正常成年人年龄相关性视盘周围视网膜神经纤维层厚度变化及影响因素

Age-Related Changes in and Determinants of the Peripapillary Retinal Nerve Fiber Layer in Normal Adults

目的:研究高分辨率光学相干断层扫描(HD-OCT)测得的正常成年人视盘周围视网膜神经纤维层(pRNFL)厚度随年龄的变化及其影响因素,从而为青光眼性视神经病变进展的诊断提供依据。方法:系列病例研究。选取2016年6-9月在北京同仁医院进行健康体检的某单位在职职工与退休职工,共195例(390眼),年龄21~90岁,以10岁为一组,分为7组(21~30岁、31~40岁、41~50岁、51~60岁、61~70岁、71~80岁、81~90岁)。应用HD-OCT进行pRNFL厚度平均值及各个区域厚度参数测量,采用方差分析比较不同年龄组之间pRNFL厚度的差异,同时建立多元线性回归方程并用广义估计方程进行矫正,探讨年龄、性别、眼压、等效球镜度(SE)对pRNFL厚度平均值的影响。结果:最终195例(352眼)的数据用于分析,pRNFL厚度为(96±10)μm;在21~90岁之间,随着年龄增加,pRNFL厚度平均值减少0.21μm/年(χ2=46.34,P<0.001);pRNFL厚度在40岁和70岁后分别出现陡坡样下降,其间pRNFL保持相对稳定。除年龄因素外,pRNFL变薄与SE向负值方向发展有关(β=-1.49,χ2=11.93,P=0.001),而与性别(β=0.73,χ2=0.34,P=0.560)和眼压(β=-0.24,χ2=2.10,P=0.148)无关。结论:pRNFL厚度随年龄增长而逐渐变薄,在40岁和70岁后分别出现陡坡样下降。pRNFL变薄与年龄增长、近视屈光度增高有关,而与性别和正常范围内的眼压波动无显著相关。在青光眼性视神经病变的进展分析中需要考虑这些因素的作用。

Objective:To determine age-related changes in and the determinants of high-definition optical coherence tomography(HD-OCT)measurements of the peripapillary retinal nerve fiber layer(pRNFL)thickness in normal adults in order to provide evidence for the progressive analysis of glaucoma.Methods:This was a case series study.One hundred ninety-five(390 eyes)people were recruited from June 2016 to September 2016 in the Beijing Tongren Hospital Health Examination Center from specific groups,including staffs and retired staffs.Age ranged from 21 to 90 years.Participants underwent Cirrus HD-OCT measurements of the pRNFL.One-way analysis of variance was used to compare mean pRNFL thickness between 7 decade-based age groups(21-30 years,31-40 years,41-50 years,51-60 years,61-70 years,71-80 years,81-90 years)and between sectors.Multiple regression analysis and linear regression determined the association between pRNFL thickness and age,gender,intraocular pressure(IOP)and spherical equivalent(SE).Results:Mean pRNFL thickness in the 352 eyes was 96±10μm.Mean pRNFL thickness decreased by 0.21μm(χ2=46.34,P<0.001)per year with an increase in age.It showed two steep drops with age,first in the 4th and next in the 7th decade with relative stability between them.pRNFL thickness was associated with SE(β=-1.49,χ2=11.93,P=0.001)but not with gender(β=0.73,χ2=0.34,P=0.560)or IOP(β=-0.24,χ2=2.10,P=0.148).Conclusions:Mean pRNFL thickness shows a small age-related linear decrease with two steep drops in the 4th and 7th decades.A thinner pRNFL was independently associated with age and a higher SE in myopia,but not with gender or IOP within the normal range.These factors should be considered if using pRNFL to detect the progression of glaucoma and other optic neuropathies.