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中华眼科医学杂志(电子版) ›› 2024, Vol. 14 ›› Issue (01) : 26 -33. doi: 10.3877/cma.j.issn.2095-2007.2024.01.005

论著

高度近视眼视网膜各分层厚度改变及其相关因素的临床研究
马张芳1, 宋薇1, 王亚星1,†()   
  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　北京市眼科研究所　眼科学与视觉科学北京市重点实验室
  • 收稿日期:2024-02-04 出版日期:2024-02-28
  • 通信作者: 王亚星
  • 基金资助:
    国家自然科学基金项目(82271086)

The retinal thickness changes and their associated factors in highly myopic eyes

Zhangfang Ma1, Wei Song1, Yaxing Wang1,†()   

  1. 1. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
  • Received:2024-02-04 Published:2024-02-28
  • Corresponding author: Yaxing Wang
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引用本文：

马张芳, 宋薇, 王亚星. 高度近视眼视网膜各分层厚度改变及其相关因素的临床研究[J]. 中华眼科医学杂志(电子版), 2024, 14(01): 26-33.

Zhangfang Ma, Wei Song, Yaxing Wang. The retinal thickness changes and their associated factors in highly myopic eyes[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2024, 14(01): 26-33.

目的

探讨高度近视眼患者视网膜各分层厚度改变及其相关因素。

方法

收集2023年2月至2023年7月就诊于首都医科大学附属北京同仁医院眼科中心的高度近视眼患者128例(128只眼)进行研究。其中，男性46例(46只眼)，女性82例(82只眼)，年龄21～69岁，平均(35.9±7.9)岁。分别按眼轴长度(AL)、年龄及性别进行分组。记录患者的血压、近视初始年龄、眼压、身高及体重并计算身高体重指数(BMI)。应用相干光断层扫描仪(OCT)测量视网膜各层厚度及中心凹下脉络膜厚度(SFCT)。视网膜各层厚度的测量数据经Kolmogorov－Smirnova正态性检验符合正态分布，以±s进行描述。不同AL组间和不同年龄组间患者视网膜各层厚度的比较采用方差分析；当差异具有统计学意义时，采用Bonferroni法进一步两两比较。不同性别组间患者视网膜各层厚度的比较采用独立样本t检验。采用单因素线性回归筛选视网膜各层厚度的相关因素。然后，将各层视网膜厚度分别作为因变量，将单因素分析中P≤0.10的因素作为自变量，并参照既往的研究结果将年龄和AL亦作为自变量进行多元线性回归分析其相关性。

结果

本研究检测患者视网膜全层、视网膜神经纤维层(RNFL)、节细胞层(GCL)、内丛状层(IPL)、内核层(INL)、外丛状层(OPL)、外核层(ONL)、视网膜色素上皮层(RPE)、视网膜内层(IRL)及视网膜外层(ORL)的厚度，AL<26.5 mm组分别为(258.9±20.0)μm、(10.1±2.9)μm、(13.1±5.0)μm、(18.5±4.0)μm、(15.4±4.4)μm、(24.8±5.5)μm、(87.6±9.4)μm、(17.2±1.7)μm、(169.2±20.1)μm及(89.7±3.5)μm；26.5 mm≤AL<27.5 mm组分别为(266.6±26.1)μm、(10.8±2.9)μm、(15.2±8.6)μm、(19.6±5.3)μm、(17.7±5.4)μm、(26.2±6.8)μm、(87.5±12.2)μm、(17.1±2.4)μm、(176.5±27.6)μm及(90.1±4.5)μm；AL≥27.5 mm组分别为(271.0±24.1)μm、(11.6±2.8)μm、(17.3±7.6)μm、(21.3±5.1)μm、(18.9±5.8)μm、(28.4±7.3)μm、(86.5±9.3)μm、(16.7±2.5)μm、(184.2±23.6)μm及(86.9±4.5)μm。年龄≤30岁组分别为(263.3±23.0)μm、(10.8±3.2)μm、(14.7±7.6)μm、(19.5±5.1)μm、(17.0±4.2)μm、(26.0±4.1)μm、(86.7±9.7)μm、(17.0±1.9)μm、(173.9±22.8)μm及(89.5±3.5)μm；31～39岁组分别为(263.8±26.1)μm、(10.7±3.1)μm、(15.2±7.3)μm、(19.7±5.0)μm、(17.0±5.4)μm、(25.5±6.1)μm、(87.0±11.8)μm、(17.1±2.1)μm、(174.8±26.8)μm及(89.1±4.3)μm；年龄≥40岁组分别为(272.0±21.4)μm、(11.3±2.3)μm、(16.0±8.4)μm、(20.3±5.2)μm、(18.8±6.2)μm、(28.7±9.0)μm、(87.9±9.3)μm、(16.8±2.7)μm、(183.4±23.2)μm及(88.5±5.4)μm。男性组分别为(277.7±22.1)μm、(11.8±2.4)μm、(16.9±6.3)μm、(21.3±4.3)μm、(19.3±5.3)μm、(27.9±7.7)μm、(91.4±11.5)μm、(17.1±2.1)μm、(188.7±22.3)μm及(89.0±3.7)μm；女性组分别为(259.3±23.0)μm、(10.4±3.0)μm、(14.4±8.2)μm、(19.0±5.2)μm、(16.5±5.2)μm、(25.7±6.0)μm、(84.8±9.4)μm、(17.0±2.3)μm、(170.4±24.3)μm及(89.0±4.8)μm。AL<26.5 mm组、26.5 mm≤AL<27.5 mm及AL≥27.5 mm组患者AL越长其IPL、INL、IRL及ORL的厚度均越厚，其差异具有统计学意义(F＝3.09，4.06，3.37，6.97；P<0.05)。进一步两两比较发现，AL≥27.5 mm组比AL<26.5 mm组患者IPL、INL和IRL的厚度更厚，其差异具有统计学意义(t＝2.58，2.87，2.90；P<0.05)。AL≥27.5 mm组比AL<26.5 mm组、AL≥27.5 mm组比26.5≤AL<27.5组患者ORL的厚度更薄，其差异具有统计学意义(t＝2.94，3.30；P<0.05)。而各不同AL组患者的视网膜全层厚度、RNFL、GCL、OPL、ONL及RPE厚度的差异均无统计学意义(F＝2.33，2.60，2.88，2.76，0.13，0.46；P>0.05)。年龄≤30岁组、30～39岁组及年龄≥40岁组患者视网膜全层厚度、RNLF、GCL、IPL、INL、OPL、ONL、RPE、IRL及ORL厚度的差异均无统计学意义(F＝1.54，0.63，0.26，0.22，1.50，2.68，0.11，0.24，1.62，0.45；P>0.05)。女性组患者比男性组患者视网膜全层、RNFL、IPL、INL、ONL及IRL的厚度均更薄，其差异具有统计学意义(t＝4.44，2.97，2.66，2.88，3.28，4.32；P<0.05)。采用单因素线性回归筛选视网膜各层厚度的相关因素有患者的年龄、性别、收缩压、舒张压、BMI、近视初始年龄、眼压、AL及SFCT。最终多因素回归分析发现，视网膜全层、RNFL、INL、ONL及IRL的厚度男性组较女性组更厚，其相关性具有统计学意义(β＝－15.40，－1.27，－2.57，－6.16，－16.77；P<0.05)。视网膜全层及IPL厚度随收缩压升高而升高，其相关性具有统计学意义(β＝0.29，0.06；P<0.05)。ORL厚度随舒张压升高而变薄，其相关性具有统计学意义(β＝－0.09，P<0.05)。RNFL、GCL、IPL、INL、OPL和IRL的厚度随AL增长而越厚，其相关性具有统计学意义(β＝0.49，1.55，0.80，0.88，1.21，4.13；P<0.05)。

结论

高度近视眼患者部分视网膜层次的厚度与性别、收缩压、舒张压及AL相关。

关键词: 高度近视, 相干光断层扫描, 视网膜厚度
Objective

To explore the changes in retinal layer thickness and related factors in high myopia eyes.

Methods

A total of 128 highly myopic patients (128 eyes) who visited the Beijing Tongren Eye Center of Beijing Tongren Hospital affiliated with Capital Medical University from February 2023 to July 2023. Among them, there were 46 males (46 eyes) and 82 females (82 eyes) with an average age of (35.9±7.9) years (ranging from 21 to 69 years). According to axial length (AL), age, and gender, they were divided. The patient′s blood pressure, initial age of myopia, intraocular pressure, height and weight were recorded, and the height and body mass index (BMI) was calculated. The thickness of each layer of the retina and the thickness of the central fovea choroid was measured using coherent light tomography (OCT). The measurement data of the thickness of each layer of the retina conformed to a normal distribution through Kolmogorov-Smirnova normality test, and was described as ±s, and compared by analysis of variance in retinal thickness between different AL and age groups and used for further pairwise by Bonferroni if there was a statistically significant difference. The retinal thickness between different gender groups was compared by independent sample t test. Single factor linear regression was used to screen for factors related to the thickness of each layer of the retina. Then, the thickness of each layer of the retina was used as the dependent variable, and the factor with P ≤ 0.10 in the univariate analysis was used as the independent variable. Referring to previous results, age and AL were also used as independent variables for multiple linear regression analysis of their correlation.

Results

The thickness of the entire retina, retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), retinal pigment epithelium layer (RPE), inner retinal layer (IRL), and outer retinal layer (ORL) in patients were measured. The AL<26.5 mm group was (258.9±20.0)μm, (10.1±2.9) μm, (13.1±5.0) μm, (18.5±4.0) μm, (15.4±4.4) μm, (24.8±5.5) μm, (87.6±9.4) μm, (17.2±1.7) μm, (169.2±20.1) μm and (89.7±3.5) μm, respectively. The groups with 26.5 mm ≤AL<27.5 mm were (266.6±26.1) μm, (10.8±2.9) μm, (15.2±8.6) μm, (19.6±5.3) μm, (17.7±5.4) μm, (26.2±6.8) μm, (87.5±12.2) μm, (17.1±2.4) μm, (176.5±27.6) μm and (90.1±4.5) μm, respectively. The AL≥27.5 mm groups were (271.0±24.1) μm, (11.6±2.8) μm, (17.3±7.6) μm, (21.3±5.1) μm, (18.9±5.8) μm, (28.4±7.3) μm, (86.5±9.3) μm, (16.7±2.5) μm, (184.2±23.6) μm and (86.9±4.5) μm, respectively. The age groups ≤ 30 years old were (263.3±23.0)μm, (10.8±3.2) μm, (14.7±7.6) μm, (19.5±5.1) μm, (17.0±4.2) μm, (26.0±4.1) μm, (86.7±9.7) μm, (17.0±1.9) μm, (173.9±22.8) μm and (89.5±3.5) μm, respectively. The age group of 31 to 39 years old was (263.8±26.1)μm, (10.7±3.1) μm, (15.2±7.3) μm, (19.7±5.0) μm, (17.0±5.4) μm, (25.5±6.1) μm, (87.0±11.8) μm, (17.1±2.1) μm, (174.8±26.8) μm and (89.1±4.3) μm, respectively. The age group ≥40 years old was (272.0±21.4)μm, (11.3±2.3) μm, (16.0±8.4) μm, (20.3±5.2) μm, (18.8±6.2) μm, (28.7±9.0) μm, (87.9±9.3) μm, (16.8±2.7) μm, (183.4±23.2) μm and (88.5±5.4) μm, respectively. The male groups were (277.7±22.1) μm, (11.8±2.4) μm, (16.9±6.3) μm, (21.3±4.3) μm, (19.3±5.3) μm, (27.9±7.7) μm, (91.4±11.5) μm, (17.1±2.1) μm, (188.7±22.3) μm and (89.0±3.7) μm, respectively. The female groups were (259.3±23.0) μm, (10.4±3.0) μm, (14.4±8.2) μm, (19.0±5.2) μm, (16.5±5.2) μm, (25.7±6.0) μm, (84.8±9.4) μm, (17.0±2.3) μm, (170.4±24.3) μm and (89.0±4.8) μm, respectively. The longer the AL, the thicker the thickness of IPL, INL, IRL, and ORL in the AL<26.5 mm group, 26.5 mm ≤AL<27.5 mm, and AL≥27.5 mm group, and the differences were statistically significant (F=3.09, 4.06, 3.37, 6.97; P<0.05). Further pairwise comparison revealed that patients with AL≥27.5 mm had thicker IPL, INL, and IRL compared to those with AL<26.5 mm, and the differences were statistically significant (t=2.58, 2.87, 2.90; P<0.05). The thickness of ORL in the AL≥27.5 mm group was thinner than that in the AL<26.5 mm group, and the AL≥27.5 mm group was thinner than that in the 26.5≤AL<27.5 group, with statistical significance (t=2.94, 3.30; P<0.05). However, there were no statistically significant differences in the retinal full thickness, RNFL, GCL, OPL, ONL, and RPE thickness among patients in different AL groups (F=2.33, 2.60, 2.88, 2.76, 0.13, 0.46; P>0.05). There were no statistically significant differences in the thickness of the entire retinal layer, RNLF, GCL, IPL, INL, OPL, ONL, RPE, IRL, and ORL among patients aged ≤30 years, 30-39 years, and ≥40 years (F=1.54, 0.63, 0.26, 0.22, 1.50, 2.68, 0.11, 0.24, 1.62, 0.45; P>0.05). The thickness of the entire retina, RNFL, IPL, INL, ONL, and IRL in the female group was thinner than that in the male group, and the differences were statistically significant (t=4.44, 2.97, 2.66, 2.88, 3.28, 4.32; P<0.05). Single factor linear regression was used to screen for factors related to the thickness of each layer of the retina, including patient′s age, gender, systolic and diastolic blood pressure, BMI, initial age of myopia, intraocular pressure, AL, and SFCT. The final multiple regression analysis found that the thickness of the full retinal layer, RNFL, INL, ONL, and IRL in the male group was thicker than that in the female group, and the correlation was statistically significant (β=- 15.40, -1.27, -2.57, -6.16, -16.77; P<0.05). The thickness of the entire retinal layer and IPL increases with increasing systolic blood pressure, and their correlation was statistically significant (β= 0.29, 0.06; P<0.05). The thickness of ORL decreases with increasing diastolic blood pressure, and its correlation was statistically significant (β=- 0.09, P<0.05). The thickness of RNFL, GCL, IPL, INL, OPL, and IRL increases with AL, and their correlation was statistically significant (β=0.49, 1.55, 0.80, 0.88, 1.21, 4.13; P<0.05).

Conclusions

The thickness of some retinal layers in patients with high myopia is related to gender, systolic blood pressure, diastolic blood pressure, and AL.

Key words: High myopia, Optical coherence tomography, Retinal thickness
图1 相干光断层扫描视网膜各层成像并进行自动分层测量
表1 不同眼轴长度组患者的各层视网膜厚度的分布情况描述及各组间厚度的比较(μm)
眼轴分组 眼数 视网膜全层 RNFL GCL IPL INL
AL<26.5 34 258.9±20.0 10.1±2.9 13.1±5.0 18.5±4.0* 15.4±4.4*
26.5≤AL<27.5 55 266.6±26.1 10.8±2.9 15.2±8.6 19.6±5.3 17.7±5.4
AL≥27.5 39 271.0±24.1 11.6±2.8 17.3±7.6 21.3±5.1 18.9±5.8
F值   2.33 2.60 2.88 3.09 4.06
P值   >0.05 >0.05 >0.05 <0.05 <0.05
眼轴分组 眼数 OPL ONL RPE IRL ORL
AL<26.5 34 24.8±5.5 87.6±9.4 17.2±1.7 169.2±20.1* 89.7±3.5*
26.5≤AL<27.5 55 26.2±6.8 87.5±12.2 17.1±2.4 176.6±27.6 90.1±4.5*
AL≥27.5 39 28.4±7.3 86.5±9.3 16.7±2.5 184.2±23.6 86.9±4.5
F值   2.76 0.13 0.46 3.37 6.97
P值   >0.05 >0.05 >0.05 <0.05 <0.05
表2 不同年龄组患者各层视网膜厚度及各组间的比较(μm)
年龄分组 眼数 视网膜全层 RNFL GCL IPL INL
≤30岁 30 263.3±23.0 10.8±3.2 14.7±7.6 19.5±5.1 17.0±4.2
31～39岁组 63 263.8±26.1 10.7±3.1 15.2±7.3 19.7±5.0 17.0±5.4
≥40岁 35 272.0±21.4 11.3±2.3 16.0±8.4 20.3±5.2 18.8±6.2
F值   1.54 0.63 0.26 0.22 1.50
P值   >0.05 >0.05 >0.05 >0.05 >0.05
年龄分组 眼数 OPL ONL RPE IRL ORL
≤30岁 30 26.0±4.1 86.7±9.7 17.0±1.9 173.9±22.8 89.5±3.5
31～39岁组 63 25.5±6.1 87.0±11.8 17.1±2.1 174.8±26.8 89.1±4.3
≥40岁 35 28.7±9.0 87.9±9.3 16.8±2.7 183.4±23.2 88.5±5.4
F值   2.68 0.11 0.24 1.62 0.46
P值   >0.05 >0.05 >0.05 >0.05 >0.05
表3 不同性别患者的各层视网膜厚度及各组间的比较(μm)
年龄分组 眼数 视网膜全层 RNFL GCL IPL INL
男性 46 277.7±22.1 11.8±2.4 16.9±6.3 21.3±4.3 19.3±5.3
女性 82 259.3±23.0 10.4±3.0 14.4±8.2 19.0±5.2 16.5±5.2
t值   4.44 2.97 1.96 2.66 2.88
P值   <0.05 <0.05 >0.05 <0.05 <0.05
年龄分组 眼数 OPL ONL RPE IRL ORL
男性 46 27.9±7.7 91.4±11.5 17.1±2.1 188.7±22.3 89.0±3.7
女性 82 25.7±6.0 84.8±9.4 17.0±2.3 170.4±24.3 89.0±4.8
t值   1.63 3.28 0.34 4.32 －0.003
P值   >0.05 <0.05 >0.05 <0.05 >0.05
表4 视网膜厚度与眼部因素及全身因素单因素线性回归分析的结果
相关因素 统计值 视网膜全层厚度 RNFL GCL IPL INL OPL ONL RPE IRL ORL
年龄                      
  回归系数 0.40 0.30 0.08 0.04 0.11 0.07 0.09 0.008 0.43 －0.04
  P值 >0.10 >0.10 >0.10 >0.10 >0.10 >0.10 >0.10 >0.10 >0.10 >0.10
性别                      
  回归系数 －18.36 －1.45 －2.53 －2.28 －2.81 －2.15 －6.51 －0.14 －18.31 0.003
  P值 <0.10 <0.10 >0.10 <0.10 <0.10 >0.10 <0.10 >0.10 <0.10 >0.10
收缩压                      
  回归系数 0.45 0.04 0.10 0.073 0.05 0.06 0.13 －0.008 0.48 －0.04
  P值 <0.10 <0.10 <0.10 <0.10 >0.10 >0.10 <0.10 >0.10 <0.10 >0.10
舒张压                      
  回归系数 0.55 0.05 0.13 0.09 0.11 0.09 0.12 －0.02 0.61 －0.07
  P值 <0.10 <0.10 <0.10 <0.10 <0.10 >0.10 >0.10 >0.10 <0.10 >0.10
BMI                      
  回归系数 1.57 0.15 0.29 0.25 0.24 0.22 0.32 －0.001 1.49 0.05
  P值 <0.10 <0.10 >0.10 <0.10 >0.10 >0.10 >0.10 >0.10 <0.10 >0.10
近视初始年龄                      
  回归系数 －0.44 －0.05 －0.15 －0.11 －0.01 －0.12 －0.06 0.08 －0.54 0.09
  P值 >0.10 >0.10 >0.10 >0.10 >0.10 >0.10 >0.10 >0.10 >0.10 >0.10
眼压                      
  回归系数 －0.09 0.007 －0.13 －0.12 0.01 0.002 0.22 0.04 －0.07 －0.04
  P值 >0.10 >0.10 >0.10 >0.10 >0.10 >0.10 >0.10 >0.10 >0.10 >0.10
AL                      
  回归系数 4.14 0.58 1.55 0.98 1.02 1.21 －0.44 －0.22 5.28 －1.09
  P值 <0.10 <0.10 <0.10 <0.10 <0.10 <0.10 >0.10 >0.10 <0.10 <0.10
SFCT                      
  回归系数 0.04 0.003 －0.004 0.01 －0.002 0.01 0.03 0.002 0.02 0.02
  P值 >0.10 >0.10 >0.10 >0.10 >0.10 >0.10 <0.10 >0.10 >0.10 <0.10
表5 视网膜厚度与眼部因素及全身因素多元线性回归分析的结果
视网膜厚度或分层厚度 眼部因素或全身因素 β值 95%置信区间 P值
视网膜全层厚度        
  收缩压 0.29 0.007, 0.56 <0.05
  性别 －15.40 －24.48, －6.29 <0.05
RNFL厚度        
  AL 0.49 0.05, 0.93 <0.05
  性别 －1.27 －2.30, －0.24 <0.05
GCL厚度        
  AL 1.55 0.39, 2.71 <0.05
IPL厚度        
  AL 0.80 0.007, 1.60 <0.05
  收缩压 0.06 0.003, 0.12 <0.05
INL厚度        
  年龄 0.12 0.004, 0.23 <0.05
  性别 －2.57 －4.47, －0.68 <0.05
  AL 0.88 0.07, 1.69 <0.05
OPL厚度        
  AL 1.21 0.18, 2.25 <0.05
ONL厚度        
  SFCT 0.02 0.001, 0.04 <0.05
  性别 －6.16 －9.83, －2.49 <0.05
IRL厚度        
  性别 －16.77 －25.34, －8.20 <0.05
  AL 4.13 0.46, 7.80 <0.05
ORL厚度        
  SFCT 0.02 0.01, 0.03 <0.05
  舒张压 －0.09 －0.15, －0.08 <0.05
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