原发性开角型青光眼患者不同体位眼灌注压昼夜波动趋势分析

Study of the circadian fluctuation of ocular perfusion pressure in different position in primary open-angle glaucoma patients

目的探讨原发性开角型青光眼(primary open-angle glaucoma,POAG)患者不同体位眼灌注压(ocular perfusion pressure,OPP)的波动趋势。设计队列研究。研究对象北京大学深圳医院POAG患者19例19眼和健康对照组18例18眼。方法受试者分别行24小时眼压及血压监测,于10:00,14:00,18:00及22:00时各时间点行坐位眼压及血压测量,POAG组于坐位测量完毕后平卧位5分钟再行监测;夜间于2:00、5:00及7:00时各时间点行卧位眼压及血压监测,POAG组于卧位测量完毕后坐起5分钟后再行监测。计算平均眼灌注压(mean ocular perfusion pressure,MOPP)、收缩期眼灌注压(systolic ocular perfusion pressure,SOPP)、舒张期眼灌注压(diastolic perfusion pressure,DOPP)。主要指标MOPP、SOPP、DOPP。结果两组习惯性体位(日间坐位、夜间卧位)MOPP、SOPP及DOPP均呈昼高夜低趋势;两组内习惯性体位MOPP均表现为夜间低于日间(POAG组t=4.092,P=0.000;对照组t=4.513,P=0.000),而两组间MOPP则无明显统计学差异(t=-0.973,P=0.350);POAG患者习惯性体位MOPP昼夜波动较对照组大(t=2.204,P=0.039),SOPP夜间波动较对照组大(t=3.097,P=0.018),DOPP的夜间及昼夜波动亦较对照组大(P均<0.05)。POAG组24小时坐位或卧位MOPP日间均值与夜间均值无明显统计学差异(P均>0.05)。24小时坐位MOPP均值明显高于24小时卧位MOPP均值(t=4.306,P=0.001)。POAG组习惯性体位MOPP均值与24小时坐位MOPP均值无明显统计学差异(t=-2.101,P=0.080),但高于24小时卧位MOPP均值(t=2.707,P=0.035)。结论不同体位下POAG患者OPP昼夜波动趋势不完全相同,习惯性体位下MOPP呈昼高夜低趋势,24小时坐位或卧位下MOPP昼夜变化不明显。

Objective To characterize the circadian fluctuation of ocular perfusion pressure(OPP) in different position in patients with newly diagnosed, untreatedprimary open-angle glaucoma(POAG). Design Cohort study. Participants Nineteen patients with POAG(19 eyes) and eighteen healthy controls(18 eyes) were included in the Peking University Shenzhen Hospital. Methods POAG patients and healthy controls were included and underwent 24-hour monitoring of IOP and blood pressure. On 10:00, 14:00, 18:00 and 22:00 o'clock in the daytime, all the subjects were monitored in sitting position, then POAG patients were monitored again after lying down for 5minutes. On 2:00, 5:00 and 7:00 o'clock at night all the subjects were monitored in supine position, then POAG patients were monitored again after sitting for 5 minutes. Calculating the mean ocular perfusion pressure(MOPP), the systolic ocular perfusion pressure(SOPP) and diastolic perfusion pressure(DOPP) by the formula and analyzing the data. Main Outcome Measures MOPP, SOPP,DOPP. Results In both groups of habitual position(sitting position in day and supine position in night), the nocturnal MOPP, SOPP and DOPP were lower than diurnal. In both groups, the nocturnal MOPP was lower than diurnal in habitual position(POAG group t=4.092,P=0.000; healthy group t=4.513, P=0.000). However, there was no obvious difference between those two groups(t=-0.973, P=0.350).POAG group had higher 24-hour fluctuation of MOPP(t=2.204, P=0.039), higher nocturnal fluctuation of SOPP(t =3.097, P =0.018),higher nocturnal and 24-hour fluctuation of DOPP than healthy group, all the differences had statistical significance(all P<0.05). In POAG group, there was no statistical difference between the nocturnal MOPP and the diurnal MOPP in sitting position or in supine position of 24 h(all P>0.05). POAG group had higher 24-hour mean MOPP in sitting position than in supine position, the difference had statistical significance(t=4.306, P=0.001). Comparing the MOPP of POAG group in habitual position with in sitting position of 24 h,there was no statistical difference(t=-2.101, P=0.080). However, POAG group had higher 24-hour mean MOPP in habitual position than in supine position of 24 h, the difference had statistical significance(t =2.707, P =0.035). Conclusions There circadian fluctuation of OPP in different position in POAG pations can not be treated as the same. The nocturnal MOPP was lower than diurnal in habitual position, but there was no obvious difference in the 24h-sitting position and 24h-supine position.