【摘要】：目的探討非動(dòng)脈炎性前部缺血性視神經(jīng)病變(non-arteritic anterior ischemic optic neuropathy,NAION)患者的病因、發(fā)病機(jī)制、相關(guān)危險(xiǎn)因素、臨床特征、治療方法、治療效果和預(yù)防措施,以期為臨床醫(yī)生提供更有力的證據(jù)指導(dǎo)臨床診斷和治療。方法采用回顧性病例分析研究。自2011年4月至2016年11月間,收集天津市第四中心醫(yī)院眼科連續(xù)收治的NAION患者66例(74眼)作為研究對象,分析其臨床表現(xiàn)、眼部及全身危險(xiǎn)因素、視力、視野、眼底熒光素血管造影(fundus fluorescein angiography,FFA)、光學(xué)相干斷層掃描(optical coherence tomography,OCT)結(jié)果,積極治療全身病,同時(shí)全身應(yīng)用糖皮質(zhì)激素、血管擴(kuò)張劑和神經(jīng)營養(yǎng)劑等綜合治療,比較治療前后矯正視力和視野的變化。結(jié)果本組66例患者中,男女之比為1.6:1,發(fā)病年齡平均為(58.6±10.4)歲。所有患者均表現(xiàn)有不同程度的中心視力下降和視野改變,71眼中與生理盲點(diǎn)相連的繞過中心注視點(diǎn)的象限性或下方視野缺損36眼(50.7%),眼底檢查可見患眼視乳頭缺血水腫66眼(89.2%),FFA檢查早期可見視乳頭血管充盈遲緩和晚期熒光增強(qiáng)者45眼(60.8%)。伴有高血壓病者46例(69.7%)、糖尿病者26例(39.4%)、高脂血癥者37例(56.0%),有吸煙史者19例(28.8%),其中高血壓、糖尿病與NAION初診視力低下(0.3)和治療有效率無直接相關(guān)。經(jīng)血管擴(kuò)張劑和營養(yǎng)神經(jīng)藥物綜合治療后患眼視力提高者38眼,有效率為51.4%;視野缺損改善者為34眼,有效率為47.9%。FFA顯示早期視乳頭充盈時(shí)間較發(fā)病初期縮短者19眼,缺血范圍較發(fā)病初期縮小者31眼。結(jié)論NAION是一種與全身及眼局部多種疾病和因素有關(guān)的眼部病變,高血壓病、糖尿病、高脂血癥或動(dòng)脈硬化、無視杯或小視杯、顯著眼內(nèi)壓升高及吸煙均是其危險(xiǎn)因素。臨床診治過程中應(yīng)注意完善各項(xiàng)檢查措施,明確診斷,經(jīng)積極綜合治療后,部分患者的中心視力和視野可有一定改善。
[Abstract]:Objective to investigate the etiology, pathogenesis, risk factors, clinical features, treatment methods, therapeutic effects and preventive measures of non-arteritic anterior ischemic optic neuropathy in patients with non-arterial inflammatory anterior ischemic optic neuropathy. In order to provide clinicians with more powerful evidence to guide clinical diagnosis and treatment. Methods retrospective case analysis was used. From April 2011 to November 2016, 66 patients (74 eyes) with NAION admitted to the fourth Central Hospital of Tianjin were collected and analyzed their clinical manifestations, ocular and systemic risk factors, visual acuity and visual field. The results of fundus fluorescein angiography (fundus fluorescein) and optical coherence tomography (Oct) were used to treat systemic diseases, and the patients were treated with glucocorticoids, vasodilators and neurotrophic agents. The changes of corrected visual acuity and visual field before and after treatment were compared. Results the ratio of male to female was 1.6: 1, and the mean age of onset was (58.6 鹵10.4) years. All the patients showed different degrees of central visual acuity decline and visual field change. In 71 eyes, the quadrant or inferior visual field defect around the central fixation point was connected with the physiological blind spot, 36 eyes (50.7%). The ocular fundus examination showed ischemic water in the optic papilla. In 66 eyes (89.2%) with FFA, 45 eyes (60.8%) showed delayed filling and late fluorescence enhancement of optic papilla. There were 46 cases (69.7%) with hypertension, 26 cases (39.4%) with diabetes, 37 cases (56.0%) with hyperlipidemia and 19 cases (28.8%) with smoking history. The visual acuity was improved in 38 eyes, the effective rate was 51.4, and the visual field defect was improved in 34 eyes, the effective rate was that 47.9%.FFA showed that the filling time of early optic nipple was shorter in 19 eyes than that in the early stage. The ischemic area was smaller in 31 eyes than in the early stage. Conclusion NAION is a kind of ocular disease related to various diseases and factors of the whole body and local eye. Hypertension diabetes hyperlipidemia or arteriosclerosis ignoring cup or cup raising intraocular pressure and smoking are the risk factors. In the course of clinical diagnosis and treatment, attention should be paid to the improvement of examination measures and definite diagnosis. After active comprehensive treatment, the central visual acuity and visual field of some patients can be improved to some extent.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R774.6

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