原发性闭角型青光眼患者外周血血小板参数与视网膜结构损害的相关性研究

Correlation Study between Peripheral Platelet Parameters and Retinal Structural Damage in Patients with Primary Angle Closure Glaucoma

摘要: 目的：分析原发性闭角型青光眼(primary angle closure glaucoma, PACG)患者外周血血小板参数与视网膜结构损害的相关性，探讨血小板在PACG中的变化及意义。方法：本回顾性研究纳入了2018年1月至2024年1月在青岛大学附属医院眼科住院并确诊为PACG的患者143人(共143眼)，根据视野的平均缺损(mean deviation, MD)进一步分为早期、中期和晚期。应用CIRRUS HD-OCT对所有受试者进行扫描，并计算视盘周围视网膜神经纤维层(retinal nerve fiber layer, RNFL)厚度、黄斑区神经节细胞–内丛状层(ganglion cell-inner plexiform layer, GC-IPL)厚度，以及视盘结构参数。采用全自动血细胞分析仪检测受试者的外周血血小板参数。Pearson相关性分析用于确定外周血血小板参数与视网膜结构参数的相关性。结果：PACG患者的血小板体积分布宽度(platelet volume distribution width, PDW)与视盘周围RNFL平均厚度(r = −0.174, P = 0.038)间存在显著负相关，与平均杯盘比(r = 0.248, P = 0.003)、垂直杯盘比(r = 0.234, P = 0.005)间存在显著正相关，与黄斑区GC-IPL平均厚度(r = −0.134, P = 0.110)存在负相关趋势，但无统计学意义。早期PACG患者的PDW与黄斑区GC-IPL的平均、上鼻、下鼻、下方、下颞厚度间存在显著负相关，与视盘周围RNFL的平均、下方厚度间存在显著负相关，与平均杯盘比、垂直杯盘比、杯容积之间存在显著正相关；中期PACG患者的PDW与各OCT参数间未发现显著相关性；晚期PACG患者的PDW与黄斑区GC-IPL的平均、下鼻、下方、下颞、上颞厚度间存在显著负相关，与视盘周围RNFL的平均、上方、颞侧厚度间存在显著负相关，与平均杯盘比、垂直杯盘比之间存在显著正相关。多元线性回归分析显示，在调整了性别、年龄、身体质量指数、高血压、糖尿病后，早期和晚期PACG的PDW水平仍与视盘周围RNFL平均厚度、黄斑区GC-IPL平均厚度、平均杯盘比和垂直杯盘比之间存在显著关联。结论：PACG患者的外周血PDW与视网膜结构损害密切相关，提示血小板活化与青光眼性视神经病变有关。

Abstract: Purpose: To analyze the correlation between peripheral platelet parameters and retinal structural damage in patients with primary angle closure glaucoma (PACG), and to explore the significance of platelet alteration in patients with PACG. Methods: This retrospective study enrolled 143 patients diagnosed with PACG (143 eyes) in the Department of Ophthalmology, the Affiliated Hospital of Qingdao University, from January 2018 to January 2024. They were further divided into early, moderate and severe groups according to the visual field mean deviation (MD). CIRRUS HD-OCT was used to scan all participants, and the thickness of peripapillary retinal nerve fiber layer (RNFL), the thickness of macular ganglion cell-inner plexiform layer (GC-IPL), and the structural parameters of the optic disc in each eye were calculated. An automated hematology analyzer was used to analyze the peripheral platelet parameters of each participant. Pearson correlation analysis was used to determine the correlation between peripheral platelet parameters and retinal structural parameters. Results: In PACG patients, the platelet volume distribution width (PDW) had significantly negative correlation with peripapillary RNFL thickness in average (r = −0.174, P = 0.038), significantly positive correlation with average and vertical cup-to-disc ratio (r = 0.248, P = 0.003 and r = 0.234, P = 0.005, respectively), and had the tendency of negative correlation with macular GC-IPL thickness in average (r = −0.134, P = 0.110) but no statistical significance. In early PACG patients, the PDW had significantly negative correlation with macular GC-IPL thickness in average and superior nasal, inferior nasal, inferior, inferior temporal regions, had significantly negative correlation with peripapillary RNFL thickness in average and inferior quadrant, and had significantly positive correlation with cup-to-disc ratio (average and vertical) and cup volume; In moderate PACG patients, there was no significant correlation between PDW and OCT parameters; In severe PACG patients, the PDW had significantly negative correlation with macular GC-IPL thickness in average and inferior nasal, inferior, inferior temporal, superior temporal regions, had significantly negative correlation with peripapillary RNFL thickness in average and superior, temporal quadrant, and had significantly positive correlation with cup-to-disc ratio (average and vertical). Multiple linear regression analysis showed significant associations between PDW and peripapillary RNFL thickness in average, macular GC-IPL thickness in average, cup-to-disc ratio (average and vertical) in early and severe PACG, after adjusting for age, gender, body mass index, hypertension, and diabetes. Conclusion: There is a close correlation between peripheral PDW and retinal structural damage in PACG patients, suggesting that platelet activation may contribute to glaucomatous optic neuropathy.