非动脉炎性前部缺血性视神经病变颈内动脉虹吸部及眼动脉模型重建与形态观察

Model reconstruction and morphological observation of internal carotid artery siphon and ophthalmic artery in non-arteritic anterior ischemic optic neuropathy patients

目的基于CT血管造影(CTA)三维重建颈内动脉(ICA)虹吸部及眼动脉(OA)模型,观察非动脉炎性前部缺血性视神经病变(NAION)患者ICA虹吸部和OA的形态特征。方法回顾性队列研究。2017年1月至2019年1月于首都医科大学附属北京友谊医院眼科检查确诊的NAION患者26例31只眼(NAION组)纳入研究。其中,男性11例13只眼,女性15例18只眼;年龄(67.52±6.30)岁。以未发病的对侧眼19例19只眼作为对侧眼组。其中,男性9例9只眼,女性10例10只眼;年龄(65.95±5.66)岁。选取同期年龄、性别匹配的眼底检查正常者26名26只眼作为正常对照组。受检者均行最佳矫正视力(BCVA)、眼压、眼底照相及CTA检查。将CT扫描获得数据进行三维模型重建,将ICA虹吸部解剖形态分为U型、V型、C型、S型;测量ICA虹吸部直径和OA起始处直径。3组受检眼之间ICA虹吸部直径及OA起始处直径比较采用单因素方差分析;ICA虹吸部解剖形态U型和V型占比采用χ^(2)检验。结果NAION组、对侧眼组、正常对照组受检眼OA起始处直径分别为(1.17±0.20)、(1.34±0.17)、(1.39±0.15)mm,3组之间的差异有统计学意义(F=12.325,P<0.05);对侧眼组与正常对照组两两比较,差异无统计学意义(P=0.310)。NAION组ICA虹吸部解剖形态U型、V型分别为20(64.52%)、8(25.81%)只眼,S型+C型3只眼(9.67%);对侧眼组、正常对照组受检眼ICA虹吸部形态也以U型、V型多见,S型、C型少见。NAION组、对侧眼组、正常对照组受检眼ICA虹吸部直径分别为(3.50±0.69)、(3.22±0.59)、(3.55±0.54)mm,3组之间的差异无统计学意义(F=1.860,P=0.163)。结论NAION患眼ICA虹吸部形态以U型及V型多见;OA起始处直径显著减小。

Objective To observe the morphological characteristics of internal carotid artery(ICA)siphon and ophthalmic artery(OA)in patients with non-arteritic anterior ischemic optic neuropathy(NAION)based on CT angiography(CTA)three-dimensional reconstruction of ICA siphon and OA models.Methods A retrospective cohort study.From January 2017 to January 2019,26 patients with 31 eyes(NAION group)who were diagnosed with NAION by ophthalmic examination at Beijing Friendship Hospital,Capital Medical Universitywere included in the study.Among them,there were 11 males with 13 eyes,and 15 females with 18 eyes;the age was 67.52±6.30 years old.Nineteen eyes of 19 non-affected contralateral eyes were selected as the contralateral eye group.Among them,there were 9 males with 9 eyes and 10 females with 10 eyes;the age was 65.95±5.66 years old.Twenty-six eyes of 26 age-and sex-matched subjects with normal fundus examination during the same period were selected as the normal control group.All subjects underwent best corrected visual acuity(BCVA),intraocular pressure,fundus photography and CTA examination.The data obtained from CT scans were reconstructed by 3D model,and the anatomical morphology of ICA siphon was divided into U-shape,V-shape,C-shape and S-shape;the diameter of ICA siphon portion and the diameter at the beginning of OA were measured.One-way analysis of variance was used to compare the diameter of the OA at the beginning of the OA and the diameter of the ICA siphon between the three groups of eyes.Results The diameters at the beginning of OA in the NAION group,the contralateral eye group,and the normal control group were 1.17±0.20,1.34±0.17,and 1.39±0.15 mm,respectively,and the differences among the three groups were statistically significant(F=12.325,P<0.05);there was no significant difference between the contralateral eye group and the normal control group(P=0.310).In the NAION group,the anatomical morphology of the ICA siphon was U-shaped and V-shaped in 20(64.52%)and 8(25.81%)eyes respectively,and S and C-shaped in 3 eyes(9.67%);in the contralateral eye group,in the control group,the ICA siphon shape of the eyes examined was U-shaped and V-shaped,and S-shaped and C-shaped were rare.The diameters of the ICA siphons in the NAION group,the contralateral eye group,and the normal control group were 3.50±0.69,3.22±0.59,and 3.55±0.54 mm,respectively.There was no significant difference between the three groups(F=1.860,P=0.163).Conclusion U-shaped and V-shaped ICA siphons are more common in NAION-affected eyes;the diameter of the starting point of OA is significantly reduced.