NA-AION患者昼夜血压、外周血ACA变化与BCVA、GC-IPL厚度的相关性

Correlation of circadian blood pressure and peripheral blood ACA changes with BCVA and GC⁃IPL thickness in patients with NA⁃AION

目的分析非动脉炎性前部缺血性视神经病变(NA-AION)患者昼夜血压及外周血抗心凝脂抗体(ACA)变化与最佳矫正视力(BCVA)和视网膜神经节细胞-内丛状层(GC-IPL)厚度的相关性。方法选取沧州市人民医院2021年6月至2022年6月收治的96例NA-AION患者(共96眼)为NA-AION组,另择本院同期50岁以上无眼科疾病的40名体检者纳入对照组。对比两组性别、年龄、昼夜血压变化、外周血ACA、BCVA及GC-IPL厚度差异,并采用多因素Logistic回归分析NA-AION的危险因素;采用pearson相关性分析NA-AION患者昼夜血压、外周血ACA水平及BMI值与BCVA、GC-IPL厚度的相关性;采用spearman相关性分析NA-AION患者血压昼夜节律与BCVA、GC-IPL厚度的相关性。结果NA-AION组高血压、BMI≥25 kg/m^(2)、嗜酒、匹兹堡睡眠指数量表(PSQI)评分>7分、血压昼夜节律异常的比例均大于对照组,且白昼平均收缩压、夜间平均收缩压、舒张压及外周血ACA水平均高于对照组,差异均有统计学意义(P<0.05);多因素Logistis回归分析显示,高血压、BMI≥25 kg/m^(2)、嗜酒、PSQI评分>7分、血压昼夜节律异常、夜间平均收缩压及外周血ACA水平均是NA-AION的独立危险因素(P<0.05)。NA-AION组的BCVA(LogMAR视力)明显高于对照组,GC-IPL厚度明显低于对照组,差异均有统计学意义(P<0.05)。相关性分析显示,NA-AION患者夜间平均收缩压、舒张压及外周血ACA水平及BMI均与BCVA(LogMAR视力)呈正比(P<0.05),与GC-IPL厚度呈反比(P<0.05);血压昼夜节律与BCVA(LogMAR视力)呈反比(P<0.05),与GC-IPL厚度呈正比(P<0.05)。结论血压昼夜节律异常、外周血ACA表达异常及BMI值与NA-AION的发病相关。

Objective To analyze the correlation between circadian blood pressure and peripheral blood anti⁃cardiolipin antibody(ACA)changes and best corrected visual acuity(BCVA)and retinal ganglion cell⁃internal plexus layer(GC⁃IPL)thickness in patients with non⁃arteritic anterior ischemic optic neuropathy(NA⁃AION).Methods 96 patients with NA⁃AION(96 eyes)admitted to Cangzhou People's Hospital from June 2021 to June 2022 were selected as the NA⁃AION group.Another 40 subjects over 50 years old with no eye disease who had undergone a physical examination at our hospital during the same period were included in the control group.The differences in gender,age,circadian blood pressure changes,peripheral blood ACA levels,BCVA and GC⁃IPL thickness were compared between the two groups,and the risk factors of NA⁃AION were analyzed using multivariate logistic regression analysis.Pearson correlation analysis was used to examine the correlation of circadian blood pressure,peripheral blood ACA levels and BMI value with BCVA and GC⁃IPL thickness.Spearman correlation analysis was applied to analyze the correlation between circadian rhythm of blood pressure and BCVA and GC⁃IPL thickness in patients with NA⁃AION.Results The propor⁃tions of hypertension,BMI≥25 kg/m^(2),alcoholism,Pittsburgh Sleep Quality Index(PSQI)score>7 points and abnormal circadian rhythm of blood pressure in the NA⁃AION group were higher than those in the control group.Additionally,the daytime mean systolic blood pressure,nighttime mean systolic blood pressure,dia⁃stolic blood pressure and peripheral blood ACA level were higher in the NA⁃AION group compared to the in control group(P<0.05).Multivariate logistic regression analysis showed that hypertension,BMI≥25 kg/m^(2),alcoholism,PSQI score>7 points,abnormal circadian rhythm of blood pressure,nighttime mean systolic blood pressure and peripheral blood ACA level were independent risk factors for NA⁃AION(P<0.05).BCVA(LogMAR visual acuity)in the NA⁃AION group was significantly higher than that in the control group,and GC⁃IPL thickness was significantly thinner than that in the control group(P<0.05).Correlation analysis indi⁃cated that the nighttime mean systolic blood pressure,diastolic blood pressure,peripheral blood ACA level and BMI in patients with NA⁃AION were positively correlated with BCVA(LogMAR visual acuity)(P<0.05),and were negatively correlated with GC⁃IPL thickness(P<0.05).Circadian rhythm of blood pressure was inversely proportional to BCVA(LogMAR visual acuity)(P<0.05),and a positively proportional to GC⁃IPL thickness(P<0.05).Conclusion Abnormal circadian rhythm of blood pressure,abnormal expres⁃sion of peripheral blood ACA and BMI value are related to the pathogenesis of NA⁃AION.