正常眼压性青光眼与原发性开角型青光眼24小时眼压曲线的比较

摘要

目的 通过24 h眼压的测量来深入分析比较正常眼压性青光眼(NTG)与原发性开角型青光眼(POAG)的眼压曲线特征.方法 前瞻性病例对照研究.收集2006年4月至2009年4月在上海市闸北区北站医院和复旦大学附属眼耳鼻喉科医院门诊就诊的NTG患者131例及POAG患者102例,测量24 h眼压,用非接触性眼压计从8 am起每隔2 h测一次眼压,0 am至6 am之间测得的为唤醒后即刻坐位眼压.主要观察指标为眼压波动曲线、平均眼压、峰值时间及眼压、谷值时间及眼压和眼压波动值.采用独立样本t检验和卡方检验比较各指标在两组之间的差异.结果 NTG组双眼平均眼压为(14.2±2.1)mmHg,低于POAG组[(19.9±3.5)mmHg];NTG组双眼峰值眼压为(17.0±2.4)mmHg,低于POAG组[(24.7±4.3)mmHg];NTG组双眼谷值眼压为(11.8±2.2)mmHg,低于POAG组[(16.5±3.1)mmHg];NTG组双眼眼压波动值为(5.2±1.8)mmHg低于POAG组(8.2±3.1)mmHg];两组的平均眼压、峰值、谷值及眼压波动值的差异均有统计学意义(t=-14.52、-16.44、-13.16、-8.90,P均＜0.01).NTG组63.3%患者、POAG组73.5%患者的峰值眼压位于门诊工作时间以外;尤其是NTG组有51.5%患者、POAG组有64.7%患者的峰值位于0 am至6 am时间段,两组差异有统计学意义(X2=8.150,P=0.017).结论 NTG及POAG患者24 h眼压曲线的变化规律具有相似性,是诊断和个体化治疗方案制订的依据,并可用作治疗随访中评价疗效和调整方案的重要参考指标.%Objective To analyze the characteristics of diurnal intraocular pressure (IOP) curves in normal tension glaucoma (NTG) patients and primary open angle glaucoma (POAG) patients by measuring IOP over 24 hours. Methods This was a prospective case control study. Subjects diagnosed as POAG and NTG were enrolled from April 2006 to April 2009 in the Shanghai Beizhan Hospital and Eye & ENT Hospital of Fudan University. A total of 131 NTG patients and 102 POAG patients were included in this study. All the subjects accepted 24-hour IOP measurements by a non-contact tonometer every two hours starting at 8:00 am in a sitting position. The IOP between 0:00 to 6:00 am were also measured in a sitting position immediately after the subject was awakened. The main observation indices included an IOP fluctuating curve, average IOP, peak time and IOP, valley time and IOP and the IOP fluctuating value. Differences in these indices between the two groups were analyzed by a independent samples t test and chi-square test. Results The average IOP in the NTG group were (14.2±2.1)mmHg for the two eyes, and in the POAG group were (19.9±3.5)mmHg. The peak IOP in the NTG group were (17.0±2.4)mmHg for the two eyes, and in the POAG group were (24.7±4.3)mmHg. The valley IOP in the NTG group were (11.8±2.2)mmHg for the two eyes, and in the POAG group were (16.5±3.1)mmHg. IOP fluctuations in the NTG group were (5.2±1.8)mmHg for the two eyes, and in the POAG group were (8.2±3.1)mmHg. All differences between the two groups were statistically significant (t=-14.52,-16.44,-13.16,-8.90, P＜0.01 for all). Notably, 63.3% of the peak IOP in the NTG and 73.5% of the peak IOP in the POAG occurred outside working hours, especially during the period from 0:00 to 6:00 am with 51.5% peak IOP in the NTG group and 64.7% in the POAG group. Differences between the two groups were statistically significant (x2=8.150, P=0.017). Conclusion The fluctuation curves of IOP in NTG and POAG patients are similar over 24 hours. These properties are not only guidelines for establishing individual treatment, but also for evaluating the therapeutic effects and treatment adjustments during follow-up.