相干光断层扫描和视野检查对鞍区肿瘤患者视功能损伤的评价

Assessing the damage to visual function by optical coherence tomography and the visual field test in Saddle area tumor patients

目的分析相干光断层扫描（OCT）测量鞍区肿瘤患者黄斑区视网膜神经节细胞复合体（GCC）及视乳头周围视网膜神经纤维层（pRNFL）厚度的变化，并分析其与视野损伤指标视野平均缺损度（MD）及视野平均敏感度（MS）的相关性。方法病例对照研究。对2010年11月至2011年6月在首都医科大学附属北京天坛医院神经外科就诊的279例不同类型鞍区肿瘤病例的540只眼和健康人188例376只眼（健康对照组）进行视野和OCT检查，测量神经纤维层厚度和GCC层厚度，比较垂体瘤组、颅咽管瘤组、鞍部脑膜瘤组和健康对照组pRNFL及GCC厚度的变化。利用Spearman等级相关系数（rs）评价其与MD、MS的相关性。结果双眼的pRNFL平均厚度（右眼rs=0．369—0．735，左眼rs=0．369—0．691）及GCC平均厚度（右眼0：0．357～0．797，左眼rs=0．375—0．681），分别与MD及MS相关（P〈0．01），且鞍部脑膜瘤组相关性更强。垂体瘤组[右眼：（101．25±19．95）μm和（91．08±13．19）μm；左眼：（99．96±20．95）μm和（89．82±15．47）μm]、颅咽管瘤组[右眼：（94．96±16．59）μm和（86．46±11．65）μm；左眼：（94．92±15．77）μm和（86．77±9．56）μm]、鞍部脑膜瘤组[右眼：（89．54±19．19）μm和（80．77±10．43）μm；左眼：（92．79±22．00）μm和（80．43±10．09）μm]的pRNFL及GCC厚度较健康对照组[右眼：（113．60±9．13）μm和（98．04±6．85）μm；左眼：（114．06±8．99）μm和（97．70±5．83）μm]薄，鞍部脑膜瘤组的pRNFL及GCC厚度较健康对照组薄，鞍部脑膜瘤组pRNFL和GCC厚度较垂体瘤组、颅咽管瘤组更薄，差异有统计学意义（P〈0．05）。结论pRNFL和GCC厚度与视野损害相关，可定量地评估鞍区肿瘤患者的视神经损害程度，pRNFL和GCC厚度越薄，视功能损害越严重。3种肿瘤中，鞍部脑膜瘤对视路损伤更严重。在临床工作中，将视野检查和OCT检查结合起来，更有助于发现及评估患者的视路损害及预后.

Objectives To analyze the differences and correlation between the ganglion cell complex （GCC）, peripapillary retinal nerve fiber layer （pRNFL） and mean deviation （MD）, mean sensitivity （MS） of saddle area tumor patients, and to evaluate the feasibility of using OCT to diagnose the visual pathway damage of saddle area tumor patients. Methods It was a case-control study. One hundred and eighty-eight normal persons and 279 saddle area tumor patients treated in Beijing Tiantan hospital, from November 2010 to june 2011, were recruited; the saddle area tumor patients were diagnosed by surgical sample pathological analysis. The recruits were divided into four groups, including the normal group, the pituitary gland turnouts group, the meningiomas group and the craniopharynglomas group. All patients received the visual field （VF） test using the Octopus 900 automated perimeter with the central 30 degree program, and the mean thickness measurements of GCC and pRNFL were made by RTVue OCT. The Spearman rank correlation coefficient was used to assess the correlation between GCC, pRNFL and MD, MS. The differences between pRNFL and GCC among the four groups were compared. Results The average thickness of the pRNFL （ rsOD = 0. 369 - 0. 735, rsOS = O. 369 - 0. 691 ） and GCC （ rsOD = 0. 357 - O. 797, rsOS =0.375-0.681 ） were correlated with MD and MS （P 〈 0.01 ）, and the measurements from the meningiomas was the most significant. Comparing with the normal group＇s thickness of pRNFL and GCC [OD： （113.60 ±9.13） μm and （98.04± 6.85） μm;OS： （114.06± 8.99） μm and （97.70 ± 5.83） μm], the pituitary gland tUrnOUtS group[ OD： （ 101.25 ± 19. 95） μm and （91.08 ± 13. 19） μm;OS： （ 99. 96 ± 20. 95 ） μm and （ 89. 82± 15.47 ） μm ], meningiomas group [ OD： （ 89. 54 ± 19. 19 ） μm and （80. 77± 10.43） μm;OS： （92. 79±22. 00） μm and （80.43 ± 10. 09） μm] and craniopharynglomas group [OD：（94.96± 16.59） μm and （86.46± 11.65）μm; OS： （94.92 ± 15.77）μm and （86.77 ±9.56）μm] were thinner. There was statistically significant difference of pRNFL and GCC, among the three tumor groups, and the thickness of pRNFL and GCC of the meningiomas group was the thinnest（ P 〈 O. 05 ）. Conclusions The average thickness of the pRNFL and GCC is correlated with vision field damage, which can be used to evaluate optic nerve damage of saddle area tumor patients quantitatively, where the meningiomas was the most significant. The thickness of the pRNFL and GCC was thinner, and the damage to visual functions was more serious. In the three tumor groups, the meningiomas group was the most serious. In the clinic, visual field test combined with OCT were helpful to find and assess the damage to visual pathway and prognosis.