无视交叉压迫的垂体瘤患者光学相干断层扫描分析

Optical coherence tomography analysis of patients with pituitary adenoma without optic chiasmal compression

目的评估无视交叉压迫的垂体瘤患者视盘周围视网膜神经纤维层(pRNFL)和黄斑节细胞复合体(GCC)厚度的改变。方法回顾性分析2017年3-9月就诊于该院的44例垂体瘤患者,其中包括MRI无视交叉压迫21例(42眼,PP-CC组),有视交叉压迫23例(46眼,PP+CC组),与18例(36眼,健康对照组)健康人的光学相干断层扫描(OCT)和视野结果进行对比。采用广义估计方程对3组间的pRNFL、GCC厚度,以及视野平均缺损(MD)、平均敏感度(MS)进行比较。结果3组间的平均pRNFL和平均GCC厚度差异有统计学意义,PP+CC组较PP-CC组pRNFL、GCC更小(P<0.05),PP-CC组较健康对照组pRNFL、GCC更小(P<0.05)。节段性分析中,PP-CC组pRNFL在鼻侧象限较健康对照组更小,下半GCC较健康对照组更小(P<0.05)。在视野的比较中,PP+CC组较PP-CC组和对照组MD增加,MS减少,差异有统计学意义(P<0.05)。PP-CC组和健康对照组的MD及MS差异无统计学意义(P>0.05)。结论无视交叉压迫的垂体瘤患者在视野正常时也可出现pRNFL和GCC的变薄,OCT扫描对于垂体瘤视神经病变的早期诊断和随访有重要价值。

Objective To evaluate changes in perioptic retinal nerve fiber layer(pRNFL)and macular ganglion cell complex thickness(GCC)in patients with pituitary adenoma without optic chiasmal compression.Methods A total of 44 patients with pituitary adenoma enrolled from March to September 2017 in this hospital were analyzedretrospectively,including 21 patients without chiasmal compression(42 eyes,the PA-CC group)and 23 patients with chiasmal compression(46 eyes,the PA+CC group).The results of optical coherence tomography(OCT)and visual field were compared with those of 18 healthy subjects(36 eyes,the healthy control group).The pRNFL and GCC thickness,visual field mean defect(MD)and mean sensitivity(MS)were compared between the three groups by the generalized estimation equation.Results The mean pRNFL and mean GCC thickness were significantly different among the three groups.The PP+CC group was thinner than the PP-CC group(P<0.05),and the PP-CC group was thinner than the healthy control group(P<0.05).In sectoral analysis,pRNFL in the PP-CC group was thinner than that in the control group in the nasal quadrant,and GCC in the lower part was thinner than that in the healthy control group,both of which were statistically significant.In comparison of visual field,MD increased and MS decreased in the PP+CC group compared with the PP-CC group and the healthy control group,the difference was statistically significant(P<0.05).There was no significant difference in MD and MS between the PA-CC group and the healthy control group.Conclusion The thinning of pRNFL and GCC can also be seen in patients with pituitary adenoma without optic chiasmal compression when the field of vision is normal.OCT scanning is of great value for the early diagnosis and follow-up of pituitary adenoma optic neuropathy.