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中华眼科医学杂志(电子版)

中华眼科医学杂志(电子版) ›› 2021, Vol. 11 ›› Issue (03) : 146 -152. doi: 10.3877/cma.j.issn.2095-2007.2021.03.004

论著

Flammer综合征样反应对视网膜色素变性患者眼部供血变化影响的临床研究
李如意1, 李雨雨1, 代贺华1, 吴幸之1, 季瑛2, 李根林2,†()   
  1. 1. 100730　首都医科大学附属北京同仁医院　北京同仁眼科中心　北京市眼科学与视觉科学重点实验室
    2. 810000　青海省西宁市第一人民医院眼科
  • 收稿日期:2021-03-05 出版日期:2021-06-28
  • 通信作者: 李根林
  • 基金资助:
    北京市教育委员会科技发展计划重点项目(KZ201510025025)

Effects of Flammer′s syndrome-like reaction on ocular blood supply in patients with retinitis pigmentosa

Ruyi Li1, Yuyu Li1, Hehua Dai1, Xingzhi Wu1, Yang Ji2, Genlin Li2,†()   

  1. 1. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing 100730, China
    2. Department of Ophthalmology, the first People′s Hospital of Xining City, Xining 810000, China
  • Received:2021-03-05 Published:2021-06-28
  • Corresponding author: Genlin Li
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引用本文：

李如意, 李雨雨, 代贺华, 吴幸之, 季瑛, 李根林. Flammer综合征样反应对视网膜色素变性患者眼部供血变化影响的临床研究[J]. 中华眼科医学杂志(电子版), 2021, 11(03): 146-152.

Ruyi Li, Yuyu Li, Hehua Dai, Xingzhi Wu, Yang Ji, Genlin Li. Effects of Flammer′s syndrome-like reaction on ocular blood supply in patients with retinitis pigmentosa[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2021, 11(03): 146-152.

目的

探讨Flammer综合征样反应对视网膜色素变性(RP)患者眼动脉(OA)、视网膜中央动脉(CRA)和睫状后动脉(PCA)血流变化的影响。

方法

回顾性病例研究。收集2019年2月至2020年12月于首都医科大学附属北京同仁医院眼科中心临床诊断为RP患者115例(115只眼)为研究对象。其中，男性60例(60只眼)，女性55例(55只眼)；年龄21~70岁，平均年龄(43.0±11.3)岁。根据评估Flammer综合征症状与体征的调查问卷，将全部患者分为阳性组31例(31只眼)和阴性组84例(84只眼)两组。采用彩色超声多普勒(CDI)检查全部患者，并记录OA、CRA及PCA的收缩期峰速(PSV)值、舒张末期流速(EDV)值、时间平均最大流速(TAMV)值、脉动指数(PI)值及阻力指数(RI)值，以均数±标准差表示。采用单因素方差分析比较阳性组、阴性组及对照组三组之间CDI各项参数的变化，当差异有统计学意义时，采用独立样本t检验进一步两两比较。

结果

阳性组、阴性组及对照组OA的PSV值分别为(30.25±8.36)cm/s、(30.89±8.04)cm/s及(32.08±9.88)cm/s；EDV值分别为(7.04±2.84)cm/s、(7.49±3.39)cm/s及(7.46±2.33)cm/s；TAMV值分别为(13.95±4.56)cm/s、(15.57±15.82)cm/s及(12.76±3.63)cm/s; PI值分别为(1.73±0.43)、(1.77±0.50)及(1.91±0.48)；RI值分别为(0.74±0.15)、(0.76±0.08)及(0.78±0.11)。经单样本方差分析，三组间OA各项参数比较的差异无统计学意义(F＝0.644，0.301，1.539，2.555，1.841；P>0.05)。阳性组、阴性组及对照组CRA的PSV值分别为(5.81±3.85)cm/s、(5.25±1.82)cm/s及(10.51±2.85)cm/s; EDV值分别为(1.86±0.74)cm/s、(1.94±1.64)cm/s及(2.89±1.11)cm/s; TAMV值分别为(3.11±1.49)cm/s、(2.81±0.95)cm/s及(5.31±2.11)cm/s; PI值分别为(1.22±0.39)、(1.25±0.37)及(1.59±0.54)。经单样本方差分析，三组间CRA上述四项参数比较的差异具有统计学意义(F＝92.769，13.821，55.877，14.803；P<0.05)。进一步两两比较，对照组CRA的四项参数均高于阳性组，两两比较的差异具有统计学意义(t＝ -6.797，-7.805，-8.210，-5.303；P<0.05)；对照组CRA的四项参数均高于阴性组，两两比较的差异具有统计学意义(t＝-26.459，-5.329，-24.107，-8.532；P<0.05)；阳性组与阴性组CRA四项参数两两比较的差异无统计学意义(t＝ -1.068，0.347，-1.068，0.343，P>0.05)。阳性组、阴性组及对照组CRA的RI值分别为(0.65±0.10)、(0.69±0.34)及(0.72±0.08)，经单样本方差分析，三组间的差异无统计学意义(F＝1.16，P>0.05)。阳性组、阴性组及对照组PCA的PSV值分别为(6.94±2.12)cm/s、(6.75±2.18)cm/s及(11.56±3.15)cm/s; EDV值分别为(2.19±0.77)cm/s、(2.27±1.70)cm/s及(3.30±1.36)cm/s; TAMV值分别为(3.76±1.25)cm/s、(3.65±1.40)cm/s及(5.83±1.91)cm/s; PI值分别为(1.27±0.35)、(1.31±0.37)及(1.49±0.43)；RI值分别为(0.67±0.10)、(0.67±0.10)及(0.73±0.14)。经单样本方差分析，三组间PCA各项参数比较的差异具有统计学意义(F＝81.82，13.388，44.188，6.01，6.387；P<0.05)。进一步两两比较，对照组PCA各项参数均高于阳性组，两两比较的差异具有统计学意义(t＝ -12.136，-7.777，-9.234，-3.567，-3.697；P<0.05)；对照组PCA各项参数均高于阴性组，两两比较的差异具有统计学意义(t＝ -20.223，-5.560，-14.247，-4.417，-4.945；P<0.05)；阳性组与阴性组PCA各项参数两两比较的差异无统计学意义(t＝-0.407，-0.255，-0.397，0.577，0.331；P>0.05)。

结论

有血管调节功能障碍视网膜色素变性患者的眼动脉供血异常，可进一步加重视网膜色素变性的病情，加大患者失明的风险。

关键词: 视网膜色素变性, Flammer综合征, 眼动脉, 视网膜血管, 睫状动脉
Objective

To explore the effect of Flammer syndrome-like reaction on blood flow changes in ocular artery (OA), central retinal artery (CRA)and posterior ciliary artery (PCA) in patients with retinitis pigmentosa (RP).

Methods

From February 2019 to December 2020, 115 RP patients (115 eyes) were collected retrospectively in Beijing Tongren Eye Center, Beijing Tongren Hospital affiliated to Capital Medical University. Among of them, there were 60 males (60 eyes) and 55 females (55 eyes) with an average age of (43.0±11.3) years-old (ranged from 21 to 70 years-old). All patients′symptoms and signs of Flammer syndrome were evaluated using a questionnaire, and then they were divided into two groups: 31 cases (31 eyes) in the positive group and 84 cases (84 eyes) in the negative group. All patients′ peak systolic velocity (PSV) value, end-diastolic velocity (EDV) value, time average maximum velocity (TAMV) value, pulsation index (PI) value and resistance index (RI) value of OA, CRA and PCA were observed and recorded using the color Doppler angiography (CDI). The quantitative data was expressed as (±s). The positive group, the negative group and control group (healthy people) data in the previous literature the changes of the parameters of CDI between three groups were compared using the method of single-factor variance analysis, and the independent sample t testing was used to further compare.

Results

The PSV values of OA in the positive group, the negative group and the control group were (30.25±8.36) cm/s, (30.89±8.04) cm/s, and (32.08±9.88) cm/s; EDV values were (7.04±2.84) cm/s, (7.749±3.39) cm/s and (7.46±2.33) cm/s; PI values were (1.73±0.43), (1.77±0.50) and (1.91±0.48). After the analysis of single-sample variance, the differences were not statistically significant in 4 indices of OA among three groups (F=0.644, 0.301, 1.539, 2.555, 1.841; P>0.05). The PSV values of CRA in the positive group, the negative group and the control group were (5.81±3.85) cm/s, (5.25±1.82) cm/s and (10.51±2.85)cm/s; EDV values were (1.86±0.74) cm/s, (1.94±1.64) cm/s and (2.89±1.11) cm/s; TAMV values were (3.11±1.49) cm/s, (2.81±0.95) cm/s and (5.31±2.11) cm/s; PI values were (1.22±0.39), (1.25±0.37) and (1.59±0.54). After analysis of single-sample variance, the differences were statistically significant in 4 indices of CRA among three groups (F=92.769, 13.821, 55.877, 14.803; P<0.05). 4 indices of CRA in the control group were higher than positive groups. After t testing, the difference was statistically significant (t=-6.797, -7.805, -8.210, -5.303; P<0.05); 4 indices of CRA in the control group were higher than negative groups. After t testing, the difference was statistically significant (t=-26.459, -5.329, -24.107, -8.532; P<0.05). The RI values of CRA in the positive group, the negative group and the control group were (0.65±0.10), (0.69±0.34) and (0.72±0.08). After analysis of the variance of single samples, the difference among three groups was not statistically significant (F=1.16, P>0.05). The PSV values of PCA in the positive group, the negative group and the control group were (6.94±2.12) cm/s, (6.75±2.18) cm/s and (11.56±3.15) cm/s; EDV values were (2.19±0.77) cm/s, (2.27±1.70) cm/s and (3.30±1.36) cm/s; TAMV values were (3.76±1.25) cm/s, (3.65±1.40) cm/s and (5.83±1.91) cm/s; PI values were (1.27±0.35), (1.31±0.37) and (1.49±0.43); RI values were (0.67±0.10), (0.67±0.10) and (0.73±0.14). After the analysis of single-sample variance, the differences were statistically significant in 4 indices of PCA among three groups (F=81.82, 13.388, 44.188, 6.01, 6.387; P<0.05). PCA of the control group were higher than the positive group. After t testing, the difference was statistically significant (t= -12.136, -7.777, -9.234, -3.567, -3.697; P<0.05). 4 indices of PCA in control group were higher than negative group. After t testing, the difference was statistically significant (t=-20.223, -2 5.560, -14.247, -4.417, -4.945; P<0.05). After t testing, the difference in 4 indices of PCA between the positive group and the negative group was non-significant (t=-0.407, -0.255, -0.397, 0.577, 0.331; P>0.05).

Conclusions

The vascular regulation dysfunction of patients with RP was shown the abnormal blood supply of OA, which might further aggravate the condition of RP and increase the risk of blindness in patients.

Key words: Retinal pigmentosa, Flammer syndrome, Ocular artery, Retina blood vessel, Ciliary artery
表1 评估Flammer综合征症状和体征的调查问卷
序号 Flammer综合征的症状或体征
1 即使在夏天，你的手或脚也会感到冷吗？
2 你有低血压吗？
3 跟别人比起来，你会更少感到口渴吗？
4 如果你必须吃药，你是否感觉对药物有强烈的反应？
5 你有偏头痛吗？
6 你有耳鸣吗？
7 当你有一段时间不活动时，你会感到冷吗？
8 你需要相对较长的时间才能入睡吗，尤其当你感到寒冷时？
9 跟其他人比起来，你识别气味更敏感吗？
10 当你兴奋或生气时，你有没有注意到可逆的(白色或红色)皮肤斑点？
表2 三组眼部供血变化的比较(±s)
组别 眼数(只) 眼动脉的血流参数 视网膜中央动脉的血流参数
收缩期峰速(cm/s) 舒张末期流速(cm/s) 时间相关平均最大流速(cm/s) 脉动指数 阻力指数 收缩期峰速(cm/s) 舒张末期流速(cm/s) 时间相关平均最大流速(cm/s)
阳性组 31 30.25±8.36 7.04±2.84 13.95±4.56 1.73±0.43 0.74±0.15 5.81±3.85 1.86±0.74 3.11±1.49
阴性组 84 30.89±8.04 7.49±3.39 15.57±15.82 1.77±0.50 0.76±0.08 5.25±1.82 1.94±1.64 2.81±0.95
对照组 90 32.08±9.88 7.46±2.33 12.76± 3.63 1.91±0.48 0.78±0.11 10.51±2.85#* 2.89±1.11#* 5.31±2.11#*
F值   0.644 0.301 1.539 2.555 1.841 92.769 13.821 55.877
P值   >0.05 >0.05 >0.05 >0.05 >0.05 <0.05 <0.05 <0.05
组别 眼数(只) 视网膜中央动脉的血流参数 睫状后动脉的血流参数
脉动指数 阻力指数 收缩期峰速(cm/s) 舒张末期流速(cm/s) 时间相关平均最大流速(cm/s) 脉动指数 阻力指数
阳性组 31 1.22±0.39 0.65±0.10 6.94±2.12 2.19±0.77 3.76±1.25 1.27±0.35 0.67±0.10
阴性组 84 1.25±0.37 0.69±0.34 6.75±2.18 2.27±1.70 3.65±1.40 1.31±0.37 0.67±0.10
对照组 90 1.59±0.54#* 0.72±0.08#* 11.56±3.15 3.30±1.36#* 5.83±1.91#* 1.49±0.43#* 0.73±0.14#*
F值   14.803 1.16 81.82 13.388 44.188 6.01 6.387
P值   <0.05 <0.05 >0.05 <0.05 <0.05 <0.05 <0.05
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