不同程度帕金森病患者黄斑区视网膜厚度及黄斑体积观察分析

Quantitative analysis of macular retinal thickness and volume in patients with different degrees of Parkinson’s disease

目的观察不同程度帕金森病(PD)患者黄斑区视网膜厚度及黄斑体积的变化。方法2016年10月至2017年10月在首都医科大学宣武医院神经内科诊断为原发性PD的30例患者30只眼纳入研究。其中,男性17例,女性13例;平均年龄(63.2±6.4)岁;平均病程(3.9±2.4)年。根据Hoehn-Yahr分级法将患者分为轻中度PD组、重度PD组,分别为15例15只眼。同时纳入健康对照者20名20只眼作为正常对照组。所有受检者均行OCT检查。软件自动将黄斑中心凹6mm范围内视网膜划分为以黄斑中心凹为中心的3个同心圆,两条放射线将3、6mm的同心圆分为上下左右4区,共9个区。分别测量每个分区的平均视网膜厚度及黄斑体积。采用SPSS16.0软件进行统计学处理,组间比较采用单因素方差分析。结果与正常对照组比较,轻中度PD组、重度PD组患眼各分区视网膜厚度变薄,黄斑体积变小;与轻中度PD组比较,重度PD组患眼黄斑各分区视网膜厚度变薄,黄斑体积变小。3组间各分区视网膜厚度(F=5.794、5.221、5.586、5.302、5.926、5.319、5.404、5.261、5.603,P=0.001、0.007、0.003、0.005、0.000、0.004、0.004、0.006、0.002)及黄斑体积(F=5.180、5.584、6.618、5.346、6.001、5.807、5.350、5.229、5.590,P=0.009、0.004、0.000、0.005、0.001、0.002、0.005、0.006、0.003)比较,差异均有统计学意义。轻中度PD组、重度PD组患眼黄斑分区中,内环4分区视网膜厚度及黄斑体积表现为内环上方、鼻侧最厚和最大,下方次之,颞侧最薄和最小,外环4分区表现为鼻侧最厚和最大,上方次之,下方、颞侧较薄和较小。结论PD患者黄斑中心凹及其周围分区视网膜厚度及黄斑体积较正常健康者明显变薄、变小;随着PD严重程度的增加,黄斑中心凹及其周围分区视网膜厚度和黄斑体积进一步变薄、变小。

Objective To observe the macular retinal thickness and volume in patients with different degrees of Parkinson's disease (PD). Methods Thirty eyes of 30 patients with primary PD and 20 eyes of 20 healthy subjects (control group) in Xuanwu Hospital of Capital Medical University from October 2016 to October 2017 were enrolled in this study. There were 17 males and 13 females, with the mean age of 63.2±6.4 years and disease course of 3.9±2.4 years. The patients were divided into mild to moderate PD group (15 eyes of 15 patients) and severe PD group (15 eyes of 15 patients). The macular area was automatically divided into 3 concentric circles by software, which were foveal area with a diameter of 1 mm (inner ring), middle ring of 1 to 3 mm, and outer ring of 3 to 6 mm. The middle and outer ring were divided into 4 quadrants by 2 radiations, respectively. The changes of retinal thickness and macular volume of the macular center and its surrounding quadrants were analyzed. SPSS 16.0 software was used for statistical analysis. One-way ANOVA were used to analyze all data. Results Compared with the control group, the retinal thickness and volume in macular center and each quadrant of the mild to moderate PD group and severe PD group were reduced. Compared with the mild to moderate PD group, the retinal thickness and volume in macular center and each quadrant of the severe PD group were reduced. The differences of retinal thickness and macular volume among 3 groups were significant(F=5.794, 5.221, 5.586, 5.302, 5.926, 5.319, 5.404, 5.261, 5.603;P=0.001, 0.007, 0.003, 0.005, 0.000, 0.004,0.004, 0.006, 0.002). In inner ring of the mild to moderate PD group and the severe PD group, the retinal thickness and macular volume in the upper and the nasal were the largest, the inferior was followed, and the temporal was the smallest. In outer ring of the mild to moderate PD group and the severe PD group, the retinal thickness and macular volume in the nasal was the largest, the upper was the second, the temporal and the inferior were the smallest. Conclusions The retinal thickness and volume of the macular central fovea and its surrounding areas in PD patients are significantly thinner than that in the healthy subjects. And with the increase of the severity of PD, the macular structure changes obviously, showing macular center and its surrounding macular degeneration thin, macular volume reduced.