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目的比较双眼与单眼非动脉炎性前部缺血性视神经病变(NAION)患者临床特征与危险因素的差异。设计回顾性病例系列。研究对象解放军总医院神经眼科2009年10月至2015年3月NAION患者201例。方法收集患者的病史、实验室检查、颈动脉超声、头颅磁共振(MRI)、多导睡眠监测、24小时动态血压检查结果,并对单眼、双眼患者两组间差异性比较。主要指标年龄、性别、基础疾病、药物使用、视盘形态。结果 201例患者中,双眼受累67例(61例双眼同时受累,6例双眼同时发病间隔小于1周),单眼受累134例。双眼受累组与单眼受累组在年龄(54.69±10.43岁、54.47±9.90岁,P=0.988)、男女比例(1.34:1、2.05:1,P=0.22)方面无明显差异。相比于单眼受累组,双眼受累组患者高血压比例更高(52.2%、37.3%,P=0.04)、夜间睡眠低血压比例更低(19.2%、37.2%,P=0.026)、使用降血压药物更多(65.7%、40.3%,P=0.03)、合并阻塞性睡眠呼吸暂停低通气更多(35.4%、21.2%,P=0.036)、肥胖比例更大(17.9%、9.7%,P=0.031)。吸烟、饮酒、糖尿病、血脂紊乱、颈动脉粥样硬化、脑梗死、高同型半胱胺酸血症、拥挤视盘、诱发因素等在两组间无明显差异。结论高血压、使用降血压药物、肥胖及合并睡眠呼吸暂停综合征是发生双眼NAION的危险因素。
Objective To compare the clinical features and risk factors between patients with binocular and unilateral non-arteritic anterior ischemic optic neuropathy (NAION). Design retrospective case series. Subjects PLA General Hospital neurosurgery 201 cases of NAION patients from October 2009 to March 2015. Methods The patient’s medical history, laboratory tests, carotid artery ultrasound, cranial magnetic resonance imaging (MRI), polysomnography and 24-hour ambulatory blood pressure test were collected. The differences between the two groups were compared. The main indicators of age, gender, underlying diseases, drug use, optic disc morphology. Results Among the 201 patients, 67 eyes were involved in both eyes (61 eyes were affected simultaneously, 6 eyes were less than 1 week apart), and 134 eyes were involved in monocular involvement. There were no significant differences in age (54.69 ± 10.43 years, 54.47 ± 9.90 years, P = 0.988), male to female ratio (1.34: 1, 2.05: 1, P = 0.22) between binocular and monocular groups. Patients with binocular involvement had a higher rate of hypertension (52.2%, 37.3%, P = 0.04) and nocturnal hypotension (19.2%, 37.2%, P = 0.026), compared with patients with monocular involvement. Hypotension More drugs (65.7%, 40.3%, P = 0.03) had more obstructive sleep apnea-hypopnea (35.4%, 21.2%, P = 0.036) and greater obesity (17.9%, 9.7%, P = 0.031). Smoking, alcohol consumption, diabetes, dyslipidemia, carotid atherosclerosis, cerebral infarction, hyperhomocysteinemia, crowded optic disc, predisposing factors, etc. There was no significant difference between the two groups. Conclusions Hypertension, use of antihypertensive drugs, obesity and sleep apnea syndrome are risk factors for NAION in both eyes.