鞍区肿瘤患者类青光眼样视神经病变的临床研究

Sellar tumors with glaucoma-like optic neuropathy

目的研究鞍区肿瘤患者发生类青光眼样视神经病变的患病率和影响因素。设计回顾性比较性病例系列。研究对象北京天坛医院2008-2009年确诊的连续的501例鞍区肿瘤患者。方法回顾患者的眼底像及自动视野检查结果。对照组454例为随机选取北京眼病研究中年龄匹配的受试者。青光眼样视神经病变依据视盘形态结合视野综合判断。鞍区肿瘤类型和大小依据头颅磁共振成像(MRI)检查测算。主要指标患病率及影响因素。结果 501例鞍区肿瘤患者中,青光眼样视神经病变患病率为6.8%(形态学标准)或6.3%(形态+功能标准),明显高于对照组(1.3%,P均<0.001)。多元回归分析显示,青光眼样视神经病变的发生与肿瘤位置(鞍上>鞍旁>鞍内)(P=0.010及P=0.001)及肿瘤宽度相关(P=0.003)。结论鞍区肿瘤患者中青光眼样视神经病变患病率明显高于正常人;青光眼样视神经病变的发生与鞍区肿瘤的位置及肿瘤宽度相关。

Objective To study the prevalence of glaucoma-like optic neuropathy with sellar tumors. Design Retrospective control study. Participants 501 patients diagnosed with sellar tumor from year 2008 to 2009 in Beijing Tiantan Hospital were chosen consec- utively. Methods All the patients had undergone fundus photography and automatic visual field examination. A total of 454 age-matched controls were randomly chosen from the population-based Beijing Eye Study. The type and size of the tumors were as- sessed on neuroradiologieal images （MRI）. Main Outcome Measures Prevalence of glaucoma-like optic neuropathy in tumor group and control group, and its associations. Results The prevalence of glaucoma-like optic neuropathy was 6.8%（34 cases） （disc-glaucoma） and 6.3%（31 cases） （field-glaucoma）, which was significantly more frequent than that in the population-based control group of the same ethnieity （1.3%; P〈0.001）. In muhivariate analysis, the presence of glaucoma-like optic neuropathy was significantly associated with tumor location （suprasellar 〉 parasellar 〉 intrasellar, P=0.010 and P=0.001） and tumor width （P=0.003）. Conclusions The prevalence of glaucoma-like optic neuropathy in sellar tumor patients was higher than that of population-based control group. Glaucoma-like optic neuropathy in sellar tumors patients was associated with tumor width and tumor location.