背景 前部缺血性视神经病变(AION)是常见的眼部病变,预后较差,其早期诊断对视力预后至关重要.频域光相干断层扫描(FD-OCT)能在活体实时显示视网膜组织的细微结构,可定量测量黄斑区神经节细胞复合体(GCC)及视盘神经纤维层厚度(RNFL)厚度.以往的研究多用视盘RNFL厚度来评估AION患者视网膜神经节细胞(RGCs)的丢失情况,近期研究显示GCC厚度可检测出AION患者视网膜结构变化,但鲜见视盘RNFL厚度和GCC厚度对AION诊断效能的比较研究. 目的 评估OCT测量的GCC和RNFL对AION的诊断效能.方法 采用诊断试验研究方法,于2013年12月至2014年7月纳入在天津医科大学眼科医院就诊的AION患者15例15眼,同期纳入天津医科大学眼科医院职工及门诊就诊的年龄和性别匹配的正常对照者14人14眼,采用频域OCT测量黄斑区GCC厚度及视盘RNFL厚度,黄斑区GCC厚度测量指标包括黄斑区周围6mm×6mm范围上方、下方GCC厚度和平均GCC厚度,计算局部丢失体积(FLV)和整体丢失体积(GLV);视盘RNFL厚度测量指标包括视盘上方、下方及平均RNFL厚度,比较AION组与正常对照组间检测结果的差异.采用受试者工作特征(ROC)曲线下面积(AUC)评估FD-OCT测量的黄斑区GCC厚度及视盘RNFL厚度对AION的诊断效能.结果 与正常对照组比较,AION组受检眼黄斑区上方、下方及平均GCC厚度均明显薄于正常对照组,差异均有统计学意义(t=-3.402,P=0.002;t 2.690,P=0.012;t=2.913,P=0.007);AION组受检眼FLV值和GLV值分别为(8.39±4.54) μm3和(19.57±10.66) μm3,明显低于正常对照组的(0.64±0.48) μm3和(1.14±0.91) μm3,差异均有统计学意义(t=5.036、6.723,均P＜0.01).AION组受检眼视盘上方、下方及平均RNFL厚度较正常对照组均明显变薄,差异均有统计学意义(t=2.815,P=0.009;t=2.392,P=0.024;t=2.863,P=0.008).AION眼测量的FLV和GLV的AUC值均为1.000,黄斑区上方、平均GCC厚度及下方GCC厚度AUC依次为0.871、0.819和0.795,视盘平均RNFL厚度及视盘上方、下方RNFL厚度AUC依次为0.814、0.809和0.762. 结论 OCT测量的GCC厚度和RNFL厚度在AION诊断能力中具有可比性,FLV和GLV在AION患者的神经节细胞层检测方面能力较强,黄斑区GCC厚度与RNFL厚度测量在AION的诊断中可互为补充.%Background Anterior ischemic optic neuropathy (AION) is a common eye disease,and early diagnosis is very important for reserving useful vision.Frequency-domain optical coherence tomography (FD-OCT) can display retinal microstructure in vivo and quantify the thickness of macular ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL).Previous study on assessing retinal ganglion cell loss is assessed by measuring the RNFL thickness,while recent researches showed that GCC thickness measurement can reveal the retinal structure change in AION patients.However,there is few comparative studies on the diagnostic efficiency of RNFL thickness versus GCC thickness for AION.Objective This study was to evaluate and analyze the diagnostic value of GCC thickness and RNFL thickness measured by FD-OCT in patients with AION.Methods Fifteen eyes of 15 patients with AION and 14 normal eyes of 14 normal persons were enrolled in Eye Hospital of Tianjin Medical University from December 2013 to July 2014.Macular GCC thickness and disc RNFL thickness were measured by FD-OCT,and macular GCC thickness included superior,inferior and average GCC thickness around 6 mm×6 mm of macula,and focal loss volume (FLV) and global loss volume (GLV) were calculated.The disc RNFL thickness included superior,inferior and mean RNFL thickness around disc.The measuring outcomes between AION group and normal control group were compared.The diagnostic efficiency of GCC thickness and RNFL thickness was evaluated by the area under the receiver operating characteristic (ROC) curve.Results Compared with normal control group,the GCC thickness at superior,inferior and average GCC thickness at macula were thinner,with significant differences between them (t=-3.402,P=0.002;t =2.690,P=0.012;t=2.913,P=0.007).The FLV and GLV values were (8.39±4.54) μm3and (19.57±10.66) μm3 in the AION group,which were significantly lower than (0.64±0.48) μm3 and (1.14±0.91) μm3 in the normal control group (t=5.036,6.732;both at P＜0.01).The disc RNFL thicknesses of superior,inferior and average RNFL were thinner in the AION group than those in the normal control group,with significant differences between them (t=2.815,P=0.009;t =2.392,P=0.024;t =2.863,P=0.008).The AUC of FLV and GLV for AION were both 1.000,and that of superior GCC thickness,inferior GCC thickness and average GCC thickness at macula was 0.871,0.819 and 0.795,respectively.The AUC of average RNFL thickness and disc superior,inferior RNFL thicknesses for AION were 0.814,0.809 and 0.762,respectively.Conclusions The diagnosis ability of GCC and RNFL thickness for AION is comparable.FLV and GLV appear to have the strongest efficiency in the evaluation of GCL in AION patients.Macular GCC measurement may provide a good alternative or a complementary practice to RNFL scans for the diagnosis of AION.
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