妊娠高血压伴眼底病变对比敏感度观察

目的观察妊娠高血压疾病伴发眼底病变患者的对比敏感度（CS）恢复情况。方法前瞻性队列研究。对98例妊娠高血压疾病患者（患者组）进行矫正视力、眼底、CS检查，随诊6个月，观察矫正视力、CS变化情况。选取同期在产科门诊就诊的50例无妊娠高血压孕妇作为正常对照组。2组的矫正视力和患者组的2种分娩方式下各空间频率CS比较采用两独立样本t检验进行分析。3个期别眼底病变各空间频率CS和随诊各时间段各空间频率的CS比较采用Kruskal-Wallis 秩和检验，多组间两两比较采用Satterthwaite近似检验。结果首诊时及随访6个月后患者组矫正视力均比正常对照组差（t=13.67、2.27，P＜0.05）。随着眼底病情的加重各空间频率CS值均下降（χ²=93.35、88.28、89.73、102.48、102.26，P＜0.01）。随诊6个月，患者组各空间频率CS逐渐接近正常，至随访结束，除了空间频率6 c/d接近正常对照组（P＞0.05）外，其他各空间频率仍较正常对照组有所降低（t=2.74、-5.42、-8.67、-4.60，P＜0.01）。随诊过程中，空间频率1.5 c/d的CS恢复最快，12 c/d恢复得最慢。患者组2种分娩方式下的各空间频率CS比较差异均无统计学意义（P＞0.05）。结论妊娠高血压疾病患者眼底病情越重，CS下降越严重；低空间频率恢复最快，高空间频率恢复最慢；2种分娩方式对于患者CS的恢复没有影响。CS较视力检查可更好地反映妊娠高血压患者视网膜功能的情况。

A study of contrast sensitivity in hypertension disorders caused by a complication of pregnancy and the resulting changes in the fundus

Objective To study contrast sensitivity (CS) in hypertensive disorders caused by a complication of pregnancy and the changes in the fundus during the follow-up period.Methods A prospective cohort study was applied to the research,ninety-eight patients with hypertensive disorders as a complication of pregnancy (the patient group) agreed to undergo eye examinations that included visual acuity,fundus examinations,and CS evaluations.Patients were followed up for 6 months and visual acuity and CS changes were monitored.Fifty pregnant women were selected as a control group during the same period.The corrected visual acuity for the two groups and the CS at each spatial frequency were compared with two independent sample t-tests.The CS of each spatial frequency in the three trimesters with retinopathy and during the follow-up was compared with a Kruskal-Wallis rank sum test.After multiple group analysis,a comparison between pairs of groups was analyzed with a Satterthwaite approximation test.Results The corrected visual acuities of patients with hypertensive disorders as a complication of pregnancy were lower than those for the normal control group at the first visit and after the six-month follow-up period (t=13.67,2.27,P＜0.05).Retinal disease worsened during retinopathy in the three trimesters and the CS values for each spatial frequency decreased (x2=93.35,88.28,89.73,102.48,102.26,P＜0.01).During the six-month follow-up period,CS spatial frequencies gradually approached normal and the 6 c/d frequency was close to that of the normal control group (P＞0.05),but the other spatial frequencies were reduced (t=2.74,-5.42,-8.67,-4.60,P＜0.01).The recovery of a CS for 1.5 c/d spatial frequency was the fastest,and recovery for 12 c/d was the slowest.There were no significant differences in spatial frequency CS between the two kinds of delivery methods used at birth (P＞0.05).Conclusion Fundus changes in patients with hypertensive disorders as a complication of pregnancy and the decrease in CS are both more serious than for normal patients.CS with the low spatial frequency had the fastest recovery and a high spatial frequency was the slowest to recover.The two kinds of delivery methods for birth have no effect on the recovery of CS.CS is a better indicator than visual acuity to reflect the function of the retina in patients with hypertensive disorders as a complication of pregnancy.