独立样本t检验。结果RNFL厚度：患者组（93．18±11．36）μm，正常对照组（99．44±8．88）μm；黄斑中心凹厚度：患者组（204．00±52．06）μm，正常对照组（211．36±49．09）μm；距黄斑中心凹1mm内厚度：患者组（232．50±23．37）μm，正常对照组（242．79±40．36）μm；距黄斑中心凹1～3mm厚度：患者组（289．42±21．37）μm，正常对照组（298．43±23．30）μm；距黄斑中心凹3～6mm厚度：患者组（256．67±20．04）μm，正常对照组（262．86±20．19）μm；距黄斑中心凹1mm内容积：患者组（0．183±0．018）m^3，正常对照组（0．188±0．031）m^3；距黄斑中心凹1—3mm容积：患者组（1．819±0．134）m^3，正常对照组（1．875±0．147）m^3；距黄斑中心凹3—6mm容积：患者组（5．443±0．424）m^3，正常对照组（5．571±0．428）m^3；上方1／4分区RNFL厚度：患者组（115．09±14．05）μm，正常对照组（127．94±12．29）μm。上述检测指标患者组均较对照组降低，其中两组间上方1／4分区RNFL厚度差异有统计学意义（t=-2，800，P〈0．05）；上方1／4分区RNFL厚度与简易智能精神状态检查量表评分值呈正相关（r=0．435，P〈0．05）。结论AD患者有视网膜神经纤维的丢失，视网膜神经纤维层可能随AD患者痴呆程度的加重而变薄，这种改变首先发生在上方视网膜区域。

Objective To determine if there are retinal abnormalities in Alzheimer＇s disease and if retinal changes are one of the causes of the visual symptom, and if the changes of retina thickness correlated with the severity of dementia. Methods Case-control study. Twelve patients of Alzheimer＇s disease and seventeen normal controls were included. General eye examinations, mini-mental state examination （MMSE） score and OCT were performed on each patient. Independent-samples t test was used to compare the results obtained from these two groups. Results The retinal nerve fiber layer （RNFL thickness ） overall： Alzheimer＇s （ 93.18 ± 11.36 ） μm, control （ 99. 44 ± 8. 88 ） μm, macula thickness min： Alzheimer＇ s （204. 00 ± 52. 06） μm, control（211.36 ± 49. 09） μm; inner 1 mm： Alzheimer＇s （232. 50 ±23.37） μm, control（242. 79 ±40. 36） μm; between 1-3 mm： Alzheimer＇s （289. 42 ± 21.37） μm, control （298.43 ± 23. 30）μm; between 3-6 mm： Alzheimer＇s （256. 67 ± 20. 04） μm, control （262. 86 ±20. 19） μm was thinner in the patients with Alzheimer＇s disease. Macula volume inner 1 mm： Alzheimer＇s（0. 183 ± 0. 018 ） m^3, control（0. 188 ± 0. 031 ） m^3 ： between 1-3 mm： Alzheimer＇s （ 1. 819 ± 0. 134 ） m^3, control （ 1. 875 ± 0. 147）m^3; between 3-6 mm Alzheimer＇ s （5.443 ± 0.424） m^3, control （5.571 ± 0.428） m^3 in the Alzheimer＇s diseases patients was smaller than that of the controls. There was significant difference （t = -2. 519,P 〈0. 05） in RNFL thickness of the superior quadrant between the two groups Alzheimer＇s disease （ 115.09 ± 14. 05 ） μm, control （ 129.23 ± 10. 69 ） μm. Conclusions There is retinal nerve fiber loss in patients with Alzheimer＇s disease, which may be responsible for the visual symptoms. The retinal nerve fiber loss is obviously in the superior quadrant, and it is correlated positively to the severity of dementia.