运用高分辨SD-OCT探测视神经脊髓炎谱系疾病视网膜厚度变化

Using High-Resolution SD-OCT to Detect Changes in Retinal Thickness inNeuromyelitis Optica Spectrum Disorders

目的分析视神经脊髓炎谱系疾病（NMOSD）在超高分辨谱域光学相干断层成像（UHR-OCT）中视网膜神经纤维和轴突损伤、视网膜厚度的亚临床变化,以更好地监测疾病进展和治疗该疾病.方法：病例对照研究.利用UHR-OCT分析21 例NMOSD患者和20 例健康志愿者（健康对照组）的9 个区域视网膜结构厚度,并根据NMOSD患者是否伴有视神经炎又分为非视神经炎（NO-ON）组（13 眼）和视神经炎（ON）组（13 眼）.运用单因素方差分析比较各组之间视网膜厚度的差异.结果：ON组在总厚度上较健康对照组、NO-ON组薄,除中央区外,其余区域差异均有统计学意义（均P 〈 0.001）.NO-ON组视网膜总厚度较健康对照组视网膜薄,主要在鼻侧内环（P=0.011）、颞侧内环（P=0.003）以及上侧外环（P=0.019）、下侧外环（P=0.002）,差异均有统计学意义.ON组视网膜神经纤维层（RNFL）及神经节细胞层＋内丛状层（GCL＋IPL）厚度在各象限与健康对照组相比较薄（P 〈 0.001）,NO-ON组的RNFL厚度较健康对照组鼻侧内环（P=0.049）和颞侧（P 〈 0.001）薄.NO-ON组的GCL＋IPL较健康对照组上侧外环（P 〈 0.001）和下侧外环（P=0.002）薄.ON组内核层厚度较对照组上侧内环（P=0.001）、下侧内环（P=0.003）、颞侧外环（P=0.043）厚,而NO-ON组较对照组在上侧外环（P=0.015）、下侧外环（P=0.012）薄.NO-ON组的Henle纤维层＋外核层厚度较对照组比较在上侧内环（P=0.009）、上侧外环（P=0.018）、下侧内环（P=0.001）、下侧外环（P=0.001）有下降,ON组与对照组比较差异无统计学意义.结论：本研究发现NMOSD患者不同层次的视网膜结构存在改变,在视神经未受累眼视网膜RNFL和GCIPL存在厚度下降,提示NMOSD患者未受累眼存在潜在的视网膜神经结构损伤.

Objective： We used ultra-high resolution spectral domain optical coherence tomography （UHR-OCT） toanalyze the subclinical changes in retinal neurons, axon injury, and retinal thickness in neuromyelitis optica spectrum disorders （NMOSD） patients. Methods： This case-control study included 21 cases of NMOSDpatients and 20 matched healthy volunteers （control group）. The NMOSD patients were divided into asubgroup without optic neuritis （NO-ON） （13 eyes） and a subgroup with optic neuritis （ON） group （13 eyes）.The thickness of the total retina of each patient and control subject was evaluated by using UHR-OCT.Data of each layer were analyzed using one-way ANOVA. Results： Except at the central region, the totalretinal thickness of the ON group in whole mapping images was significantly thinner than the control groupand NO-ON group. There were significant differences in total thickness between the NO-ON group andthe control group in some regions （nasal interior [NI], P=0.011; temporal interior[TI], P=0.003; superiorexterior [SE], P=0.019; inferior exterior [IE], P=0.002）. The thicknesses of the retinal nerve fiber layer（RNFL） and the combined ganglion cell layer and inner plexiform layer （GCL＋IPL） in the ON group wassignificantly thinner in each quadrant compared with the control group （P 〈 0.001）. The RNFL thicknessof the NO-ON group was thinner in the nasal and temporal areas compared with the control group （NI,P=0.049; TI and temporal exterior [TE], P 〈 0.001）. The GCL＋IPL thickness in the NO-ON group wasthinner than control group （SE, P 〈 0.001; IE, P=0.002）. The thickness of inner nuclear layer （INL） inthe ON group was thicker than in the control group （superior interior [SI], P=0.001; inferior interior [II],P=0.003; TE, P=0.043）; however the thickness of the INL in the NO-ON group was thinner than in thecontrol group （SE, P=0.015; IE, P=0.012）. The thickness of Henle fiber layer and outer nuclear layer（HFL＋ONL） in the NO-ON group was thinner than for the control group （SI, P=0.009; SE, P=0.018; II,P=0.001; IE, P=0.001 ）, but there were no significant differences between the ON group and the controlgroup. Conclusions： There were significant changes in the different retinal layers of NMOSD patientscompared to healthy controls. The thicknesses of RNFL and GCIPL in the NO-ON subgroup were decreased,suggesting that NMOSD patients with no optic neuritis potentially have structural damage in the retinal nerve.