原发性开角型青光眼或正常眼压性青光眼患者夜间血压降低与视野缺损进展之间的关联。

Association between nocturnal blood pressure reduction and progression of visual field defect in patients with primary open-angle glaucoma or normal-tension glaucoma.

作者信息

Tokunaga Takaharu, Kashiwagi Kenji, Tsumura Toyoaki, Taguchi Kazuyuki, Tsukahara Shigeo

机构信息

Department of Ophthalmology, University of Yamanashi, Faculty of Medicine, Yamanashi, Japan.

出版信息

Jpn J Ophthalmol. 2004 Jul-Aug;48(4):380-5. doi: 10.1007/s10384-003-0071-6.

DOI:10.1007/s10384-003-0071-6

PMID:15295667

Abstract

PURPOSE

To assess prospectively the relationship between nocturnal blood pressure reduction (dip) and progression of the visual field defect in patients with normal-tension glaucoma (NTG) or primary open-angle glaucoma (POAG).

PATIENTS AND METHODS

The subjects studied were 38 patients with glaucoma (23 patients with NTG, 15 patients with POAG), in whom 48-h ambulatory blood pressure monitoring was conducted, who were followed for at least 4 years, and in whom reliable visual field tests were performed at least 5 times. The progression was determined by the mean deviation (MD) slope analysis system installed in the Humphrey field analyzer Statpac program. Glaucoma patients with a dip of <10% were assigned to the nondipper group, those with a dip of 10%-20% to the tipper group, and those with a dip of >20% to the extreme dipper group. The dipper group was defined as physiologic dippers, while the nondipper and the extreme dipper groups were defined as nonphysiologic dippers, to study the relationship between the disturbance of the dip and progression of the visual field defect.

RESULTS

Thirteen patients showed significant progression, while 25 patients did not. There were no significant differences in the mean intraocular pressure and follow-up period between the patients with progression and those without progression. Half (7/14) of the nondippers, 20% (4/20) of the dippers, and 50% (2/4) of the extreme dippers showed progression, indicating a tendency of progression in the nondipper and the extreme dipper groups. The nonphysiologic dippers had a higher incidence of progression compared with the physiologic dippers (P = 0.05). Among the glaucoma patients in the nondipper and dipper categories only, those with progression had significantly smaller dips (P = 0.02).

CONCLUSION

These results suggest that disturbance in the physiologic dip may be involved in the progression of glaucoma.

摘要

目的

前瞻性评估正常眼压性青光眼（NTG）或原发性开角型青光眼（POAG）患者夜间血压下降（谷值）与视野缺损进展之间的关系。

患者与方法

研究对象为38例青光眼患者（23例NTG患者，15例POAG患者），对其进行了48小时动态血压监测，随访至少4年，且至少进行了5次可靠的视野检查。进展情况通过Humphrey视野分析仪Statpac程序中安装的平均偏差（MD）斜率分析系统来确定。夜间血压下降幅度<10%的青光眼患者被归入非勺型组，下降幅度为10% - 20%的患者被归入勺型组，下降幅度>20%的患者被归入极端勺型组。勺型组被定义为生理性勺型，而非勺型组和极端勺型组被定义为非生理性勺型，以研究勺型异常与视野缺损进展之间的关系。

结果

13例患者出现显著进展，25例患者未出现进展。进展患者与未进展患者之间的平均眼压和随访时间无显著差异。非勺型组中有一半（7/14）、勺型组中有20%（4/20）、极端勺型组中有50%（2/4）出现进展，表明非勺型组和极端勺型组有进展倾向。与生理性勺型组相比，非生理性勺型组进展发生率更高（P = 0.05）。仅在非勺型和勺型类别的青光眼患者中，进展患者的夜间血压下降幅度显著更小（P = 0.02）。