【作者】 赵亮；

【导师】 孙丰源； 唐东润； 潘叶；

【作者基本信息】 天津医科大学 ， 眼科学， 2010， 硕士

【摘要】 目的：研究甲状腺相关眼病(Thyroid-Associated Ophthalmopathy, TAO)患者眼动脉及视网膜中央动脉血流动力学特点,并结合血流参数及临床特点分析其相关性,探讨不同因素对TAO患者视网膜供血的影响。方法：(1)应用美国GE公司生产的Logic7彩色多普勒超声诊断仪,探测49例(90只眼)明确诊断TAO且甲状腺功能正常或稳定半年以上的患者及24例(48只眼)正常对照者的眼动脉及视网膜中央动脉,记录其频谱图并测量收缩期峰值速度(PSV)、舒张末期速度(EDV)、阻力指数(RI)。(2)根据视网膜中央动脉频谱特点将TAO患者分成两组,即频谱中断组(21例,40只眼)与频谱无中断组(28例,50只眼)。(3)比较分析：分析各组血流参数之间的差别是否有统计学意义,并且分析血流参数之间及血流参数与临床特点之间的相关性。(4)统计学方法：两个样本均数的比较采用两个独立样本的非参数检验；率的比较采用2×2四格表x2检验。结果：(1)正常对照组与TAO组比较：正常对照组OA及CRA PSV、EDV高于TAO组,RI低于正常对照组,差别均有统计学意义,P<0.05。(2)TAO组CRA频谱中断的构成比大于正常对照组,差别有统计学意义,P<0.05。(3)TAO组中,频谱中断组与频谱无中断组比较：两组OA PSV差别无统计学意义,P>0.05；频谱中断组CRA PSV低于频谱无中断组,P<0.05；频谱中断组OA及CRA EDV低于频谱无中断组,P<0.05；频谱中断组OA及CRA RI高于频谱无中断组,P<0.05。(4)正常对照组与频谱中断组比较：OA及CRA PSV、EDV均高于频谱中断组,差别有统计学意义(P<0.05)；正常对照组OA及CRA RI均低于频谱中断组,差别有统计学意义(P<0.05)。(5)正常对照组与频谱无中断组比较：两组OA PSV比较差别无统计学意义(P>0.05)；正常对照组OA EDV高于频谱无中断组,差别有统计学意义(P<0.05)；正常对照组OA RI低于频谱无中断组,差别有统计学意义(P<0.05)；正常对照组CRA PSV及EDV高于频谱无中断组,差别有统计学意义(P<0.05)；两组CRA RI差别无统计学意义(P>0.05)。(6)频谱中断组与频谱无中断组比较：两组之间眶压、眼球突出度差别有统计学意义,P<0.05；两组之间存在眼外肌肥大的构成比无明显区别,P>0.05。(7)TAO组OA PSV、EDV与眼球突出度呈负相关,P<0.05；TAO组CRA EDV与眼球突出度之间呈负相关,P<0.05；(8)TAO组OA RI与EDV存在负相关,P<0.05；TAO组CRA RI与EDV存在负相关,P<0.05。结论：(1)在甲状腺功能正常情况下,TAO患者OA及CRA PSV、EDV较正常人下降,而RI较正常人升高。且各血流参数与眼球突出度存在一定相关性。(2)TAO患者中CRA血流频谱发生中断的比率明显高于正常对照组。(3)TAO患者中,CRA血流频谱发生中断组OA及CRA血流速度低于频谱无中断组,而RI则大于频谱无中断组。(4)TAO患者眶压增高导致OA及CRA血流参数的改变,频谱图则表现为CRA频谱出现中断,以及OA频谱较正常人变得陡峭。更多还原

【Abstract】 Objectives:To study the hemodynamic characteristics of ophthalmic artery and central retinal artery in patients with thyroid-associated ophthalmopathy(TAO). And analyze the relevance between the blood flow parameters and the clinical characteristics.At last, discuss the different influence factors on tetinal blood supply of patients with TAO.Methods:(1) Use the U.S. company GE’s Logic7 Color Doppler Ultrasound diagnostic apparatus, to detect the ophthalmic artery and central retinal artery on 49 TAO cases (ninety eyes) whose thyroid function is normal or stable over six months and 24 normal controls (48 eyes), simultaneously, record its spectrum and measure the peak systolic velocity (PSV), end diastolic velocity (EDV), resistance index (RI). (2) According to the spectral characteristics of the central retinal artery, the TAO group was divided into two groups, the spectrum interruption group that include 21 patients(40 eyes) and the spectrum without interruption group that include 28 patients (50 eyes).(3) Analysis:To analyze the differences among the blood flow parameters are significant.,and analyze the correlation between the blood flow parameters and the clinical characteristics (4)Statistical Methods:The non-parametric test was used to compare the independent samples; The 2×2 tables x2 was used to compare the ratio.Results:(1)The PSV and EDV in normal control group are higher than in TAO group,and the RI in normal group is lower than in TAO group,P<0.05.(2)The constituent ratio of the eyes whose CRA spectrum is interrupted is higher in TAO group than in normal control group, P<0.05.(3)There is no statistical significance of the OA PSV between spectrum interruption group and spectrum without interruption group,P>0.05;The CRA PSV in spectrum interruption group is lower than in spectrum without interruption group, P<0.05;The EDV of OA and CRA in spectrum interruption group is lower than in spectrum without interruption group, P<0.05; The RI of OA and CRA in spectrum interruption group is higher than in spectrum without interruption group, P<0.05.(4)Either the PSV or the EDV of OA and CRA in normal control are higher than in spectrum interruption group, P<0.05; The RI of OA and CRA in normal control are lower than in spectrum interruption group, P<0.05.(5)For the PSV of OA,there is no statistical significance between normal control group and spectrum without interruption group, P>0.05;The EDV of OA in normal control group is higher than in spectrum without interruption group, P<0.05; The RI of OA in normal control group is lower than in spectrum without interruption group, P< 0.05;The PSV and EDV of CRA in normal control group are higher than in spectrum without interruption group, P<0.05; There is no statistical significance of the CRA RI between two groups,P>0.05.(6)There is statistical significance for the differences of orbital pressure and exophthalmos between the spectrum interruption group and spectrum without interruption group; There is no statistical significance for the differences of the constituent ratio of enlarged extraocular muscle between the spectrum interruption group and spectrum without interruption group.(7)The PSV and EDV of OA tended to be negative correlated with exophthalmos, P<0.05; The EDV of CRA tended to be negative correlated with exophthalmos, P<0.05.(8)The RI of OA tended to be negative correlated with the EDV in TAO group, P<0.05; The RI of CRA tended to be negative correlated with the EDV in TAO group, P<0.05.Conclusions:(1)Under the situation of normal thyroid function,either the PSV or the EDV of OA and CRA in TAO patients is decreased compared with normal subjects,and the RI is higher than normal subjects,and the blood flow parameters are correlated with exophthalmos.(2) The ratio of the eyes whose CRA spectrum is interrupted is higher in TAO group than in normal control group.(3)In the TAO patients,the blood flow velocity of the eyes whose CRA spectrum is interrupted is lower than the eyes whose CRA spectrum is not interrupted,but the RI is higher than the eyes whose CRA spectrum is not interrupted.(4)The increase of orbital pressure of TAO patients leads to the change of the blood flow parameters,that is the CRA spectrum is interrupted and the OA spectrum becomes steep compared with the normal subjects.更多还原