彩色多普勒超声检测青光眼患者眼后血流动力学与视觉功能的关系

Relationship between ocular hemodynamics and visual function in patients with glaucoma detected by color doppler ultrasound

目的探讨彩色多普勒超声检测青光眼患者眼后血流动力学与视觉功能的关系。方法回顾性病例研究。选择2020年3月至2022年3月在我院眼科接受治疗的青光眼患者110例作为研究对象,另选择同期在我院体检的健康者110例作为对照组。根据视野损害程度将青光眼组患者分为轻度组(n=43)、中度组(n=35)和重度组(n=32)三个亚组。通过彩色多普勒超声检测青光眼组和对照组的眼动脉(OA)、视网膜中央动脉(CRA)、睫状后短动脉(SPCA)的血流动力学,并比较不同亚组之间的血流动力学差异。通过多因素Logistic回归分析青光眼患者视野损害程度的影响因素,并对模型效能进行评价。结果青光眼组患者OA、CRA以及SPCA的收缩期峰值流速(PSV)、舒张期血流速度(EDV)和平均流速(MV)均低于对照组(均P<0.05),搏动指数(PI)和阻力指数(RI)均高于对照组(均P<0.05)。重度组患者OA、CRA以及SPCA的PSV、EDV和MV均低于轻度组和中度组(均P<0.05);中度组患者OA、CRA以及SPCA的PSV、EDV和MV均低于轻度组(均P<0.05)。低CRA⁃PSV、低CRA⁃EDV、低SPCA⁃PSV、低SPCA⁃EDV为青光眼患者视野损害程度的独立危险因素(均P<0.05)。轻度组患者的平均视野缺损(MD)与OA、CRA和SPCA的PSV均呈显著负相关关系;中度组患者的MD与OA、CRA和SPCA的PSV、EDV均呈显著负相关关系;重度组患者的MD与OA、CRA和SPCA的PSV、EDV均呈显著负相关关系,与OA、CRA和SPCA的RI均呈显著正相关关系反向传播(BP)神经网络模型具有良好的区分度和较高的准确性。结论青光眼患者眼后血流动力学与视野损害程度存在相关关系,低CRA⁃PSV、低CRA⁃EDV、低SPCA⁃PSV、低SPCA⁃EDV为青光眼患者视野损害程度的独立危险因素。

Objective To investigate the relationship between ocular hemodynamics and visual function in patients with glaucoma by color doppler ultrasound.Methods A retrospective case⁃control study.110 patients with glaucoma ad⁃mitted to our hospital from March 2020 to March 2022 were selected as the study group,and 110 healthy people who were examined in our hospital at the same time were selected as the control group.According to the degree of visual field dam⁃age,glaucoma patients were divided into three subgroups:mild group(n=43),moderate group(n=35)and severe group(n=32).The hemodynamics of ophthalmic artery(OA),central retinal artery(CRA)and short posterior ciliary artery(SPCA)in glaucoma group and control group were detected by color doppler ultrasound,and the hemodynamic differences between different subgroups were compared.The risk factors of visual field damage in glaucoma patients were analyzed by multifactorial logistic regression,and the effectiveness of the model was evaluated.Results Peaksy stolic ve⁃locity(PSV),end diastolic velocity(EDV)and mean velocity(MV)of OA,CRA and SPCA in the glaucoma group were significantly lower than those in the control group(P<0.05),and pulsatility index(PI)and resistance index(RI)were significantly higher than those in the control group(P<0.05).PSV,EDV and MV of OA,CRA and SPCA in the severe group were significantly lower than those in the mild group and moderate group(P<0.05).PSV,EDV and MV of OA,CRA and SPCA in moderate group were significantly lower than those in the mild group(P<0.05).Low CRA⁃PSV,low CRA⁃EDV,low SPCA⁃PSV and low SPCA⁃EDV were independent risk factors of visual field damage in glaucoma patients(P<0.05).Mean defect(MD)in the mild group was negatively correlated with PSV in OA,CRA and SPCA.MD in the moderate group was negatively correla⁃ted with PSV and EDV of OA,CRA and SPCA.MD in the severe group was significantly negatively correlated with PSV and EDV of OA,CRA and SPCA,and was significantly posi⁃tively correlated with RI of OA,CRA and SPCA.Back propagation(BP)neural network model has good discrimination and accuracy.Conclusions There is a correlation between the postocular hemodynamics and the degree of visual field damage in patients with glaucoma.Low CRA⁃PSV,low CRA⁃EDV,low SPCA⁃PSV and low SPCA⁃EDV are independent risk factors of visual field damage in patients with glaucoma.