臂间收缩压差对原发性青光眼视野进展的影响

doi:10.3760/cma.j.issn.1674-845X.2020.01.006

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摘要

目的：探讨臂间收缩压差（IASBPD）对眼压已控制的原发性青光眼患者视野损害进展的影响。方法：前瞻性临床研究。选择2013年8月至2018年11月就诊于长沙爱尔眼科医院的原发性青光眼患者69例（69眼），均行5次以上视野检查。根据Humphrey视野计的青光眼进展引导分析（GPA）结果分为视野进展组和视野无进展组，对所有受检者进行多次双臂序贯血压测量。采用两独立样本t检验、Fisher's 精确概率法及Logistic回归进行数据分析。结果：最终纳入患者34例（34眼），其中视野进展组15例（15眼），无进展组19例（19眼），2组的IASBPD分别为（10.6±9.0）mmHg（1 mmHg=0.133 kPa）、（5.3±2.8）mmHg，视野进展组较无进展组高5.26 mmHg（95%可信区间为0.14～10.37 mmHg），差异有统计学意义（t=-2.177，P=0.045）。2组间脉压差、平均动脉压、舒张期眼灌注压差异均无统计学意义（t=0.946、-1.118、-1.967，P>0.05）。Logistic回归分析结果显示IASBPD≥10 mmHg 是视野进展的一个危险因素（OR=20.310，P=0.022）。将患者分为IASBPD<10 mmHg组（26眼）和 IASBPD≥10 mmHg组（8眼），2组的视野进展率分别为30.8%和87.5%，2组的视网膜神经纤维层厚度进展率分别为42.3%和87.5%，差异均具有统计学意义（P=0.011、0.030）。结论：IASBPD增大可能是眼压已控制的原发性青光眼患者视野进展的危险因素之一。

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关键词 ：原发性青光眼, 眼压, 视野, 臂间收缩压差

Abstract：

Objective: To investigate the effects of inter-arm systolic blood pressure differences (IASBPD) on visual field progression in primary glaucoma patients with controlled intraocular pressure. Methods: In this prospective clinical study, 69 primary glaucoma patients (69 eyes) who had visited Changsha Aier Eye Hospital from August 2013 to November 2018 and who had at least 5 reliable visual reportson file were selected. According to the guided progression analysis (GPA) of the Humphrey Field Analyzer, subjects were divided into two groups, the visual field progression group and the non-progression group. All of the patients underwent multiple sets of sequential blood pressure measurements on both arms. A student t test, Fisher's exact test and logistic regression analysis were used for data analysis. Results: Thirty-four patients (34 eyes) were included in the analysis, among which 15 patients (15 eyes) were in the progression group and the other 19 patients (19 eyes) were in non-progression group. The IASBPD of the two groups was 10.6±9.0 mmHg (1 mmHg=0.133 kPa) and 5.3±2.8 mmHg, respectively, and IASBPD in the progression group was 5.26 mmHg (95% credibility interval: 0.14-10.37 mmHg) higher than that in the non-progression group (t=-2.177, P=0.045). There were no significant differences in pulse pressure, mean arterial pressure, or diastolic ocular perfusion pressure between the two groups (t=0.946, -1.118, -1.967, all P>0.05). Logistic regression analysis showed that an IASBPD of ≥10 mmHg was a risk factor for visual field progression (OR=20.310, P=0.022). Participants were also stratified into two groups with an IASBPD of <10 mmHg (n=26) and ≥10 mmHg (n=8). The rates of visual field progression for the two groups were 30.8% and 87.5%, and rates of retinal nerve fiber layer thickness progression were 42.3% and 87.5%, respectively (P=0.011, 0.030). Conclusions: Increased IASBPD may be one of the risk factors for visual field progression in primary glaucoma patients with controlled intraocular pressure.

Key words： primary glaucoma intraocular pressure visual field inter-arm systolic blood pressure differences

收稿日期: 2019-05-15

通讯作者: 叶长华（ORCID：0000-0003-2534-4793），Email：yechanghua@csu.edu.cn

引用本文:

刘琼1，2 荣敏娜2 邓文2 王钦1，2 曹兴1，2 周丹2 叶长华1，2. 臂间收缩压差对原发性青光眼视野进展的影响[J]. 中华眼视光学与视觉科学杂志, 2020, 22(1): 32-38. Qiong Liu1, 2, Minna Rong2,Wen Deng2,Qin Wang1, 2, Xing Cao1, 2, Dan Zhou2,Changhua Ye1, 2. Effects of Inter-Arm Systolic Blood Pressure Differences on Visual Field Progression in Primary Glaucoma. Chinese Journal of Optometry Ophthalmology and Visual science, 2020, 22(1): 32-38. DOI: 10.3760/cma.j.issn.1674-845X.2020.01.006

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https://www.cjoovs.com/CN/10.3760/cma.j.issn.1674-845X.2020.01.006 或 https://www.cjoovs.com/CN/Y2020/V22/I1/32

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