摘要
目的探讨青光眼和脑卒中患者视网膜血管分形的改变。方法选取2020年4月至2020年10月在首都医科大学附属北京同仁医院就诊的青光眼95例(95只眼)患者、同期于神经科诊治脑卒中患者97例(97只眼)及体检的健康对照组受试者100例(100只眼)。其中,青光眼组男性患者51例(51只眼),女性44例(44只眼);年龄46~69岁,平均年龄为(55.6±7.8)岁。脑卒中组男性患者63例(63只眼),女性34例(34只眼);年龄58~73岁,平均年龄为(64.7±5.6)岁。对照组男性受试者50例(50只眼),女性50例(50只眼);年龄40~60岁,平均年龄为(52.4±6.4)岁。所有受试者都进行常规眼科检查、眼底照相、视野及光学相干断层扫描检查,应用计算机辅助图像分析和测量视网膜血管管径宽度、血管弯曲度及血管分形维数。视网膜神经纤维层(RNFL)厚度和视网膜血管参数的测量值采用Kolmogorov-Smirnov方法检验符合正态分布,以±s表示,多组间比较采用单因素方差分析,当差异有统计学意义时,进一步采用LSD两两比较。视网膜血管参数与RNFL厚度的关系采用Pearson相关性分析。结果青光眼组、脑卒中组患者及对照组受试者平均RNFL厚度分别为(75.3±12.6)μm、(89.5±8.7)μm及(103.6±6.2)μm,差异有统计学意义(F=148.516,P<0.05)。青光眼和脑卒中组患者平均盘周RNFL厚度降低,青光眼组和脑卒中组患者分别与对照组受试者比较差异有统计学意义(t=-4.362,-3.216;P<0.05)。对照组、青光眼组及脑卒中组患者的Zone B+C区动静脉宽度比、Zone B区动静脉宽度比、位于Zone B+C区的较大6个动脉宽度、位于Zone B区的较大6个动脉动脉宽度、位于Zone B+C区的较大6个静脉宽度、位于Zone B区的较大6个静脉宽度、全部血管简单弯曲度、全部血管曲率弯曲度、动脉简单弯曲度、动脉曲率弯曲度、静脉简单弯曲度、静脉曲率弯曲度、全部血管分形维数、动脉分形维数及静脉分形维数分别为0.552±0.216、0.530±0.137、(8.491±2.039)像素、(8.804±2.136)像素、(15.959±2.138)像素、(15.934±2.962)像素、1.057±0.984、0.033±0.002、1.083±0.169、0.027±0.026、1.069±0.187、0.042±0.006、1.527±0.148、1.295±0.065、1.344±0.058、0.558±0.111、0.567±0.104、(8.852±1.931)像素、(8.923±1.872)像素、(16.015±2.787)像素、(15.891±2.921)像素、1.069±0.251、0.003±0.001、1.044±0.021、0.003±0.001、1.068±0.041、0.044±0.002、1.529±0.032、1.286±0.051、1.342±0.049、0.609±0.108、0.774±0.143、(10.082±2.151)像素、(10.417±2.223)像素、(16.548±2.885)像素、(16.739±2.768)像素、1.221±1.378、0.331±0.024、1.262±1.605、0.029±0.015、1.082±0.209、1.932±0.137、1.544±0.156、1.331±0.039及1.367±0.035,差异均有统计学意义(F=108.973、117.136,104.762,119.531,113.538,121.539,119.968,134.472,125.162,104.167,76.106,136.262,109.421,116.632,43.279;P<0.05)。青光眼组患者Zone B+C区较大6个动静脉宽度比、Zone B+C动脉宽度、Zone B区视网膜动脉宽度、Zone B+C视网膜静脉宽度、Zone B区视网膜静脉宽度、视网膜血管的简单弯曲度、视网膜全部血管曲率弯曲度、视网膜动脉简单弯曲度、视网膜静脉曲率弯曲度、视网膜血管分形维数及视网膜动脉分形维数与对照组比较,差异均有统计学意义(t=-3.326,-3.761,-3.964,-2.237,-2.453,-2.447,-3.895,-2.963,-3.871,-2.037,-2.363;P<0.05)。青光眼组患者视网膜血管分形维数与盘周RNFL厚度呈正相关,其相关性具有统计学意义(r=0.783,P<0.05)。脑卒中组患者Zone B+C区较大6个视网膜动静脉宽度比、Zone B+C动脉宽度、Zone B区动脉宽度、Zone B+C视网膜静脉宽度、Zone B区视网膜静脉宽度、视网膜血管简单弯曲度、视网膜全部血管曲率弯曲度、视网膜动脉简单弯曲度、视网膜静脉曲率弯曲度、视网膜血管分形维数及视网膜动脉分形维数与对照组比较,差异有统计学意义(t=-2.741,-3.153,-2.930,-2.041,-2.726,-2.323,-3.881,-3.267,-2.965,-2.024,-2.473;P<0.05)。脑卒中组患者视网膜血管分形维数与盘周RNFL厚度呈正相关,其相关性具有统计学意义(r=0.645,P<0.05)。脑卒中患者视网膜血管分形维数越低,平均盘周RNFL厚度越低。结论青光眼和脑卒中患者的视网膜血管管径变窄和血管弯曲度降低,视网膜血管分形维数降低,脑卒中患者的视网膜血管改变出现与青光眼变化趋势相近,青光眼患者视网膜血管分形维数与青光眼严重程度相关,较低的视网膜血管分形维数和较低的RNFL厚度与脑卒中相关。
Objective The aim of this study is to explore the changes in retinal vascular fractal dimension in patients with glaucoma and stroke.Methods From April 2020 to October 2020,95 patients(95 eyes)with glaucoma who were treated at Beijing Tongren Hospital affiliated to Capital Medical University,97 patients(97 eyes)with stroke who were diagnosed in the Neurology Department of Beijing Tongren Hospital,100 healthy subjects(100 eyes)were recruited in the same period.Among them,there were 51 male patients(51 eyes)and 44 female patients(44 eyes)with an average age of(55.6±7.8)years(ranging from 46 to 69 years)in the glaucoma group;63 male patients(63 eyes)and 34 female patients(34 eyes)with an average age of(64.7±5.6)years(ranging 58 to 73 years)in the stroke group;50 male cases(50 eyes)and 50 female cases(50 eyes)with an average age of(52.4±6.4)years(ranging from 40 to 60 years)in the control group.All subjects underwent routine ophthalmic examinations,fundus photography,visual field and optical coherence tomography examinations,and computer-aided image analysis and measurements of retinal vessel diameter width,vessel curvature,and vessel fractal dimension were applied.The measurement values of retinal nerve fiber layer(RNFL)thickness and retinal vascular parameters were tested using Kolmogorov Smirnov method to conform normal distribution,expressed as±s,and compared between multiple groups using one-way analysis of variance.When the differences were statistically significant,LSD was further used for comparison between two groups.The relationship between retinal vascular parameters and RNFL thickness was analyzed using Pearson correlation analysis.Results The average RNFL thickness in the glaucoma group,stroke group,and control group was(75.3±12.6)μm,(89.5±8.7)μm,and(103.6±6.2)μm,respectively,with statistically significant differences(F=148.516,P<0.05).The average RNFL thickness around the disc decreased in glaucoma group and stroke group,there was statistically significant difference between the glaucoma group and the stroke group compared to the control group(t=-4.362,-3.216;P<0.05).The arterial to venous width ratio in Zone B+C,arterial to venous width ratio in Zone B,6 larger arterial widths located in Zone B+C,6 larger arterial widths located in Zone B,6 larger venous widths located in Zone B+C,6 larger venous widths located in Zone B,all vessel simple bending,all vessel curvature bending,arterial simple bending,arterial curvature bending,venous simple bending,venous curvature bending,all vessel fractal dimension,arterial fractal dimension,and venous fractal dimension were 0.552±0.216,0.530±0.137,(8.491±2.039)pixels,(8.804±2.136)pixels,respectively,for the control group,glaucoma group,and stroke group(15.959±2.138)pixels,(15.934±2.962)pixels,1.057±0.984,0.033±0.002,1.083±0.169,0.027±0.026,1.069±0.187,0.042±0.006,1.527±0.148,1.295±0.065,1.344±0.058,0.558±0.111,0.567±0.104,(8.852±1.931)pixels,(8.923±1.872)pixels,(16.015±2.787)pixels,(15.891±2.921)pixels,1.069±0.251,0.003±0.0011.044±0.021,0.003±0.001,1.068±0.041,0.044±0.002,1.529±0.032,1.286±0.051,1.342±0.049,0.609±0.108,0.774±0.143,(10.082±2.151)pixels,(10.417±2.223)pixels,(16.548±2.885)pixels,(16.739±2.768)pixels,1.221±1.378,0.331±0.024,1.262±1.605,0.029±0.015,1.082±0.209,1.932±0.1371.544±0.156,1.331±0.039,and 1.367±0.035,showed statistically significant differences(F=108.973,117.136,104.762,119.531,113.538,121.539,119.968,134.472,125.162,104.167,76.106,136.262,109.421,116.632,43.279;P<0.05).Compared between the glaucoma group and the control group,vascular parameters of retinal arteriovenous width ratio(Zone B+C),arterial width in Zone B+C,arterial width in Zone B,retinal vein width in Zone B+C,retinal vein width in Zone B,simple bending of all retinal blood vessels,curvature bending of all retinal blood vessels,simple bending of retinal arteries,curvature bending of retinal veins,fractal dimension of retinal blood vessels,and fractal dimension of retinal arteries,had shown that the differences were statistically significant(t=-3.326,-3.761,-3.964,-2.237,-2.453,-2.447,-3.895,-2.963,-3.871,-2.037,-2.363;P<0.05).The fractal dimension of retinal blood vessels in glaucoma patients was positively correlated with the thickness of RNFL around the disc,and the correlation was statistically significant(r=0.783,P<0.05).Compared between the stroke group and the control group,vascular parameters of retinal arteriovenous width ratio(Zone B+C),arterial width in Zone B+C,arterial width in Zone B,retinal vein width in Zone B+C,retinal vein width in Zone B,simple bending of all retinal blood vessels,curvature bending of all retinal blood vessels,simple bending of retinal arteries,curvature bending of retinal veins,fractal dimension of retinal blood vessels,and fractal dimension of retinal arteries,had shown that the differences were statistically significant(t=-2.741,-3.153,-2.930,-2.041,-2.726,-2.323,-3.881,-3.267,-2.965,-2.024,-2.473;P<0.05).The fractal dimension of retinal blood vessels in stroke patients was positively correlated with the thickness of RNFL around the disc,and the correlation is statistically significant(r=0.645,P<0.05).The lower the fractal dimensionality of retinal vascular analysis in stroke patients,the lower the average RNFL thickness.Conclusions Patients with glaucoma and patients with stroke have narrower retinal vessel diameter,decreased retianl vascular bending,and decreased retinal vascular fractal dimension.The parameters of retinal vascular in stroke patients show a trend similar to glaucoma patients.The fractal dimension of retinal vascular in glaucoma is correlated with the severity of glaucoma,lower retinal vascular fractal dimension and RNFL thickness are associated with stroke.
作者
张莉
余双
王宁利
Zhang Li;Yu Shuang;Wang Ningli(Beijing Institute of Ophthalmology,Beijing Ophthalmology&Visual Sciences Key Laboratory,Beijing Tongren Hospital,Capital Medical University,Beijing 100005,China;Tencent HealthCare,Tencent Jarvis Laboratory,Shenzhen 515899,China)
出处
《中华眼科医学杂志(电子版)》
2025年第3期141-148,共8页
Chinese Journal of Ophthalmologic Medicine(Electronic Edition)
基金
国家自然科学基金重点项目(82130029)。
