116例非动脉炎性前部缺血性视神经病变发病相关因素的回顾性分析

Retrospective analysis of risk factors in 116 patients with nonarteritic anterior ischemic optic neuropathy

目的观察分析非动脉炎性前部缺血性视神经病变（NAION）患者发病的相关因素。方法临床资料完整的NAION患者116例134只眼纳入研究。所有患者均详细询问病史、症状，行视力、裂隙灯显微镜、间接检眼镜、视野、荧光素眼底血管造影（FFA）检查。同时行血压、血糖、血脂、头颅MRI或CT检查。排除疑似NAION、临床资料不完整者。回顾分析患者年龄、视野、FFA、全身及眼部因素、发病月份与NAION的关系。结果116例患者中，55～70岁80例，占68．97％；其他年龄36例，占31．03％。无全身疾病19例，占16．3％；有全身疾病97例，占83．7％。其中，糖尿病38例，占39．2％;高血压32例，占32．9％；血脂异常28例，占28．9％；腔隙性脑梗死等脑血管疾病16例，占16．5％；冠心病6例，占6．2％。眼局部因素中，既往有白内障手术史3例，占所有患者的2．6%；小视盘5例，占所有患者的4．2％。糖尿病、高血压构成比与无糖尿病、高血压构成比比较，差异有统计学意义（x^2=362、259，P〈0．05）。发病时间3～4、9～10月者占全年发病的51．7％，其他月份发病者占48．3％。3、4、9、10等4个月发病率与全年其他月份发病率比较，差异有统计学意义（x^2=580，P〈0．05）。视野检查结果显示，下方视野缺损49只眼，占36．5％；上方视野缺损12只眼，占9．0％。FFA检查结果显示，视盘早期弱荧光103只眼，占76．9％；强荧光13只眼，占9．7％。晚期强荧光110只眼，占82．1%；弱荧光8只眼，占6．0％。结论糖尿病、高血压可能是NAION发病的危险因素；春夏及秋冬季节转换可能也是NAION发病的另一危险因素。

Objective To analyze retrospectively the risk factors of nonarteritic anterior ischemic optic neuropathy （NAION）. Methods The complete clinical data of 116 patients （134 eyes） were collected. All patients were asked in detail about the disease history and symptoms and were examined for the visual acuity, intraocular pressure, fundus, visual field and fundus fluorescein angiography （FFA）, blood pressure, blood glucose, blood fat and head MRI or CT. Suspicious cases and patients with incomplete clinical data were excluded. The relationship between NAION and age, visual field, FFA, systemic and ocular factors, onset seasons were retrospectively analyzed. Results 80 patients （68.97%） were 55 to 70 years old. 97 patients （83.7%） had systemic diseases, including 38 patients （39.2） with diabetes mellitus, 32 patients （32.9%） with hypertension （8 patients had low blood pressure at night）, 28 patients （28.9 % ） with hyperlipidemia, 16 patients （ 16.5 %） with cerebrovascular diseases （mainly lacunar cerebral infarction）, 6 patients （6.2%） with coronary heart disease. There were 8 patients with ocular factors, including 3 patients （2.6%） with cataract surgery history, 5 patients （4.2%） with small optic discs. The difference of percentage of with or without diabetes mellitus and hypertension was significant （x^2= 362, 259; P〈0.05）. There were 27.6% patients with disease onset at March to April, 24. 1% patients with disease onset at September to October, much higher than other months （x^2 =580,P〈0.05）. Visual field test results showed that 49 eyes （36.5%） had inferior visual field defect, 12 eyes （9.0%） had superior visual field defect. FFA showed that in the early stage 103 eyes （76.9%） had optic weak fluorescence, 13 eyes （9.7%） had strong fluorescence; in the late stage, 110 eyes （82.1%） had strong fluorescence, 8 eyes （6.0%） had weak fluorescence. Conclusions Diabetes mellitus, hypertension may be the system risk factors of NAION. The seasonal variation from spring to summer and from autumn to winter may also be another risk factor for the onset of NAION.