Coats病的超声影像特征及血流动力学分析

目的 探讨Coats病的超声影像学及血流动力学特征.方法 前瞻性、自身对照研究.对18例(18只眼)临床确诊的Coats病患者,采用A超测量眼轴长度;彩色多普勒超声(CDFI)观察眼部病灶的形态改变,同时与彩色眼底图像进行比较.CDFI检测患者眼动脉(OA)、视网膜中央动脉(CRA)及睫状后动脉(PCA)的收缩期峰值血流速度(PSV)和舒张末期血流速度(EDV)、单位时间内平均最大血流速度(TAMX)、搏动指数(PI)及阻力指数(RI).以患者的对侧健眼作为对照组.Coats病组与对照组的眼轴长度和血流参数比较,采用两样本均数比较t检验.结果 Coats病组眼轴长度(21.36±1.19)mm,较对照组(22.92±1.09)mm缩短,差异有统计学意义(t=3.617,P<0.05).Coats病组超声影像改变包括视网膜脱离、视网膜囊肿、视网膜下机化形成等,少数患眼有视网膜前增殖膜,玻璃体一般无混浊,偶见病灶内"钙化斑"及眼球壁骨化现象.Coats病组血流频谱未见明显异常,其CRA的PSV(6.96±1.21)cm/s和EDV(1.99±0.36)cm/s,较对照组PSV(8.30±1.46)cm/s和EDV(2.48±0.47)cm/s下降,差异有统计学意义(t=2.995,3.476,P<0.05),其他血流参数无明显异常.结论 Coats病为先天性疾病,可能影响患者眼球发育.超声检查有助于Coats病的诊断与鉴别诊断.Coats病患者可能存在视网膜中央动脉灌注不良,其血流动力学改变尚需进一步观察研究.

Analysis of changes of ultrasonic image and hematodynamics of retrobulbar blood vessels in Coats disease

Objective To analyze the changes of color Doppler flow imaging (CDFI) and hematodynamics of retrobulbar blood vessels in Coats disease. Methods It was a prospective and selfcomparative study in which 18 cases ( 18 eyes) were included. Axial eye length was measured with A scan.Routine CDFI was performed in all cases. We examined ophthalmic arteries (OA), central retinal arteries (CRA) and posterior ciliary arteries (PCA) by CDFI, and recorded the peak systolic velocities (PSV),end diastolic velocities ( EDV), time averaged maximum velocities ( TAMX), pulsatility indexies (PI) and resistance indexes (RI) in all cases. Each hemodynamic parameter in the affected eye(21.36 ± 1.19)mm was compared with those in the contralateral normal eye (controls). T-test was used for the estimation of significance of the difference between the diseased and normal eyes. Results The axial length in diseased eyes was significantly shorter than that of the controls ( 22. 92 ± 1.09 ) mm ( t = 3. 617, P < 0.05 ). The changes of CDFI in diseased eyes included retinal detachment, retinal cyst, subretinal organization, etc.Vitreoretinal traction, intraocular ossification and calcification were uncommon. The PSV (6. 96 ± 1.21 ) cm/s and EDV( 1.99 ± 0. 36)cm/s in the diseased eyes were significantly lower than the PSV (8. 30 ± 1.46)cm/s and EDV (2. 48 ± 0. 47) cm/s in the control eyes ( t = 2. 995,3. 476; P < 0. 05 ). No significance difference was present in other hemodynamic parameters between diseased and normal eyes. Conclusions Coats disease is a congenital disease that may influence the development of the eye. The ultrasonography is helpful for the diagnosis and differential diagnosis in Coats disease. Low perfusion of the central optic artery might exist in Coats disease. The hematodynamics changes in Coats disease require further studies.