慢性青光眼血流动力学及其影响因素分析

目的:探讨慢性青光眼眼部血流情况及其影响因素和青光眼的可能发病机制.方法:采用彩色多普勒成像检测中、晚期原发性开角型青光眼(POAG)54例(65眼)、原发性慢性闭角型青光眼(PCACG)32例(53眼)和正常组30例(30眼)的眼动脉、睫状后短动脉、视网膜中央动脉的收缩期峰值血流速度、舒张末期血流速度及阻力指数.应用计算机进行多因素Logistic回归分析.结果:POAG、PCACG的阻力指数显著增高,与正常对照组比较差异均有统计学意义(均P＜0.01).两组青光眼舒张末期的血流速度明显减慢,与正常对照组比较差异均有统计学意义(均P＜0.05).多因素Logistic回归分析,筛选出影响青光眼的3个显著因素.眼动脉的舒张末期血流速度是影响PCACG的显著因素(P=0.000);眼动脉、睫状后短动脉的舒张末期血流速度是影响POAG的显著因素(P＜0.01).结论:慢性青光眼的视功能损害与眼部血流速度尤其舒张末期血流速度及阻力指数密切相关.眼动脉的舒张末期血流速度减慢可能是PCACG前房角关闭的诱发因素.眼动脉、睫状后短动脉的舒张末期血流速度减慢可能是POAG视神经缺血的主要原因.

OCULAR HEMODYNAMICS AND ITS RELATED FACTORS IN PATIENTS WITH CHRONIC GLAUCOMA

Objective:To study the blood flow and the related factors of hemodynamics in patients with chronic glaucoma in order to approach the possible mechanism of glaucoma.Methods:The peak systolic velocity, end diastolic velocity, resistance index of ophthalmic artery, short posterior ciliary artery, central retinal artery were measured by color Doppler imaging in 54 patients (65 eyes) with primary open-angle glaucoma,32 patients (53 eyes) with primary chronic angle-closure glaucoma and 30 patients (30 eyes)normal control. Logistic regression analysis was used to screen the hemodynamic factors related to chronic glaucoma. Result:Compared with the normal control, the resistance index was remarkably increased (P<0.01) in patients with glaucoma while the end diastolic velocity was significantly decreased(P<0.05).The results of logistic regression analysis showed three hemodynamic factors related to chronic glaucoma. The end diastolic velocity of ophthalmic artery related to primary chronic angle-closure glaucoma and primary open-angle glaucoma. Furthermore short posterior ciliary artery was well related to primary open-angle glaucoma. Conclusion:The damage of optic nerve in patients with chronic glaucoma was correlated with the end diastolic velocity and resistance index. The end diastolic velocity of ophthalmic artery may be an inducement to the peripheral anterior chamber to close in patients with primary chronic angle-closure glaucoma. To primary open-angle glaucoma, the decreasing end diastolic velocity of ophthalmic artery and short posterior ciliary artery may be main causes of deficiency of the optic nerve's blood supply.