急性缺血性视网膜病与缺血性视神经病血管危险因素比较研究

Clinical characteristics of acute ischemic retinopathy and nonarteritic anterior ischemic optic neuropathy

目的比较急性缺血性视网膜病与缺血性视神经病血管危险因素的异同。方法病例对照研究。收集2008年1月至2009年1月首都医科大学附属北京同仁医院北京同仁眼科中心及神经内科临床确诊为急性缺血性视网膜病（AIR组）及非动脉炎性前部缺血性视神经病（NAION组）的连续病例，采集所有患者详尽临床资料、实验室检查、颈动脉超声、头颅MRI资料。将两组结果进行卡方比较。结果共收集AIR病例91例，NAION病例143例。AIR组患者平均年龄为（55．4±15．8）岁；NAION组平均年龄为（51．4±8．9）岁。两组之间差异有统计学意义（t=2．514，P=0．013）。两组间性别、吸烟、高血压、空腹血糖等各项危险因素差异无统计学意义（χ2分别为0．023，2．727，0．217及0．012，所有P〉0．05）。高胆固醇血症（总胆固醇〉5．17mmol／L）在NAION组为46．2％（66／143），较AIR组26．4％（24／91）高（χ2=9．193，P=0．002）。缺血性心脏病比例在AIR组为13．2％（12／91），高于NAION组的4．9％（7／143；χ2=5．125，P=0．024）。34．5％（30／87）的AIR组患者存在颈动脉狭窄或闭塞，而NAION组无1例（χ2=44．37，P=0．000）。在完成头颅MRI扫描的57例AIR和127例NAION患者中，脑梗死在AIR组为47．4％（27／57），明显高于NAION组的0．8％（1／127；χ2=66．210，P=0．000），脑白质病变在NAION组为66．9％（85／127），高于AIR组的36．8％（21／57）（χ2=66．460，P=0．000）。结论NAION发病年龄较早。颈动脉病变及脑梗死等大中血管病在AIR患者中多见，而脑白质病变等小血管损害在NAION患者中常见，有可能与高脂血症导致的小动脉硬化有关。

Objective To compare the vascular risk factors between acute ischemic retinopathy （AIR） and nonarteritic anterior ischemic optic neuropathy （NAION）. Methods Single center retrospective study Patients diagnosed of AIR and NAION from Jan 2008 to Jan 2009 in Beijing Tongren hospital were enrolled in this study. The demographical data, the results of blood tests, cardiac examinations, carotid vascular ultrasound and brain MRI were analyzed by Chi-square test. Results Ninety-one AIR patients and 143 NAION patients were enrolled. The mean age of the NAION patients （51.4 ±8. 9） was lower than that of the AIR group （ 55.4 ± 15.8 ） （ t = 2. 514, P = 0. 013 ）. There was no significant difference in the gender, smoking status, hypertension and fasting blood glucose levels between these two groups （ χ2 = 0. 023,2. 727, 0. 217,0. 012; all P 〉 0.05 ）. The percentage of hypercholesterolemia （ total cholesterol 〉 5.17 mmoL/L） was 46. 2% （66/143） in the NAION group and 26.4 % （24/91） in the AIR group （χ2= 9. 193, P = 0. 002 ） Prevalence of carotid artery disease and ischemic heart disease was 13.2% （ 12/91 ） in the AIR group and 4. 9% （7/143） in the NAION group （χ2= 5. 125, P = 0. 024）. Carotid artery stenosis was present in 34. 5% （30/87） patients in the AIR group, whereas none in the NAION group （χ2 =44. 370,P =0. 000）. Among 57 AIR patients and 127 NAION patients who finished brain MRI, the percentage of cerebral infarction was 47.4% （27/57） in the AIR group and 0. 8% （ 1/127 ） in the NAION group （ χ2 = 66. 210, P = 0. 000）. Cerebral white matter hyperintensities （WMH） were present in 66. 9% （85/127） of the NAION group and36.8%（21/57） in the AIR group （χ2 =66.46,P =0.000）. Conclusions The mean age of NAION patients was lower than that of the AIR patients. Carotid artery stenosis and stroke, which might indicate large-middle vessel disease, are common in ischemic retinopathy. WMH with small vascular atherosclerosis, possibly caused by hypercholesterolemia, is more common in the NAION group.