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中华实验和临床感染病杂志(电子版)

中华实验和临床感染病杂志(电子版) ›› 2021, Vol. 15 ›› Issue (04) : 270 -275. doi: 10.3877/cma.j.issn.1674-1358.2021.04.009

论著

获得性免疫缺陷综合征合并新型隐球菌性脑膜炎患者视乳头水肿急性期的频域光学相干断层扫描特征
鲁丹1, 毛菲菲1, 李丹1, 王胜男1, 刘夕瑶1, 孙挥宇1,†()   
  1. 1. 100015　北京，首都医科大学附属北京地坛医院，感染病科国家临床重点专科
  • 收稿日期:2020-09-02 出版日期:2021-08-15
  • 通信作者: 孙挥宇
  • 基金资助:
    北京市医院管理中心科研培育计划(No. PX2018061)

Optical coherence tomography manifestations of the acute papilledema in patients with acquired immunodeficiency syndrome complicated with cryptococcal meningitis

Dan Lu1, Feifei Mao1, Dan Li1, Shengnan Wang1, Xiyao Liu1, Huiyu Sun1,†()   

  1. 1. Department of Ophthalmology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
  • Received:2020-09-02 Published:2021-08-15
  • Corresponding author: Huiyu Sun
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鲁丹, 毛菲菲, 李丹, 王胜男, 刘夕瑶, 孙挥宇. 获得性免疫缺陷综合征合并新型隐球菌性脑膜炎患者视乳头水肿急性期的频域光学相干断层扫描特征[J]. 中华实验和临床感染病杂志(电子版), 2021, 15(04): 270-275.

Dan Lu, Feifei Mao, Dan Li, Shengnan Wang, Xiyao Liu, Huiyu Sun. Optical coherence tomography manifestations of the acute papilledema in patients with acquired immunodeficiency syndrome complicated with cryptococcal meningitis[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2021, 15(04): 270-275.

目的

探讨获得性缺陷免疫综合征（AIDS）合并新型隐球菌性脑膜炎（CNM）患者视乳头水肿急性期视乳头周围视神经纤维层厚度（RNFLT）及其形态学改变。

方法

回顾性分析2009年5月至2018年10月共30例就诊或随诊于首都医科大学附属北京地坛医院确诊为AIDS合并CNM患者的眼部资料（57只眼），根据眼底情况分为两组：眼底正常患者（对照组）15例，共30只眼；颅高压视乳头水肿患者组（观察组）15例，共27只眼。均用频域光学相干断层扫描仪（SD-OCT）检测视盘周围3.4 mm区域上、下、鼻、颞侧4个象限的RNFLT；粗略估算神经管开口的颞侧和鼻侧边缘处视网膜色素上皮层Bruch’s膜（RPE/BM）的角度及其延长线所构成的形态。

结果

对照组和观察组患者的平均年龄[（36.5 ± 12.3）岁vs. （30.2 ± 9.1）岁，t = 1.588、P = 0.298]、男/女构成比（12/3 vs. 13/2，P = 1.000）、AIDS平均确诊时间[（4.90 ± ?.??）年vs.（4.06 ± 2.37）年，t = 0.906、P = 0.543]、非接触眼压[（12 ± 3）mmHg vs. （13 ± 4）mmHg，t =-0.815、P = 0.362]和最佳矫正视力[（0.85 ± 0.15） vs. （0.81 ± 0.17），t = 0.690、P = 0.853）的差异均无统计学意义。对照组和观察组患者视盘周围RNFLT平均数值及分别在4个象限的平均数值差异均有统计学意义（P均< 0.001）。对照组15例患者30只眼视神经管开口处RPE/BM夹角及形态中有23只眼（76.7%）为负角，其延长线在玻璃体反方向形成特征性"V"形；观察组15例患者27只眼RPE/BM夹角及形态中有16只眼（59.3%）为正角，形成凸向玻璃体方向的特征性"倒U"形。

结论

AIDS合并CNM患者盘周RNFLT较正常组显著增厚；视神经管开口处RPE/BM形成的特征性形态正角（"倒U"形）、负角（"V"形）均为鉴别视乳头水肿的有效方法。

关键词: 获得性免疫缺陷综合征, 新型隐球菌性脑膜炎, 视乳头水肿, 颅高压, 频域光学相干断层扫描仪
Objective

To investigate the acute papilledema by measuring the peripapillary retinal nerve fiber layer thickness (RNFLT) changes and its morphology in patients with acquired immunodeficiency syndrome (AIDS) complicated with cryptococeal neoformans menin-gitis (CNM).

Methods

The ophthalmic manifestations of the 30 patients (57 eyes) diagnosed as AIDS complicated with CNM from May 2009 to October 2018 were analyzed in Beijing Ditan Hospital, Capital Medical University, retrospectively, and were divided into two groups according to the situation of fundus: 15 patients (30 eyes) with normal fundus as control group and 15 patients (27 eyes ) of papilledema with intracranial hypertension as observation group. The mean thickness of peripapillary retinal nerve fiber layer (RNFLT) in upper, lower, nasal and temporal quadrants at 3.4 mm around optic disc was measured by spectral domain optical coherence tomography (SD-OCT), and the angle of retinal pigment epithelial Bruch’s membrane (RPE/BM) at the temporal and nasal edges of the neural tube opening and the morphology of the elongation line was estimated roughly.

Results

The average age of the control group and observation group [(36.5 ± 12.3) years old vs. (30.2 ± 9.1) years old; t = 1.588, P = 0.298)], gender (12/3 vs. 13/2, P = 1.000), AIDS diagnosis period [(4.90 ± ?.??) years vs. (4.06 ± 2.37) years; t = 0.906, P = 0.543], IOP [(12 ± 3) mmHg vs. (13 ± 4) mmHg; t =-0.815, P = 0.362] and the best corrected visual acuity [(0.85 ± 0.15) vs. (0.81 ± 0.17); t = 0.690, P = 0.853] were all without significant differences. The mean RNFLT of peripapillary and the four quadrants of patients in control group and observation group all had a statistical significance (P < 0.001). During control group, 23 eyes of 30 eyes (76.7%) had negative angle with outward angulation ( "V" shape), while in observation group, 16 eyes of 27 eyes (59.3%) had positive angle with inward angulation ( "inverted U" shape).

Conclusions

The peripapillary RNFLT in patients with papilledema were significantly thickened than the normal group. The characteristic morphological positive angle ( "inverted U" shape) and negative angle ( "V" shape) formed at the RPE/BM at the opening of the optic canal were all effective methods to identify papilledema.

Key words: Acquired immune deficiency syndrome, Cryptococeal neoformans meningitis, Peripapillary, Cranial hypertension, Spectral domain-optical coherence tomography
表1 对照组和观察组患者的基本资料
组别 例数 眼睛只数 平均年龄（± s，岁） 性别（男/女，例） AIDS确诊时间（± s，年） 非接触眼压（± s，mmHg） 最佳矫正视力（± s）
对照组 15 30 36.5 ± 12.3 12/3 4.90 ± 2.69 12 ± 3 0.85 ± 0.15
观察组 15 27 30.2 ± 9.1 13/2 4.06 ± 2.37 13 ± 4 0.81 ± 0.17
统计量     t = 1.588 —a t = 0.906 t =-0.815 t = 0.690
P值     0.298 1.000 0.543 0.362 0.853
表2 对照组和观察组患者视盘周围及4个象限平均RNFLT（± s，μm）
组别 例数 眼睛数（只） RNFLT
平均值 上方 下方 鼻侧 颞侧
对照组 15 30 108.10 ± 33.60 141.60 ± 12.68 134.20 ± 17.93 82.30 ± 14.14 74.30 ± 13.28
观察组 15 27 227.07 ± 82.88 280.64 ± 86.48 267.92 ± 75.71 184.93 ± 59.14 174.79 ± 51.05
t值     -9.69 -5.92 -6.36 -6.25 -7.01
P值     < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
表3 对照组和观察组鼻侧和颞侧视神经管开口处RPE/BM的夹角及形态
组别 例数 眼睛数（只） RPE/BM夹角[只（%）]
负角（"V"形） 0角（水平） 正角（"倒U"形）
对照组 15 30 23（76.7） 6（20.0） 1（3.3）
观察组 15 27 3（11.1） 8（29.6） 16（59.3）
χ2值     28.828
P值     < 0.001
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