24小时血压参数与原发性开角型青光眼视神经损害的相关性

目的：研究24 h血压参数与原发性开角型青光眼（POAG）视神经损害之间的相关性。方法：病例对照研究。选择2013年6月至2016年12月期间成都市第一人民医院确诊的60例POAG患者作为POAG组，55 例正常人群作为对照组。2 组均进行24 h眼压和血压的同步监测，比较2 组受检者24 h血压参数、眼灌注压及眼压的差异，并分析POAG组患者24 h血压参数、眼灌注压及眼压与相关视功能之间的关系。采用独立样本t检验和多重线性回归等进行统计学分析。结果：①POAG组的24 h平均眼压、眼压差、眼灌注压差及脉压差显著高于对照组，2 组差异均有统计学意义（t =3.22、6.57、2.29、2.39，P ＜0.05）。②POAG组平均收缩压显著高于对照组（t =3.02，P =0.003），其收缩压最高值、收缩压波动值、夜间平均收缩压、夜间最高收缩压及其波动值均显著高于对照组（t =4.38、5.27、4.13、4.13、4.14，P ＜0.001）。③POAG组24 h平均舒张压、舒张压最高值、夜间平均舒张压、夜间舒张压最高值也显著高于对照组（t =2.22、2.50、2.29、2.10，P ＜0.05）。④POAG组患者的24 h血压相关参数与视神经损害相关性：平均眼压是POAG视野的平均缺损值（MD）的影响因素，二者呈负相关（b =-0.44，P =0.004）；盘周平均视网膜神经纤维层（RNFL）厚度与平均眼压（b =-0.956，P =0.001）、眼压差（b =-1.125，P =0.003）呈负相关；夜间平均舒张压（b =0.395，P ＜0.001）和夜间平均动脉压（b =0.046，P =0.001）分别与AP100和AP50值呈正相关。结论：①24 h血压相关参数与POAG的视神经损害之间存在相关性；②夜间眼灌注压、夜间舒张压和夜间动脉压可能是POAG视神经损害的影响因素；③在POAG的治疗中，稳定的血压和靶眼压有利于保持有效的稳定的眼灌注压，提示在关注降眼压治疗POAG的同时应该关注血压的变化。

Correlation between 24-Hour Blood Pressure Parameters and Optic Nerve Damage in Primary Open-Angle Glaucoma

Objective: To study the correlation between the 24-hour blood pressure parameters and optic nerve damage in primary open-angle glaucoma (POAG). Methods: In this case control study, 60 patients with POAG were assigned to POAG group, and 55 normal subjects were assigned to control group. Synchronous monitoring of 24-hour intraocular pressure (IOP) and blood pressure was conducted in both groups. Blood pressure parameters, optic perfusion pressure, and intraocular pressure for the two groups were compared. We also evaluated the connections among the blood pressure parameters, optic perfusion pressure, and IOP with visual function. Inter-group comparisons were made by independent samples t-tests and multiple linear regression. Results: ①The average IOP, IOP fluctuation, the ocular perfusion pressurefluctuation, and pulse pressure fluctuation of POAG group were significantly higher than those of control group (t =3.22, 6.57, 2.29, 2.39, respectively, all P <0.05). ②The mean systolic blood pressure of POAG group was significantly higher than that of control group (t =3.02, P =0.003). The highest systolic blood pressure, systolic blood pressure fluctuations, nighttime average systolic blood pressure, highest nighttime systolic blood pressure value and fluctuation of POAG group were also significantly higher than those of control group (t =4.38, 5.27, 4.13, 4.13, 4.14, all P <0.001). ③The mean 24-hour diastolic pressure, the maximum diastolic pressure, the mean nighttime diastolic pressure, and the maximum nighttime diastolic pressure of POAG group were significantly higher than those of control group (t =2.22, 2.50, 2.29, 2.10, all P <0.05). ④In POAG group, the mean IOP was negatively correlated with the visual field mean defect in POAG (b =-0.44, P =0.004), and the RNFL thickness was negatively correlated with mean IOP (b =-0.956, P =0.001), IOP fluctuation (b =-1.125, P =0.003). The mean nighttime diastolic pressure (b =0.395, P <0.001)and the mean nighttime arterial pressure (b =0.046, P =0.001) were positively correlated with AP100 and AP50 values, respectively. Conclusions: ①There was a correlation between the blood pressure parameters and the optic nerve damage in POAG. ②The nighttime optic perfusion pressure, the nighttime diastolic blood pressure, and the nighttime arterial pressure may be influential factors affecting optic nerve damage of POAG. ③In the treatment of POAG, a stable normal blood pressure and stable target IOP are beneficial to maintain an effective and stable optic perfusion pressure. This suggests that we should pay attention to the treatment of POAG with IOP reduction and changes of blood pressure at the same time.