정상 안압 녹내장 환자에서 24시간활동혈압 측정: 망막혈관너비 및 시야결손 진행과의 연관성
24-hour Ambulatory Blood Pressure in Normal Tension Glaucoma: Associations with Retinal Vessel Diameter and Visual Field Defect Progression
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목적: 정상 안압 녹내장 환자에서 24시간활동혈압을 측정하여 이와 시신경유두 주위 망막혈관너비 및 시야결손 진행과의 연관성을알아보고자 하였다. 대상과 방법: 24시간활동혈압 검사에서 야간 혈압 저하가 10% 미만인 경우를 야간 혈압 저하가 없는 군(non-dipper), 10% 이상인 경우를 야간 혈압 저하군(dipper)으로 정의하였고, 이를 안저 촬영에서 측정한 망막혈관너비와 시야검사의 mean deviation (MD)값, Glaucoma Progression Analysis (GPA)를 통해 확인한 시야결손의 진행 정도와 비교하였다. 결과: 망막 동맥 너비는 야간 혈압 저하가 없는 군에서 7.99 ± 0.82 μm로 야간 혈압 저하군의 동맥 7.33 ± 0.79 μm와 유의한 차이를 보였으나(p=0.015), 망막 정맥 너비는 야간 혈압 저하가 없는 군에서 9.65 ± 1.35 μm, 야간 혈압 저하군에서 10.27 ± 1.14 μm로 두 군 간의 유의한 차이는 보이지 않았다(p=0.131). 시야검사의 MD값은 야간 혈압 저하가 없는 군에서 초기 시야검사 -3.91 ± 2.39 dB, 2년 후 시야검사 -5.05 ± 3.26 dB로 야간 혈압 저하군에서 초기 시야검사 -1.65 ± 1.17 dB, 2년 후 시야검사 -2.53 ± 1.85 dB과 유의한 차이를 보였다(각각 p=0.006, p=0.030). 그러나 2년 후, 4년 후 GPA에서 야간 혈압 저하와 시야결손의 진행이 유의한 상관관계를 보이지 않았다(p=0.658). 결론: 야간 혈압 저하 유무는 망막 동맥 너비, MD값의 변화와 유의한 상관관계를 보여, 안저 사진과 같은 비침습적 검사로 야간 혈압저하와 같은 혈역학적 요인을 예측할 수 있음을 시사한다.
Abstract
Purpose: To investigate the correlation between 24-hour ambulatory blood pressure (BP) monitoring and peripapillary retinal vessel width and visual field (VF) defect progression in normal tension glaucoma (NTG) patients. Methods: All patients were classified by 24-hour ambulatory BP monitoring as non-dipper (nocturnal dip < 10%) and dipper (nocturnal dip ≥ 10%) group. Vessel diameter, mean deviation (MD) value by VF test and VF progression from Glaucoma Progression Analysis (GPA) were compared among non-dipper and dipper groups. Results: Retinal arterial diameter was wider in the non-dipper group compared to the dipper group (p = 0.015), while retinal venous diameter had no significant relationship between the two groups (p = 0.131). The MD value at baseline and 2 years after was worse in the non-dipper group than the dipper group, respectively (p = 0.006, p = 0.030). But, there was no significant relationship between nocturnal dip and GPA progression (p = 0.658). Conclusions: There was a statistically significant correlation between nocturnal dips and retinal arterial diameter and MD values. These results suggest that non-invasive fundus photography can predict hemodynamic features like nocturnal dip.
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