颈动脉狭窄患者眼缺血表现及其影响因素分析

Ocular ischemic appearance associated with carotid artery stenosis and its influence factor

目的 观察颈动脉狭窄患者眼缺血表现的发生率,分析颈动脉狭窄程度及狭窄部位与眼缺血表现的相关性.方法 前瞻性研究.彩色多普勒超声及CT血管成像检查确诊为颈动脉狭窄的132例患者纳入研究.所有患者均行彩色多普勒超声及CT血管成像检查,明确其颈动脉狭窄程度和部位.详细询问患者眼科症状,行矫正视力、屈光度、眼压、裂隙灯显微镜及眼底检查确定是否存在眼缺血表现.分析颈动脉狭窄程度、部位与眼缺血表现的相关性.以颈动脉狭窄程度≤50％为轻度狭窄,＞50％但≤75％为中度狭窄,＞75％但≤99％为重度狭窄,100％为闭塞.结果 132例患者中,颈动脉狭窄程度为轻度狭窄16例,占12.1％;中度狭窄46例,占34.8％;重度狭窄50例,占37.9％;闭塞20例,占15.2％.颈动脉狭窄分布在颈外动脉21例,占15.9％;分布在颈内动脉46例,占34.8％;分布在颈内外动脉分叉处55例,占41.7％;分布在颈总动脉10例,占7.6％.伴有眼缺血表现并确诊为眼缺血性疾病者54例,占40.9％.其中,视网膜中央或分支动脉阻塞5例,占9.2％;静脉淤滞性视网膜病变13例,占24.1％;新生血管性青光眼7例,占13.0％;缺血性视神经病变19例,占35.2％;眼缺血综合征10例,占18.5％.眼部症状包括一过性黑矇、视力减退、眼及眼眶周围疼痛、视网膜出血及渗出、复视、虹膜红变、眼内压增高等.相关性分析发现,颈动脉狭窄程度与眼缺血表现有明显相关性（r=0.287,P=0.018）;颈动脉狭窄部位与眼缺血表现无相关性（P＞0.05）.结论 40.9％的颈动脉狭窄患者可发生眼缺血表现.颈动脉狭窄程度与眼缺血表现有明显相关性,颈动脉狭窄部位与眼缺血表现无相关性.

Objective To observe the prevalence of ocular ischemic appearance （OIA） associated with carotid artery stenosis,and to explore the correlation between the ocular ischemic appearance and the carotid stenosis degree and location.Methods A total of 132 patients with carotid artery stenosis diagnosed by color Doppler ultrasound and CT angiography were enrolled in this prospective study.The carotid stenosis degree and location were identified.The ophthalmic symptoms was inquired.The corrected vision,diopter,intraocular pressure,slit lamp microscope and fundus examination were used to determine if OIA exists.The correlation between the OIA and the carotid stenosis degree and location were analyzed.The carotid stenosis degree was divided into 4 types：mild （≤50%）,moderate （〉50% but ≤75%）,severe （〉75%but ≤99 %） and occlusion （100 %）.Results The distribution of carotid stenosis degree as follow：mild in 16 patients （12.1%）,moderate in 46 patients （34.8%）,severe in 50 patients （37.9%） and occlusion in 20 patients （15.2 %）.The stenosis located in the external carotid artery in 21 patients （15.9%）,in internal carotid artery in 46 patients （34.8%）,in crotch of extracranial internal carotid artery in 55 patients （41.7%）,and in common carotid artery in 10 patients （7.6%）.There were 54 patients （40.9%） with ocular ischemic diseases,which including retinal arterial obstruction （5 patients,9.2%）,retina change of venous stasis （13 patients,24.1%）,neovascular glaucoma （7 patients,13.0%）,ischemic optic neuropathy （19 patients,35.2%）,ocular ischemia syndrome （10 patients,18.5%）.The ophthalmic symptoms included transient amaurosis,decreased visual acuity,eye and periorbital pain,retinal hemorrhage and exudation,diplopia,rubeosis iridis and increased intraocular pressure.There was highly positive correlation between the carotid stenosis degree and OIA （r=0.287,P=0.018）.There was no correlation between the carotid stenosis location and OIA （P〉0.05）.Conclusion 40.9% carotid stenosis patients has OIA.There is relationship between the carotid stenosis degree and OIA,but carotid stenosis location showed no correlation with OIA.