动脉内溶栓治疗视网膜中央动脉阻塞患者的临床特征及功能性视觉恢复单中心研究

doi:10.3969/j.issn.1673-5765.2024.03.004

摘要/Abstract

摘要： 目的探讨动脉内溶栓（intra-arterial thrombolysis，IAT）治疗视网膜中央动脉阻塞（central retinal artery occlusion，CRAO）患者的临床特征及功能性视觉恢复情况。
方法纳入2018年1月—2023年8月西北大学附属第一医院神经内科和神经眼科连续收治的非动脉炎性CRAO患者，根据入院后是否进行IAT治疗分为IAT组和非IAT组。功能性视觉定义为
视力≥20/100。比较分析两组患者的临床特征和不同时间段（入院、出院时和出院1个月时）功能性视觉恢复情况。
结果共纳入131例（131只眼）非动脉炎性CRAO患者，男性93例（71.0%），平均年龄为（61.6±12.6）岁，
其中IAT组57例（43.5%），非IAT组74例（56.5%）。与非IAT组患者相比，IAT组患者年龄更低[（58.4±12.5）岁 vs.（64.1±12.2）岁，P=0.011]、合并卒中病史者比例更低[10（17.5%）vs. 25（33.8%），
P=0.037]、发病至就诊时间更短[10.0（6.0～24.0）h vs. 55.0（20.2～162.0）h，P＜0.001]、醒后发病者比例更高[26（45.6%）vs. 15（20.3%），P=0.002]和患侧颈内动脉血管状态更佳（无狭窄∶轻度狭窄∶中-重度狭窄∶闭塞=41∶7∶7∶2 vs. 32∶11∶21∶10，P=0.006）。IAT组患者出院1个月时功能性视觉比例较非IAT组患者更高[25（43.9%）vs. 18（24.3%），P=0.018]，而入院和出院时差异无统计学意义
（P＞0.05）。多因素logistic回归分析显示，IAT组患者出院1个月时的功能性视觉较非IAT组患者显著改善（OR 3.24，95%CI 1.08～9.69，P=0.036）。IAT组患者术中发生眼动脉痉挛2例（3.5%）、穿刺部位皮肤出血2例（3.5%）和新发脑栓塞（均为无症状性栓塞）事件4例（7.0%）。
结论是否进行IAT治疗的CRAO患者部分临床特征存在差异，IAT治疗可显著提高CRAO患者出院1个月时的功能性视觉，且手术安全性较好。提示临床医师需重视CRAO患者的IAT治疗，以期改善患者的视觉功能。

文章导读： 本研究显示动脉内溶栓组视网膜中央动脉阻塞患者的部分临床特征与非动脉内溶栓组患者存在差异。动脉内溶栓可显著改善视网膜中央动脉阻塞患者出院1个月时的功能性视觉，且安全性较好。

关键词: 视网膜中央动脉阻塞; 动脉内溶栓; 临床特征; 功能性视觉

Abstract: Objective To investigate the clinical characteristics and functional visual recovery of patients with central retinal artery occlusion (CRAO) treated with intra-arterial thrombolysis (IAT).
Methods The non-arteriotic CRAO patients admitted to the Department of Neurology and Neuro-ophthalmology of the First Affiliated Hospital of Northwest University from January 2018 to August 2023 were included. They were divided into IAT group and non-IAT group according to whether IAT was performed after admission. Functional vision is defined as visual acuity≥20/100. The clinical features and functional visual recovery at different time periods (admission, discharge and 1 month after discharge) were compared and analyzed between the two groups.
Results A total of 131 patients (131 eyes) with non-arteriotic CRAO were included, including 93 males (71.0%) with a mean age of (61.6±12.6) years. There were 57 patients (43.5%) in IAT group and 74 patients (56.5%) in non-IAT group. Compared with patients in non-IAT group, patients in IAT group had younger age [(58.4±12.5) years vs. (64.1±12.2) years, P=0.011], lower proportion of stroke history [10 (17.5%) vs. 25 (33.8%), P=0.037], shorter time from onset to visit [10.0 (6.0-24.0) h vs. 55.0 (20.2-162.0) h, P<0.001], higher proportion of onset after awakening [26 (45.6%) vs. 15 (20.3%), P=0.002] and better internal carotid artery status on the affected side (none-stenosis∶mild stenosis∶moderate-severe stenosis∶occlusion=41∶7∶7∶2 vs. 32∶11∶21∶10, P=0.006). The proportion of functional vision at 1 month after discharge was higher in IAT group than that in non-IAT group
[25 (43.9%) vs. 18 (24.3%), P=0.018], but there was no statistically significant difference in other time periods (admission and discharge) (P>0.05). Multivariate logistic regression analysis showed that the functional vision of CRAO patients in the IAT group at 1 month after discharge was significantly improved compared with those in the non-IAT group (OR 3.24, 95%CI 1.08-9.69, P=0.036). In the IAT group, ophthalmic artery spasm occurred in 2 cases (3.5%), skin bleeding at the puncture site in 2 cases (3.5%), and new cerebral embolism (all asymptomatic embolism) occurred in 4 cases (7.0%).
Conclusions Some clinical features of CRAO patients who were treated with or without IAT were different. IAT can significantly improve the functional vision of CRAO patients at 1 month after discharge, and the surgical safety is good. This suggests that clinicians should pay more attention to IAT in CRAO patients in order to improve their visual function.

Key words: Central retinal artery occlusion; Intra-arterial thrombolysis; Clinical feature; Functional vision

中图分类号:

逯青丽, 刘仲仲, 刘彤, 刘佩, 张咪, 常乔乔, 刘燕, 孙超, 彭林娜, 刘国正, 蔺雪梅, 吴松笛. 动脉内溶栓治疗视网膜中央动脉阻塞患者的临床特征及功能性视觉恢复单中心研究[J]. 中国卒中杂志, 2024, 19(3): 273-279.

LU Qingli, LIU Zhongzhong, LIU Tong, LIU Pei, ZHANG Mi, CHANG Qiaoqiao, LIU Yan, SUN Chao, PENG Linna, LIU Guozheng, LIN Xuemei, WU Songdi. Clinical Features and Functional Visual Recovery of Patients with Central Retinal Artery Occlusion Treated with Intra-Arterial Thrombolysis: A Single-Center Study[J]. Chinese Journal of Stroke, 2024, 19(3): 273-279.

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