青光眼视网膜血氧饱和度与结构功能损害程度的相关分析

doi:DOI:10.3760/cma.j.issn.1674-845X.2017.03.006

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摘要

目的比较青光眼与正常人视网膜血氧饱和度的差异，分析青光眼患者中视网膜血氧饱和度与结构功能损害程度的相关性。方法病例对照研究。选取原发性开角型青光眼患者28例（35眼）为青光眼组，记录患者年龄、性别、眼压、血压、杯盘比，并进行中心30°阈值视野检测和光学相干断层扫描（OCT）检测视乳头旁视网膜神经纤维层（RNFL）厚度，并纳入27例（41眼）正常人作为对照组，采用视网膜血氧饱和度分析仪测量青光眼患者和正常人视网膜血管血氧饱和度。2组动静脉血氧饱和度差异比较采用独立样本t检验。采用Pearson或Spearman秩相关分析对青光眼组视网膜血氧饱和度与年龄、眼压、血压、杯盘比、视野平均缺损（MD）、视野指数（VFI）、视乳头旁RNFL厚度进行相关分析。结果青光眼组与正常对照组的视网膜动脉血氧饱和度差异无统计学意义，青光眼组静脉血氧饱和度较对照组高（t=4.017，P＜0.001），动静脉血氧饱和度差值较小（t=-4.431，P＜0.001）。青光眼组视网膜动脉血氧饱和度、静脉血氧饱和度、动静脉血氧饱和度差值与年龄、眼压、血压均无线性相关性。视网膜动脉血氧饱和度与杯盘比、视野MD、VFI、视乳头旁RNFL厚度等均无线性相关。视网膜静脉血氧饱和度与杯盘比、视野MD值呈正相关（杯盘比：r=0.418，P=0.012；视野MD：r=0.504，P=0.002），与RNFL厚度、VFI呈负相关（RNFL：r=-0.514，P=0.002；VFI：r=-0.470，P=0.004）。视网膜动静脉血氧饱和度差值与杯盘比、视野MD均呈负相关（杯盘比：r=-0.390，P=0.021；视野MD：r=-0.478，P=0.004），与VFI、视乳头旁RNFL厚度呈正相关（VFI：r=0.449，P=0.007；RNFL：r=0.385，P=0.022）。结论随着青光眼加重，静脉血氧饱和度增加，动静脉血氧饱和度差值降低。青光眼患者视网膜耗氧量降低可能与视网膜神经组织萎缩有关。

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	聂莉
	吴西施
	沈丽君
	王君
	虞冠舜
	潘伟华
	廉恒丽

关键词 ：青光眼, 视网膜血氧饱和度, 杯盘比, 视野, 视网膜神经纤维层厚度

Abstract：

Objective To determine if retinal oxygen metabolism is different in glaucoma patients compared to healthy subjects and to determine if retinal vessel oxygen saturation is correlated with structural and functional damage in glaucoma patients. Methods This case control study included 28 patients (35 eyes) with primary open-angle glaucoma and 27 healthy individuals(41 eyes). Visual fields were measured with a Humphrey field analyzer. Optical coherence tomography (OCT) was performed to detect the thickness of the retinal nerve fiber layer (RNFL) in glaucoma patients. Retinal vessel oxygen saturation was measured in glaucoma patients and healthy individuals with a non-invasive spectrophotometric retinal oximeter. Statistical analysis was performed using independent t-test and Pearson′s correlation. Results There was no significant difference in retinal arteriole oxygen saturation between glaucoma patients and healthy individuals. However, the oxygen saturation in venules was higher and the arteriovenous difference was lower in glaucoma patients (t=4.017, P＜0.001; t=-4.431, P＜0.001). Retinal arteriolar oxygen saturation was not associated with age, intraocular pressure, blood pressure, cup-to-disc ratio, mean deviation (MD), visual field index (VFI), or RNFL thickness in glaucoma patients. The retinal oxygen saturation in both the venules and arteriovenous (AV) difference was not correlated with age, intraocular pressure, or blood pressure in glaucoma patients. Retinal venous oxygen saturation was positively correlated with the cup-to-disc ratio (r=0.418, P=0.012) and MD (r=0.504, P=0.002) and negatively correlated with RNFL thickness (r=-0.514, P=0.002) and VFI (r=-0.470, P=0.004) in glaucoma patients. On the other hand, the AV difference was negatively correlated with the cup-to-disc ratio (r=-0.390, P=0.021) and MD (r=-0.478, P=0.004) and positively correlated with RNFL thickness (r=0.385, P=0.022) and VFI (r=0.449, P=0.007) in glaucoma patients. Conclusion Severe glaucomatous damage is associated with increased oxygen saturation in venules and a decrease in the AV difference in retinal oxygen saturation, suggesting that reduced retinal oxygen consumption is related to the atrophy of the retinal nerve fibers.

Key words： Glaucoma Retinal vessel oxygen saturation Cup-to-disc ratio Visual fields Retinal nerve fiber layer thickness

收稿日期: 2016-10-19

基金资助:

浙江省医药卫生科研基金（2017KY496）；温州市科技计划项目（Y20160463，Y20160444）

通讯作者: 沈丽君，Email：slj@mail.eye.ac.cn

引用本文:

聂莉,吴西施,沈丽君,王君,虞冠舜,潘伟华,廉恒丽. 青光眼视网膜血氧饱和度与结构功能损害程度的相关分析[J]. 中华眼视光学与视觉科学杂志, 2017, 19(3): 152-157. NIE Li, WU Xishi,SHEN Lijun,WANG Jun,YU Guanshun,PAN Weihua,LIAN Hengli. Correlation of retinal vessel oxygen saturation with structural andfunctional damage in glaucoma. Chinese Journal of Optometry Ophthalmology and Visual science, 2017, 19(3): 152-157. DOI: DOI:10.3760/cma.j.issn.1674-845X.2017.03.006

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[1]	李美玉. 青光眼学[M]. 北京:人民卫生出版社, 2004: 331-333.
[2]	Foster PJ, Buhrmann R, Quigley HA, et al. The definition and classification of glaucoma in prevalence surveys[J]. Br J Ophthalmol, 2002, 86(2): 238-242. DOI: 10.1136/bjo.86.2.238.
[3]	Quigley HA, Addicks EM, Green WR, et al. Optic nerve damagein human glaucoma. II. The site of injury and susceptibility to damage[J]. Arch Ophthalmol, 1981, 99(4): 635- 649.
[4]	Mitchell P, Leung H, Wang JJ, et al. Retinal vessel diameter and open-angle glaucoma: the Blue Mountains Eye Study[J]. Ophthalmology, 2005, 112(2): 245-250. DOI: 10.1016/j.ophtha.2004. 08.015.
[5]	Yin ZQ, Vaegan, Millar TJ, et al. Widespread choroidal insufficiency in primary open-angle glaucoma[J]. J Glaucoma,1997, 6(1): 23-32.
[6]	Ramm L, Jentsch S, Peters S, et al. Dependence of diameters and oxygen saturation of retinal vessels on visual field damage and age in primary open-angle glaucoma[J]. Acta Ophthalmol, 2016, 94(3): 276-281. DOI: 10.1111/aos.12727.
[7]	Garh?觟fer G, Fuchsj?覿ger-Mayrl G, Vass C, et al. Retrobulbar blood flow velocities in open angle glaucoma and their association with mean arterial blood pressure[J]. Invest Ophthalmol Vis Sci, 2010, 51(12): 6652-6657. DOI: 10.1167/iovs. 10-5490.
[8]	Lee TE, Kim YY, Yoo C. Retinal vessel diameter in normal- tension glaucoma patients with asymmetric progression[J]. Graefes Arch Clin Exp Ophthalmol, 2014, 252(11): 1795-1801. DOI: 10.1007/s00417-014-2756-6.
[9]	Olafsdottir OB, Vandewalle E, Abeg?觔o Pinto L, et al. Retinal oxygen metabolism in healthy subjects and glaucoma patients[J]. Br J Ophthalmol, 2014, 98(3): 329-333. DOI: 10.1136/bjophth- almol-2013-303162.
[10]	Michelson G, Scibor M. Intravascular oxygen saturation in retinal vessels in normal subjects and open-angle glaucoma subjects[J]. Acta Ophthalmol Scand, 2006, 84(3): 289-295. DOI:10.1111/j.1600-0420.2005.00631.x.
[11]	Olafsdottir OB, Hardarson SH, Gottfredsdottir MS, et al. Retinal oximetry in primary open-angle glaucoma[J]. Invest Ophthalmol Vis Sci, 2011, 52(9): 6409-6413. DOI: 10.1167/iovs.10-6985.
[12]	Vandewalle E, Abeg?觔o Pinto L, Olafsdottir OB, et al. Oximetry in glaucoma: correlation of metabolic change with structural and functional damage[J]. Acta Ophthalmol, 2014, 92(2):105-110. DOI: 10.1111/aos.12011.
[13]	Stef?觃nsson E, Pedersen D, Jensen P, et al. Optic nerve oxygenation[J]. Prog Retin Eye Res, 2005, 24(3): 307-332. DOI: 10.1016/j.preteyeres.2004.09.001.
[14]	O'Connell RA, Anderson AJ, Hosking SL, et al. Provocative intraocular pressure challenge preferentially decreases venous oxygen saturation despite no reduction in blood flow[J]. Ophthalmic Physiol Opt, 2015, 35(2): 114-124. DOI: 10.1111/opo. 12170.
[15]	Tezel G, Wax MB. Hypoxia-inducible factor 1alpha in the glaucomatous retina and optic nerve head[J]. Arch Ophthalmol,2004, 122(9): 1348-1356. DOI: 10.1001/archopht.122.9.1348.
[16]	Yang X, Wei A, Liu Y, et al. IGF-1 protects retinal ganglion cells from hypoxia-induced apoptosis by activating the Erk-1/2 and Akt pathways[J]. Mol Vis, 2013, 19(9): 1901-1912.
[17]	Peng Y, Zhang J, Xu H, et al. Neuroprotective effect of protease-activated receptor-2 in the hypoxia-induced apoptosis of rat RGC-5 cells[J]. J Mol Neurosci, 2013, 50(1): 98-108. DOI: 10.1007/s12031-012-9876-4.
[18]	Hardarson SH, Gottfredsdottir MS, Halldorsson GH, et al. Glaucoma filtration surgery and retinal oxygen saturation[J]. Invest Ophthalmol Vis Sci, 2009, 50(11): 5247-5250. DOI: 10. 1167/iovs.08-3117.
[19]	Siesky B, Harris A, Cantor LB, et al. A comparative study of the effects of brinzolamide and dorzolamide on retinal oxygen saturation and ocular microcirculation in patients with primary open-angle glaucoma[J]. Br J Ophthalmol, 2008, 92(4): 500-504. DOI: 10.1136/bjo.2007.125187.
[20]	Siesky B, Harris A, Kagemann L, et al. Ocular blood flow and oxygen delivery to the retina in primary open-angle glaucoma patients: the addition of dorzolamide to timolol monotherapy[J]. Acta Ophthalmol, 2010, 88(1): 142-149. DOI: 10. 1111/j.1755-3768.2009.01604.x.
[21]	Traustason S, Hardarson SH, Gottfredsdottir MS, et al. Dorzolamide-timolol combination and retinal vessel oxygen saturation in patients with glaucoma or ocular hypertension[J]. Br J Ophthalmol, 2009, 93(8): 1064-1067. DOI: 10.1136/bjo.2008. 148460.