彩色多普勒超声成像观察原发性开角型青光眼球后血流动力学变化的meta分析

Color Doppler imaging analysis of retrobulbar blood flow velocities in primary open-angle glaucomatous eyes： a meta-analysis

目的 系统评价彩色多普勒超声成像（CDI）技术观察原发性开角型青光眼（POAG）患眼的球后血流动力学的变化情况.方法 对美国国立医学图书馆PubMed、美国科技信息所ISI Web of Knowledge及临床对照试验数据库the Coehrane Central Register of Controlled Trials进行广泛地检索,选取以POAG患者作为研究对象,应用CDI技术测定眼动脉（OA）、视网膜中央动脉（CRA）及睫状后短动脉（SPCA）的收缩期峰值血流速度（PSV）、舒张末期血流速度（EDV）和阻力指数（RI）等血流参数的随机对照试验或病例对照研究.检索时间为建库至2014年4月.对纳入文献进行meta分析,计算各血流参数的平均差（MD）和95％可信区间（CI）.结果 共纳入24篇文献.涉及POAG患眼1336只,对照眼1102只.POAG患眼OA（MD=-3.05,95％CI：-4.49--1.61,P＜0.001）、CRA（MD=-1.66,95％CI：-1.95--1.38,P＜0.001）、SPCA（MD=-0.87,95％CI：-1.49--0.26,P=0.005）的PSV明显低于对照眼,差异均有统计学意义.POAG患眼OA（MD=-1.78,95％CI：-2.14--1.41,P＜0.001）、CRA（MD=-0.95,95％CI：-1.17--0.74,P＜0.001）、SPCA（MD=-0.53,95％CI：-0.71--0.36,P＜0.001）的EDV较对照眼明显下降,差异均有统计学意义.POAG患眼OA（MD=0.04,95％CI：0.03-0.05,P＜0.001）、CRA（MD=0.06,95％CI：0.05-0.07,P＜0.001）、SPCA（MD=0.04,95％CI：0.03-0.06,P＜0.001）的RI明显高于对照眼,差异均有统计学意义.结论 POAG患眼球后血流速度明显下降,血流阻力明显增加.

Objective To observe the hemodynamic parameters of retrobulbar vessels of eyes with primary open-angle glaucoma （POAG） by using color Doppler imaging （CDI） technique.Methods Pertinent publications were retrieved from the PubMed of The National Library of Medicine,the ISI Web of Knowledge of The Institute for Scientific Information,and Cochrane Central Register of Controlled Trials.Case control studies involved POAG patients were included.Changes in retrobulbar blood flow parameters including peak systolic velocity （PSV）,end diastolic velocity （EDV） and resistive index （RI） of the ophthalmic artery （OA）,central retinal artery （CRA） and short posterior ciliary artery （SPCA） were evaluated by CDI.The searching time was from the data base established up to April,2014.Meta analysis was used on the included articles,the mean difference （MD） along with 95 ％ confidence interval （95 ％ CI） of the blood flow parameters were calculated.Results Twenty-four articles were retrieved,including 1336 eyes as cases,1102 eyes as controls.PSV of POAG eyes was statistically signiflcantly lower than controls in theOA （MD=-3.05,95％CI：-4.49--1.61,P＜0.001）,CRA （MD=-1.66,95％CI：-1.95--1.38,P＜0.001）,SPCA （MD=-0.87,95％ CI：-1.49--0.26,P=0.005）.EDV of POAG eyes was statistically significantly reduced than controls in the OA （MD=-1.78,95％CI：-2.14--1.41,P＜0.001）,CRA （MD=-0.95,95％CI：-1.17--0.74,P＜0.001）,SPCA （MD=-0.53,95％CI：--0.71--0.36,P＜0.001）.Statistically significant increases in RI of POAG eyes than controls in the OA （MD=0.04,95％CI：0.03-0.05,P＜0.001）,CRA （MD=0.06,95％CI：0.05-0.07,P＜0.001）,SPCA （MD=0.04,95％CI：0.03-0.06,P＜0.001）.Conclusion This meta-analysis suggests that significant decreased velocity and increased resistance of retrobulbar blood flow are found in POAG eyes.