Ge J, Zhou W, Zhu J, Cheng A, Lin Y, Tong H, Lian L, Chen Z
National Ophthalmological Laboratories, Ministry of Public Health, China.
Yan Ke Xue Bao. 1993 Mar;9(1):3-11.
Researches of glaucoma visual function damage, hemorheology, ocular rheography and other related multiplex factors, with computed multifactorial stepwise regression analysis, indicate that the elevation of intraocular pressure (IOP) is not the only factor to induce visual impairment. POAG patients are shown to have markedly reduced diastolic perfusion pressure in ophthalmic artery, besides prolonged filling time of the retinal artery and vein, diminished erythrocyte deformability and increased platelet adhesion rate. The characteristic of ocular rheographic changes in POAG patients of controlled IOP suggest that the abnormal changes of hemorheology be responsible for the damage of visual function. The abnormal changes of plasma viscosity, blood apparent viscosity, blood viscoelasticity, hematocrit, mean red cell volume etc could be found in addition to the reduction of PO2, SO2% and trace elements (Cr, Zn, Mg, Fe) in patients with POAG. Computed multiply stepwise regression analysis and Bayes discrimination were made among the deteriorate rate of quantitative visual field and 28 factors from the combined investigation. Only the hemorrheological index could be introduced into the multiply regression equations. The more the damage of visual function in POAG patients, the more accurate the discriminatory effect. Based upon the results, and the reports of articles published as well as the search of 1982-1989 Compact Combridge MEDLINE Medical data base, the new clinical concept could be presented that POAG might belong to the scope of blood hyperviscosity syndromes. When IOP elevation and the decrease of ocular artery pressure existed, the damage of visual function in POAG patients should be deteriorated.
对青光眼视功能损害、血液流变学、眼血流图等相关多因素进行研究,并采用计算多因素逐步回归分析,结果表明眼压升高并非导致视力损害的唯一因素。原发性开角型青光眼(POAG)患者除视网膜动静脉充盈时间延长、红细胞变形能力降低和血小板黏附率增加外,还显示眼动脉舒张期灌注压明显降低。眼压得到控制的POAG患者眼血流图变化特征表明,血液流变学异常变化是视功能损害的原因。POAG患者除氧分压、血氧饱和度降低及微量元素(铬、锌、镁、铁)减少外,还可发现血浆黏度、血液表观黏度、血液黏弹性、血细胞比容、平均红细胞体积等异常变化。对定量视野恶化率与综合检查的28项因素进行计算多元逐步回归分析和贝叶斯判别。只有血液流变学指标可被引入多元回归方程。POAG患者视功能损害越严重,判别效果越准确。基于这些结果,以及已发表文章的报道和对1982 - 1989年康奈尔医学数据库的检索,可提出新的临床概念,即POAG可能属于高黏滞血症综合征范畴。当眼压升高和眼动脉压降低同时存在时,POAG患者的视功能损害会加重。