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Резюме Резюме Summary Рецензент: д.мед.н., проф. А.М. Петруня УДК 617.731-002-005:616-099-085 1Харківська медична академія післядипломної освіти Харьковская медицинская академия последипломного образования 61176, г. Харьков, ул.Корчагинцев, 58 Kharkov medical academy of Postgraduate Education 61176, Kharkov, 58 str.Korchahyntsev 2КЗ Сумська обласна клінічна лікарня КУ Сумская областная клиническая больница MI Sumy regional hospital
daria_petrushenko@ukr.net
Introduction. At chronic alcohol intoxication (CAI) the system haemodynamics disturbances as well as increase in permeability of histohaematic barriers develop [6]. The eye is involved in the pathological process simultaneously with other organs and systems. Solitary investigations devoted to haemodynamics disturbances at CAI does not illuminate the entire spectrum of these disorders [4,5]. Purpose - Dopplerography study of haemodynamics disturbances in the eye and orbit arteries at CAI. Material and methods 81 male patient (162 eyes) with alcoholic toxic neuroretinopathy (ATN), smokers, in-patients of the narcological department of Sumy Regional Narcological Health Center with the diagnose of “Mental and behavioral disorders due to use of alcohol” aged from 30 to 60 years with the history of chronic alcohol abuse from 10 to 20 years were examined. The patients were divided into groups according to pathogenetic classification of the stages of optic nerve swelling of any origin by Zhaboyedov G. D., Skrypnik R. L. (1992) [1] based on the ophthalmoscopic image of the eye fundus: A – the stage of hyperemia, B – the stage of swelling, C – the stage of dystrophy. In the same way as it was done by Zhaboyedov G. D., Skrypnik R. L. in point of diabetic optic neuropathy the pathogenetic stages of ischemia and glial atrophy in ATN were joined into the stage of dystrophy. There were 32 men (63 eyes, 38,41%) at the stage of hyperemia (the group A), 33 men (65 eyes, 39,63%) at the stage of swelling (the group B), 17 men (34 eyes, 20,73%) at the stage of dystrophy (the group C). The control group included 30 almost healthy male volunteers (60 eyes), smokers of the same age range. According to the one-way ANOVA all the groups did not vary in age. The visual acuity and colour vision were examined. The biomicroophthalmoscopy using the Goldmann lense was held. The colour vision was examined by Rabkin Y. B. method. In order to estimate the colour vision the index of the colour vision was proposed. The index is a percentage of the number of tables which the patient reads to the total number of the main tables without demonstrational ones which is 25. The investigation of the eye and orbit arteries blood flow was held by transorbital method by means of an ultrasound diagnostic device Toshiba “Aplio” (Japan). Colour and power Doppler imaging were used. The arteries were identified according to the anatomical localization and blood flow direction. The following haemodynamics parameters were measured: Vmax – maximal systolic flow velocity; Vmed – mean flow velocity; Vmin – the end-diastolic (minimal) velocity; PI – pulsatility index; RI – resistivity index. The orbital artery (OA), the central retinal artery (CRA), the posterior short (PSCA) and long ciliary arteries (PLCA) were examined [2,3,7,8]. The statistical analysis was performed by means of the program “SPSS 15.0 for Windows”. Results and discussion The visual acuity at the stage of hyperemia was 0,88±0,01; at the stage of swelling it was significantly lower than at the stage of hyperemia (0,24±0,02); at the stage of dystrophy the visual acuity was 0,17±0,02, which tended to be lower than at the stage of swelling, but the difference was not statistically significant. The visual acuity in the control group was 0,99±0,04. The index of colour vision was reliably lower at every next stage of ATN: at the stage of hyperemia it was 85,14±1,0%, at the stage of swelling – 45,66±1,31%; at the stage of dystrophy –37,18±1,72%. In the control group the index of colour vision was 99,47±0,18%. The examined indexes of visual functions were significantly lower at all stages of ATN than in the control group. At the stage of hyperemia ATN (the group A) blood flow velocities in all examined arteries were significantly lower (Р<0,05) than in the control group (Tab. 1). In OA all measured blood flow velocities were equally lower than in the control group without significant changes in РІ and RI. In PSCA and PLCA the decrease in Vmin was more significant ( 2,99 and 1,59 times lower than in the control group respectively) with moderate reduction of Vmax (1,57 and 1,26 times lower than in the control group respectively) and Vmed (1,64 and 1,57 times lower than in the control group respectively). In CRA just Vmin was 2,13 times significantly lower than in the control group. Consequently the pulsatility index (PI) increased (in the CRA PI was 1,22 times higher than in the control group, in the PSCA – 1,30 times higher, in the PLCA – 1,37 times higher), which might be a sign of elasticity reduction of the arteries vascular wall due to the processes of sclerosis in consequence of the toxical injury at CAI. Besides the significant increase in the RI was obtained: in the CRA – the RI was 1,24 times higher than in the control group, in the PSCA – 1,24 times higher, in the PLCA – 1,11 times higher. It may indicate the initial occlusion of the small branches of the arteries. At the stage of swelling ATN (the group B) blood flow velocities in the OA tended to further decrease (Tab. 1), but just Vmin was 1,57 times significantly lower than at the stage of hyperemia and 2,03 times lower than in the control group. RI was reliably higher than in the control group. In the CRA the significant changes in the spectral velocity waveform were observed (Tab. 1, Pic. 1, Pic. 2). Though Vmax was high enough (10,73±0,11 sm/s, which was 1,54 times lower than in the control group) the pulsation wave faded away soon, and Vmin reached 0,51±0,03 sm/s, which was 10,25 times lower than in the control group, besides in 13,8% cases Vmin equaled zero. Thereafter the decrease in Vmed (it was 1,64 times lower than in the control group) and the increase in РІ (it was 1,49 times higher than in the control group and 1,16 times higher than in the group А) were observed. Thus the blood flow had a character of “splashes”. Besides the significant increase of the RI was observed (it was 1,4 times higher than in the control group and 1,13 times higher than in the group А), which сould be connected with progression of the CRA brunches occlusion as compared with the stage of hyperemia. The changes in the spectral velocity waveform were similar to those at the ischemic optic neuroretinopathy [6] but differed from the last ones by higher Vmax and Vmed and a bit lower Vmin, which might be caused by obstacles of the blood flow in the lumen of smaller branches of the CRA at ATN [3,7,8]. The haemodynamics indexes of PSCA and PLCA did not show significant difference between groups A and B (Tab. 1) though RI tended to increase. At the stage of dystrophy ATN (the group С) in the ОА Vmed was significantly lower than in the group В with consequent 44,35% increase in РІ (Tab. 1). The haemodynamics indexes of CRA did not show significant difference between groups C and B. In PSCA Vmax was significantly lower than in the group В (11,16±0,25 sm/s vs 14,53±0,18 sm/s in the group B) which caused the decrease in PI. In the PLCA the PI was significantly 5,96% higher than in the group B due to lower Vmed. Thus compared to the stage of swelling further deterioration of haemodynamics indexes of the eye and orbit arteries blood flow with significant decrease in blood flow velocities and increase in PI in OA and PLCA due to sclerosis processes in the vascular wall were observed. Conclusions
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