8.4体位
Evans等[32]对开角型青光眼患者的体位影响研究,发现从直立到仰卧位的改变可以引起健康人OA的EDV升高,OA和CRA的RI下降;青光眼患者OA的EDV和RI出现类似改变,但是CRA的各项指标变化不明显。Galambos等[33]对正常眼压性青光眼和原发性开角型青光眼的体位影响研究,发现从直立到仰卧位后两组SPCA的PSV和EDV均显著升高;NTG组SPCA的RI显著降低;两组及正常对照组OA和CRA的EDV均升高,RI则下降;NTG组CRA的PSV显著升高。以上说明NTG和POAG患者体位改变后血流代偿不充分,调节机制受损。
9青光眼机制研究 除了以上应用范围外,CDI作为一种测量球后血流动力学的手段被广泛应用于青光眼的机制研究中。Cellini等[34]发现内皮素1(Endothelin1,ET1)在低眼压性青光眼(lowtension, LTG)中表达明显高于正常对照,而LTG的血流动力学指标均差于正常对照(OA和睫状后动脉更低的PSV和更高的RI),因此分析LTG的视野缺损可能归因于内皮自身调节分泌的改变,特别是作用于睫状后动脉影响了视乳头的血供而导致不可逆的功能损害。Harris等[35]针对夜间血压降低对青光眼患者眼部血流灌注的影响作了CDI研究,发现在青光眼非进展期,并没有证据说明夜间血压下降对头部及球后血流动力学产生异常影响;夜间血压下降时青光眼患者和正常对照组的睫状后动脉血流速度相似。Galassi等[36]研究NO对正常眼压性青光眼的影响,发现实验组眼动脉收缩期和舒张期的血流速度均发生改变,cGMP水平低于对照组,说明NO调节过程紊乱可能影响视乳头血供和房水流出。Niwa等[37]研究发现吸入CO2能增加开角型青光眼患者远端动脉的血流速度,而不影响近端血管,从而改善眼眶血流动力学。 CDI因为具有无创、重复性好、一致性好等优点[38],因此在医学各领域应用广泛,相信随着CDI临床和科研的广泛应用和开展, 经验的逐步积累以及仪器的进一步改进, CDI 技术会有更广阔的应用前景。
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