本文選題：青光眼　切入點(diǎn)：視路　出處：《大連醫(yī)科大學(xué)》2011年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:利用磁共振成像(MRI)評估原發(fā)性開角型青光眼(POAG)和慢性閉角型青光眼(CACG)的視覺通路改變及差異,探索青光眼患者視野損害與視路改變的相關(guān)性,探討MRI成像技術(shù)作為青光眼診斷的輔助檢查的準(zhǔn)確性和可行性。 方法:選擇2010年5月至2011年2月間于大連醫(yī)科大學(xué)附屬第一醫(yī)院眼科就診的符合入選標(biāo)準(zhǔn)的12名原發(fā)性開角型青光眼患者(24眼)和8名原發(fā)性慢性閉角型青光眼患者(16眼)進(jìn)行視覺通路的MRI(1.5T磁共振儀器)分析,質(zhì)子密度加權(quán)成像(PDWI)測量外側(cè)膝狀體的體積,彌散張量成像(DTI)測量視神經(jīng)、視束、視放射的各向異性分?jǐn)?shù)(FA)和平均彌散率(MD)。病例組所有患者病史均為三至五年內(nèi),具有青光眼的臨床表現(xiàn)及體征,所有患者用非接觸性眼壓計(jì)測量24小時(shí)眼壓,利用Humphrey視野計(jì)記錄視野缺損的分貝值,查房角,眼底照相記錄C/D值。對照組18人(36眼)要求無眼科其他疾病及高血壓,糖尿病等全身疾病的正常健康成年人(25——69歲)。開青組、閉青組和對照組均行t檢驗(yàn),年齡差異均無統(tǒng)計(jì)學(xué)意義。根據(jù)外側(cè)膝狀體的體積和所得FA和MD值來評估原發(fā)性開角型青光眼和慢性閉角型青光眼患者視路改變及其差異。通過Humphrey視野計(jì)記錄視野缺損的分貝值,視野損害與各參數(shù)間進(jìn)行Pearson相關(guān)性分析。將青光眼患者分為前期、早期、中期、晚期,檢測四組患者的年齡、視力(矯正)、C/D、外側(cè)膝狀體體積,視神經(jīng)、視束、視放射的FA值和MD值并進(jìn)行單因素方差分析。 結(jié)果:開青組、閉青組分別與對照組相比較,青光眼患者外側(cè)膝狀體的體積明顯減小(72.91±15.81),p0.01,差異均具有統(tǒng)計(jì)學(xué)意義,視神經(jīng),視束及視放射的FA值明顯減小,p0.01,差異均具有統(tǒng)計(jì)學(xué)意義,閉青組與對照組相比較,視神經(jīng)、視束及視放射MD值明顯升高,p0.01,差異有統(tǒng)計(jì)學(xué)意義,開青組與對照組相比較,視神經(jīng)、視束的MD值明顯升高,P0.01,差異有統(tǒng)計(jì)學(xué)意義;原發(fā)性開角型青光眼患者與慢性閉角型青光眼患者相比較,外側(cè)膝狀體體積、視神經(jīng)、視束及視輻射的FA值和MD值均無明顯差異,P0.05,差異無統(tǒng)計(jì)學(xué)意義。視野損害程度與各參數(shù)在α=0.05上具有相關(guān)性。根據(jù)視野損害程度分組,組間各參數(shù)進(jìn)行單因素方差分析,視束FA值、視神經(jīng)MD值及外側(cè)膝狀體組間差異具有統(tǒng)計(jì)學(xué)意義。 結(jié)論:青光眼是一種復(fù)雜的神經(jīng)系統(tǒng)疾病,影響不同層次的視神經(jīng)纖維。MRI作為青光眼診斷的輔助檢查對整個(gè)視覺通路改變提供量化依據(jù),為青光眼患者的病情評估及隨訪提供影像學(xué)支持。原發(fā)性開角型青光眼患者與慢性閉角型青光眼患者病程進(jìn)展過程相似,視路改變無明顯差異。
[Abstract]:Objective: to evaluate the changes and differences of visual pathways between primary open-angle glaucoma (Poag) and chronic angle-closure glaucoma (CACGG) by magnetic resonance imaging (MRI), and to explore the correlation between visual field damage and visual pathway change in patients with glaucoma. To investigate the accuracy and feasibility of MRI imaging as auxiliary examination for glaucoma diagnosis. Methods: from May 2010 to February 2011, 12 patients (24 eyes) with primary open angle glaucoma and 8 patients with primary chronic angle-closed light were selected from the first affiliated Hospital of Dalian Medical University. The visual pathway was analyzed by MRI(1.5T magnetic resonance instrument (MRI(1.5T). The volume of lateral geniculate body was measured by proton density weighted imaging (PDWI), the volume of lateral geniculate body was measured by diffusion Zhang Liang imaging (DTI), the optic nerve, optic bundle, anisotropic fraction of visual radiation (FAA) and the mean diffusion rate (MDD) were measured. The history of all patients in the case group was within three to five years. All patients were measured with non-contact intraocular pressure (IOP) for 24 hours. The Humphrey visual field meter was used to record the decibels of visual field defect and the angle of inspection. C / D value recorded by fundus photography. Control group (18 eyes, 36 eyes). Normal healthy adults without other diseases of ophthalmology, hypertension, diabetes mellitus and other systemic diseases were required to undergo t test in Kaiqing group, closed green group and control group. According to the volume of lateral geniculate body and the values of FA and MD, the changes of visual pathway in patients with primary open-angle glaucoma and chronic angle-closure glaucoma were evaluated. The visual changes were recorded by Humphrey visual field meter. The decibel value of the field defect, The correlation between visual field damage and parameters was analyzed by Pearson. The patients with glaucoma were divided into three groups: pre, early, middle and late stage. The age, visual acuity (corrected C / D, lateral geniculate body volume, optic nerve, optic tract) were measured in the four groups. FA value and MD value of visual radiation were analyzed by single factor ANOVA. Results: compared with the control group, the volume of the lateral geniculate body in the Kaiqing group and the closed green group was significantly reduced by 72.91 鹵15.81% (P 0.01), and the difference was statistically significant. The FA value of optic tract and visual radiation decreased significantly (P 0.01), and the difference was statistically significant. Compared with control group, the value of optic nerve, visual bundle and apparent radiation MD in closed green group was significantly higher than that in control group (P 0.01), the difference was statistically significant, and that in Kaiqing group was higher than that in control group, the optic nerve was higher in open green group than in control group. Compared with chronic angle closure glaucoma patients, the volume of lateral geniculate body, optic nerve, the volume of lateral geniculate body, and optic nerve in patients with primary open-angle glaucoma were significantly higher than those in patients with chronic angle closure glaucoma. There was no significant difference between FA value and MD value of visual beam and apparent radiation (P 0.05), but there was no statistical significance. The degree of visual field damage was correlated with each parameter on 偽 -0.05. According to the degree of visual field damage, single factor variance analysis was carried out among the parameters. There were significant differences in FA value, MD value of optic nerve and lateral geniculate body. Conclusion: glaucoma is a complex nervous system disease. MRI can provide quantitative evidence for the changes of the whole visual pathway. The clinical course of primary open-angle glaucoma was similar to that of chronic angle-closure glaucoma, but there was no significant difference in visual changes between patients with primary open-angle glaucoma and patients with chronic angle-closure glaucoma.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R775

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