夜间血压下降对开角型青光眼视神经损伤的影响

目的：探讨夜间血压下降与开角型青光眼和正常眼压性青光眼患者视神经损伤进展的关系。

方法：对我院眼科门诊确诊的开角型青光眼和正常眼压性青光眼患者51例51眼分别进行视野、OCT检查，进行平均视神经纤维层厚度、24h动态血压监测、24h眼压监测等检查，分析夜间血压过度下降与视野进展率的关系。

结果：根据夜间血压下降值(dip)进行分组，三组间有显著性差异的数值为平均缺损(MD)差值(P=0.032)、眼压峰值(P=0.003)、视野缺损计分差值(P=0.041)。在视野缺损进展组、视野缺损改善组、视野缺损不变组间，dip有显著性差异(P=0.028)。视野缺损进展组夜间血压下降值明显高于其他两组。夜间血压过度降低组视野缺损进展率明显高于不过度降低组(视野缺损进展率分别为50%，7%)。影响视神经纤维层(RNFL)厚度的相关因素为夜间最低平均动脉压和dip(P=0.011，P=0.032，R²=0.081)； 影响MD值的相关因素为眼压波动(P=0.026，R²=0.115)； 影响模式标准差(PSD)值的相关因素为眼压波动和dip(P=0.020，P=0.044，R²=0.141)。

结论：与开角型青光眼相比，正常眼压性青光眼患者中夜间血压过度下降的发生率较高。夜间血压过度降低组中视野损伤进展明显。视野缺损进展组夜间血压降低更明显。眼压波动与dip是正常眼压性青光眼和高眼压开角型青光眼的患者视神经损伤与视野缺损高危因素。

Declining of nocturnal blood pressure influences the optic nerve damage of open angle glaucoma

AIM: To investigate the relationship between nocturnal blood-pressure declining(dip)and retinal nerve injury of patients with open angle glaucoma and normal tension glaucoma.

METHODS: The procedure included vision field examination, OCT checking of the average retinal nerve fiber layer thickness, 24-hour monitoring of intraocular pressure, 24-hour ambulatory blood pressure monitoring on 51 ophthalmic clinic's test subjects(51 eyes)with open angle glaucoma and normal-tension glaucoma, then the differences between three DIP groups were compared.

RESULTS:The patients were classified into three groups according to dip, and there were significant variance in the value of mean defect(MD)(P=0.032), intraocular pressure peak value(P=0.003), and visual field defect score deviation(P=0.041)among the three groups. There was significant dip differences(P=0.028)among the visual field defect progressing group, visual field defect invariant group and visual field defect improving group: The visual field defect progressing incidence rate in overdipper group(50%)was higher than that in non-overdipper group(7%). The RNFL correlated factors were the nocturnal minimum mean arterial-pressure and dip(P=0.011, P=0.032,R²=0.081); MD correlated factor was intraocular pressure fluctuations(P=0.026,R²=0.115); pattern standard deviation's correlated factors were intraocular pressure fluctuations and dip(P=0.020, P=0.044, R²=0.141).

CONCLUSION: Normal tension glaucoma demonstrated a higher incidence rate of excessive declining of nocturnal blood pressure than open angle glaucoma. Overdipper group has a higher incidence rate of visual field defect progressing than non-overdipper group. This result supports that there is obvious vision damage progress in the nocturnal blood-pressure excessive declining group. The nocturnal blood pressure value of declining in the visual field defect progressing group is higher than the other two groups. The data confirms that both the excessive declining of nocturnal blood pressure and the excessive fluctuations of diurnal intraocular pressure are high risk influential factors in glaucoma retinal nerve injury progressing.