Leber家族遗传视神经病变RNFL厚度的影响因素

Influencing factor study on retinal nerve fiber layer thickness of LHON patients

目的:探讨Leber遗传视神经病变视乳头旁视网膜神经纤维层(RNFL)厚度与病程、视力、发病年龄的关系。方法:本研究为病例-对照研究,应用Zeiss Cirrus 3D光学相干断层扫描(OCT)仪的Optic Disc Cube 200×200扫描程序,测量64例LHON患者及88例年龄相匹配的正常对照者的视乳头旁全周及各象限RNFL厚度平均值,并分析病程、视力等因素对RNFL厚度的影响。结果:正常对照组RNFL厚度随年龄不同有一定差异,其中18～29岁组最厚,随年龄增长RNFL平均厚度有所降低;LHON发病后3mo内RNFL厚度明显增厚,3～6mo RNFL厚度与正常人群值无明显差异(P=0.745),超过6mo以后RNFL厚度逐渐变薄,与相应年龄正常人群RNFL厚度值比较,薄变量(差值)以下方象限最大,鼻侧象限最小,薄变率(百分比)以颞侧象限最大,鼻侧象限最小。此外,不同视力组患者RNFL厚度差异不显著(P=0.58)。结论:年龄、发病时间等是影响Leber遗传视神经病变患者RNFL厚度的重要因素,患者各象限RNFL薄变程度不同,而视力则与RNFL厚度无明显相关性。应用OCT测量RNFL厚度是判断LHON疾病进展及进一步研究其临床特征的重要手段。

AIM：To research the factors that may influence retinal nerve fibre layer（RNFL） thickness of Leber＇s hereditary optic neuropathy（LHON）,such as time,visual acuity,age,etc.METHODS：This is a case control study,Zeiss Cirrus 3D optical coherence tomography（OCT,Optic Disc Cube 200×200 program） were used to detect RNFL thickness of peri-disc and each quadrant retina of 64 LHON patients and 88 normal people of same age,data were collected and assorted by patients＇ age,gender,visual acuity,how long time after diseases onset,etc.the differences between each group of data were also compared and their clinical value discussed.RESULTS：RNFL thickness of normal people were differed by their age,of which the 18-29 age group was the thickest,younger or elder people both had a thicker RNFL thickness.RNFL thickness of patients with a disease time short of 3 months were thicker than normal people,but patients with a disease time about 3-6 months were almost the same（P=0.745） as normal people,while patients with a disease time longer than 6 months had a much thicker RNFL thickness than normal people.Further more,the change of RNFL thickness in each quadrant was not equal.It was also found that there was no evidence to connect patient＇s visual acuity with RNFL thickness in our research（P=0.58）.CONCLUSION：RNFL thickness of LHON patients can be influenced by many factors,such as age and time,but it＇s still lack of evidence to uncover the relationship of RNFL thickness and visual acuity.We believe that OCT can be used to evaluate the progress of LHON and other clinical features.