一过性黑朦球后血管血流动力学特点及颈动脉彩色多普勒超声特征相关分析

Correlation analysis on retrobulbar vascular hemodynamic characteristics and carotid artery color Doppler ultrasonographic features of amaurosis fugax

目的：探讨一过性黑朦与颈动脉狭窄的相关性及其球后血管血流动力学变化规律。方法病例对照研究。收集2011年5月至2012年12月在沧州市中心医院眼科就诊的32例（32只眼）一过性黑朦患者的临床资料（一过性黑朦组），男性19例，女性13例，年龄50～80岁，平均年龄（64.31±8.15）岁。并收集同期眼科门诊收治的30例非视网膜缺血性疾病患者的临床资料作为对照组。两组患者均行眼动脉、视网膜中央动脉及颈动脉的彩色超声检查，检测其球后血管的收缩期峰值流速（PSV）、舒张末期流速（EDV）、阻力指数（RI）及颈动脉狭窄程度、颈动脉斑块部位及类型。分别采用卡方检验和 t 检验对检测结果进行统计学分析。结果一过性黑朦组患者眼动脉 PSV [（25.95±2.45）cm/s]较对照组PSV[（27.53±1.41） cm/s]流速减低（t＝3.087， P＝0.003）、EDV [（6.01±0.87） cm/s]较对照组EDV[（6.89±0.56） cm/s]降低（t＝0.712， P＝0.048），RI值与对照组差异无统计学意义（t ＝0.188， P ＝0.852）。一过性黑朦组其视网膜中央动脉 PSV[（7.13±0.96）cm/s]较对照组 PSV[（8.23±0.92） cm/s]流速减低（t ＝4.648， P ＝0.000），EDV[（1.78±0.26）cm/s]较对照组EDV[（2.13±0.29）cm/s]流速降低（t＝4.976， P＝0.000），RI值与对照组比较，差异无统计学意义（t＝0.180， P＝0.855）。一过性黑朦组颈动脉中重度狭窄检出率（59.4％）明显高于对照组（6.7％）（χ2＝19.205， P＝0.000）。结论一过性黑朦患者的视网膜中央动脉和眼动脉的血流速度明显降低，而阻力正常，而且约60％的患者存在中重度的颈动脉狭窄，提示颈动脉狭窄与一过性黑朦的发病密切相关。（中华眼科杂志，2014，50：421-425）

Objective To investigate the correlation of amaurosis fugax and carotid stenosis as well as posterior ocular blood vessel hemodynamic changes.Methods Case series studies.32 patients （19 men and 13 women whose age were 50 to 80 years old and average age was 64.31 ±8.15） who were diagnosed as amaurosis fugax with 32 eyes were enrolled from 2011.5-2012.12.During the same period 30 cases without posterior ocular ischemic diseases were collected as the control group.Their ophthalmic artery , central retinal artery and carotid artery were examinated by color Doppler ultrasound , to detect vascular peak systolic velocity, end diastolic velocity, resistance index, the degree of carotid stenosis, carotid artery plaque area and type.All data were analyzed by chi-square test and t-test.Results PSV（25.95 ±2.45） cm/s,EDV （6.01 ±0.87） cm/s of the ophthalmic artery in AmF group were lower compared with the control group [PSV：（27.53 ±1.41） cm/s, EDV： （6.89 ±0.56） cm/s].The differences were statistically significant （t=3.087, 0.712, P=0.003, 0.048）.There was no statistical difference of RI between AmF and the control group （t=0.188, P=0.852） .PSV（7.13 ±0.96） cm/s,EDV（1.78 ±0.26） cm/s of the central＆amp;nbsp;retinal artery in AmF group were lower compared with the control group [PSV：（8.23 ±0.92） cm/s, EDV：（2.13 ±0.29） cm/s].The differences were statistically significant （t=4.648, 4.976, P=0.000, 0.000）.There was no statistical difference of RI between AmF and the control group （ t=0.180, P=0.855）.Detection rate of carotid artery moderately and severe stenosis （ 59.4%） was significantly higher compared with the control group （6.7%）.The difference was statistically significant （χ2 =19.205, P =0.000）.Conclusions The blood flow velocity of ophthalmic artery and central retinal artery in amaurosis fugax patients reduced significantly , while the resistance was normal.About 60%of the patients had carotid artery moderately and severe stenosis.There was significant correlation between amaurosis fugax and carotid artery stenosis.