早期帕金森病患者视网膜及视野改变的临床研究

A clinical study of changes in retina and visual field in patients with early Parkinson＆#39;s disease

目的 研究早期帕金森病（PD）患者视网膜形态结构及视野平均缺损（MD）深度改变的特点及相关因素.方法 研究对象系临床确诊的25例早期PD患者（PD组）和33例年龄、性别相匹配的健康人（正常对照组）,对PD患者行“关期”统一PD评分量表（UPDRSⅢ）和Hoehn-Yahr（H-Y）分级评估.采用光学相干断层扫描对两组受检者行视网膜神经纤维层（RNFL）及黄斑区视网膜检查,全自动视野计检测MD值.结果 （1）早期PD患者平均RNFL厚度及C11象限RNFL厚度小于正常对照组[（96.2±7.6） μm比（102.6±5.0） μm,P=0.000;（124.4 ±18.4）μm比（135.4±21.8） μm,P=0.047].与正常对照组比较,PD组平均黄斑厚度较薄[（277.2±9.6）μm比（285.8±12.6） μm,P=0.006],黄斑体积较小[（10.0±0.3）mm3比（10.3±0.4）mm3,P =0.006].PD组的视野MD值较正常对照组未见加深[（0.43±2.75） dB比（-0.18±1.41）dB,P=0.322].（2）Pearson相关分析显示,PD患者平均RNFL厚度、平均黄斑厚度和体积与H-Y分级呈负相关（r=-0.569、-0.501和-0.417,P均＜0.05）,与病程及UPDRSⅢ得分无相关性.结论 早期PD患者平均RNFL和C11象限RNFL厚度、平均黄斑厚度较正常者明显变薄,黄斑体积减小,其视野MD深度较正常者未见明显加深;PD患者的视网膜厚度及黄斑体积与H-Y分级呈负相关.

Objective To characterize the changes of retinal structure and visual field mean defects （MD） in early Parkinson＆#39;s disease （PD） and the related factors.Methods Twenty-five patients with early stage PD and 33 normal controls were enrolled in this study.PD patients were evaluated by unified Parkinson＆#39;s disease rating scale （UPDRS） and Hoehn-Yahr （H-Y） stage in ＆quot;off＆quot; period.All subjects undertook retina of retinal nerve fiber layer （RNFL） and macular examinations by optical coherence tomography （OCT）,and MD by automatic visual field analyzer.Results （1） The average thicknesses of RNFL and C11 quadrant RNFL were thinner in PD group [（96.2 ±7.6） μm and （124.4 ± 18.4） μm] than in healthy controls [（102.6 ± 5.0） μm and （135.4 ± 21.8） μm,respectively,P =0.000 and P =0.047].Moreover,PD patients had a thinner average thickness of macular[（277.2 ±9.6） μm vs （285.8 ± 12.6）μm,P=0.006],and smaller macular volume compared with controls [（10.0 ± 0.3） mm3 vs （10.3 ±0.4） mm3,P =0.006].However,there was no significant difference in MD between PD and control subjects [（0.43 ± 2.75） dB vs （-0.18 ± 1.41） dB,P =0.322].（2） Pearson＆#39;s correlation analysis showed that H-Y stage was negative correlated with the average RNFL thickness （r =-0.569）,average macular thickness and volume （r=-0.501 and r=-0.417） in PD patients （all P〈0.05）.Conclusions PD patients have thinner average thicknesses of RNFL,C11 quadrant RNFL and macular,smaller macular volume than those in normal controls.There were no significant differences in MD between two groups.There were negative relationships between H-Y stage,and retinal thickness and volume of PD patients.