慢性肾衰竭患者血液透析前后脉络膜厚度及眼灌注压变化的研究

Changes of choroidal thickness and ocular perfusion pressure in patients with chronic renal failure after hemodialysis

目的观察慢性肾衰竭(CRF)患者血液透析(HD)前后脉络膜厚度及眼灌注压的改变,评估HD对CRF患者眼部供血状态的影响。方法收集2015年1~12月经青岛大学附属医院肾内科确诊为慢性肾衰竭并进行HD的患者,共计52例(52眼,均取右眼为观察眼)。于透析前1 min及透析结束后1 min内,抽取患者静脉血,测定其血浆渗透压。分别于透析前30 min、透析开始2 h后、透析结束后30 min内,采用回弹式眼压计测量眼压,并记录收缩期及舒张期血压,根据公式换算眼灌注压(OPP;OPP=4/9舒张压+2/9收缩压-眼压)。于透析前30 min、透析结束后30 min内,利用相干光断层扫描技术(OCT)观察脉络膜厚度的变化。结果受试对象HD后,血浆渗透压较透析前降低,差异具有统计学意义(P<0.05,t=3.04)。透析开始后2 h与透析前相比眼灌注压降低,差异具有统计学意义(P<0.05,t=2.57);透析结束后眼灌注压恢复至透析前水平,两者相比差异无统计学意义(P>0.05,t=-1.18)。透析开始后2 h与透析前相比,眼压变化无统计学意义(P>0.05,t=-0.67);透析结束后30 min与透析前相比,眼压变化无统计学意义(P>0.05,t=0.88)。HD后脉络膜厚度变薄,各测量点(中心凹下、距离中心凹鼻侧及颞侧1 500μm)与透析前相比,差异均具有统计学意义(P<0.01,t=6.24;P<0.01,t=6.17;P<0.01,t=3.41)。结论 CRF患者HD后脉络膜厚度变薄,透析过程中眼灌注压一过性降低,这可能会影响患者眼部的供血状态。

Objective To observe the changes of choroidal thickness and ocular perfusion pressure （OPP）in chronic renal failure patients before and after hemodialysis , and to assess the impact of hemodialysis on ocular blood flow state. Methods Collect the patients that were diagnosed with chronic renal failure and hemodialysis patients by Affiliated Hospital of Qingdao University of Nephrology between January to December in 2015, a total of 52 patients of 52 eyes （all right eyes as the observing eyes）. Before hemodialysis 1 min, within 1 min after hemodialysis venous blood was collected, and plasma osmotic pressure was measured. Before hemodialysis 30 min, after hemodialysis 2 h, within 30 min after hemodialysis, intraocular pressure （IOP） was measured by using rebound tonometer, and systolic and diastolic blood pressure were recorded. OPP was calculated in terms of formula （ OPP = 4/9 diastolic ＋ 2/9 systolic blood pressure -intraocular pressure）. Before hemodialysis 30 min, Within 30 min after hemodialysis, OCT was used to measure the choroidal thickness. Results After hemodialysis plasma osmotic pressure reduced, and the difference was statistically significant （P 〈 0.05, t = 3.04）. After hemodialysis 2 h, OPP is reduced, and the difference was statistically significant （P 〈 0.05, t = 2.57 ）. Within 30 min after hemodialysis, OPP recovered to the pre-dialysis level, and the difference was not statistically significant （P 〉 0.05, t = - 1.18 ）. IOP change was not statistically significant. Choroid thickness became thinner after hemodialysis at each measuring points, and the differences were statistically significant （ P 〈 0. 01, t = 6.24 ; P 〈 0.01, t = 6. 17 ; P 〈 0.01, t = 3.41 ） Conclusions Choroid thickness became thinner after hemodialysis in chronic renal failure patients, and OPP decreased transiently during hemodialysis, which might affect the ocular blood flow state in the hemodialysis patients. （Chin J Ophthalmol and Otorhinolaryngo1,2017,17：28-32）