目的:探讨非动脉炎性前部缺血性视神经病变(NAION)与视网膜中央动脉阻塞(CRAO)危险因素的差异,并建立预测诊断列线图。
方法:该研究包括37例单眼NAION患者,20与单眼CRAO,和24患有高血压。性别,年龄,并记录全身疾病。血常规,脂质,血液流变学,颈动脉和肱动脉多普勒超声,并收集超声心动图。视神经盘区域,杯区,测量NAION和CRAO组未受累眼和高血压组右眼的杯盘比(C/D)。
结果:CRAO组患侧颈动脉内膜中层厚度(C-IMT)较NAION组厚(P=0.039),血流介导扩张(FMD)较低(P=0.049)。与高血压患者相比,NAION患者全血降低粘度低切变(WBRV-L)和红细胞聚集指数(EAI;P=0.045,0.037)较高,CRAO患者红细胞刚性指数(IR)和红细胞变形指数(EDI;P=0.004,0.001)较高。NAION组的视杯和C/D小于其他两组(P<0.0001)。诊断预测模型具有较高的诊断特异性(83.7%)和敏感性(85.6%),这与高血压高度相关,患侧的C-IMT,口蹄疫,血小板(PLT),EAI,C/D
结论:CRAO患者表现出比NAION更厚的C-IMT和更差的内皮功能。NAION和CRAO可能与血液流变学异常有关。NAION可能涉及小杯和小C/D。诊断列线图可用于初步识别NAION和CRAO。
OBJECTIVE: To investigate the difference in risk factors between non-arteritic anterior ischaemic optic neuropathy (NAION) and central retinal artery occlusion (CRAO) and develop a predictive diagnostic nomogram.
METHODS: The study included 37 patients with monocular NAION, 20 with monocular CRAO, and 24 with hypertension. Gender, age, and systemic diseases were recorded. Blood routine, lipids, hemorheology, carotid and brachial artery doppler ultrasound, and echocardiography were collected. The optic disc area, cup area, and cup-to-disc ratio (C/D) of the unaffected eye in the NAION and CRAO group and the right eye in the hypertension group were measured.
RESULTS: The carotid artery intimal medial thickness (C-IMT) of the affected side of the CRAO group was thicker (P=0.039) and its flow-mediated dilation (FMD) was lower (P=0.049) than the NAION group. Compared with hypertension patients, NAION patients had higher whole blood reduced viscosity low-shear (WBRV-L) and erythrocyte aggregation index (EAI; P=0.045, 0.037), and CRAO patients had higher index of rigidity of erythrocyte (IR) and erythrocyte deformation index (EDI; P=0.004, 0.001). The optic cup and the C/D of the NAION group were smaller than the other two groups (P<0.0001). The diagnostic prediction model showed high diagnostic specificity (83.7%) and sensitivity (85.6%), which was highly related to hypertension, the C-IMT of the affected side, FMD, platelet (PLT), EAI, and C/D.
CONCLUSIONS: CRAO patients show thicker C-IMT and worse endothelial function than NAION. NAION and CRAO may be related to abnormal hemorheology. A small cup and small C/D may be involved in NAION. The diagnostic nomogram can be used to preliminarily identify NAION and CRAO.