干性老年黄斑变性的临床和眼功能状况变化取决于 AREDS 阶段

D. A. Teuvazhukova, L. Arutyunyan, T. G. Tlupova
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The complex research involved visual acuity measurement, including the assessment of near vision in various illumination conditions according to the authors’ methodology, fluorescein angiography, refractometry, tonometry, optical coherence tomography (OCT), ultrasound duplex scanning of the eye; and an immunological study aimed at determining interleukins and interferons in blood serum.Results. Visual acuity was found to depend on test illumination in healthy subjects and to substantially drop at all illumination levels in AMD, especially in the 3rd stage. With the development of AMD, the activity of the immune response was recorded.The patients of groups 1 and 2 showed an increase in the inflammatory response and a depression of the anti-inflammatory response. In group 1, an increase was recorded in IL-I by 23.5% (p < 0.05), in IL5 by 25.4% (p < 0.05), and in IL8 by 19.9% (p < 0.05). In group 2, the value of these parameters exceeded the norm by 32.1, 39.5 and 25.4% (p < 0.05), respectively. The parameters of anti-inflammatory immunity (IL10 and TGF l) were lower than the reference level by 18.3 and 24.6% (p < 0.05) of patients of group 1 and by 24.3 and 30.75 (p < 0.05) of group 2. It was established that the degree of imbalance of the immune system is associated with the stage of AREDS. In group 2 patients with AREDS 3, the content of pro-inflammatory interleukins exceeded those of group 1: IL-I by 12.5% (p < 0.05), IL5 by 11.9% (p < 0.05), IL8 by 11, 2% (p < 0.05). IL10 and TGF l in group 2 were lower than in group 1 by 10.2 and 11.8% (p < 0.05).Conclusion. Near visual acuity measurement depending on test illumination may be used as a sensitive diagnostic test in AMD in patients. 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引用次数: 0

摘要

目的:根据AREDS分类阶段,评估老年性黄斑变性患者眼睛的功能状态。对 60 名年龄为 55.1 ± 4.2 岁的干性 AMD 患者(120 只眼睛)进行了临床研究,其中包括 30 名年龄为 52.7 ± 3.9 岁的 AREDS 2 类患者(AMD 初期阶段,第 1 组)和 30 名年龄为 57.9 ± 7.8 岁的 AREDS 3 类患者(AMD 中期阶段,第 2 组)(60 只眼睛)。这项复杂的研究涉及视力测量,包括根据作者的方法评估各种照明条件下的近视力、荧光素血管造影术、屈光度计、眼压计、光学相干断层扫描(OCT)、眼部超声双工扫描;以及旨在确定血清中白细胞介素和干扰素的免疫学研究。结果发现,健康人的视力取决于测试照明度,而老年性黄斑变性患者的视力在所有照明度下都会大幅下降,尤其是在第三阶段。随着老年性黄斑变性的发展,免疫反应的活性也被记录下来。第 1 组和第 2 组患者的炎症反应增强,而抗炎反应减弱。在第 1 组中,IL-I 增加了 23.5%(p < 0.05),IL5 增加了 25.4%(p < 0.05),IL8 增加了 19.9%(p < 0.05)。在第 2 组中,这些参数值分别超出标准值 32.1%、39.5% 和 25.4% (p < 0.05)。在抗炎免疫参数(IL10 和 TGF l)方面,第 1 组患者分别有 18.3% 和 24.6% 低于参考水平(P < 0.05),第 2 组患者分别有 24.3% 和 30.75% 低于参考水平(P < 0.05)。在第 2 组 AREDS 3 患者中,促炎性白细胞介素的含量超过了第 1 组:IL-I 增加了 12.5%(p < 0.05),IL5 增加了 11.9%(p < 0.05),IL8 增加了 11.2%(p < 0.05)。第 2 组的 IL10 和 TGF l 比第 1 组低 10.2%和 11.8%(P < 0.05)。根据测试照明度测量近视力可作为AMD患者的敏感诊断测试。在老年性黄斑变性的早期阶段,可以观察到免疫防御功能紊乱,表现为促炎谱的激活和抗炎成分的抑制,以及微循环的变化。 眼部的自律性变化出现在疾病的早期阶段,并随着临床症状的恶化而发展。AREDS 第 3 阶段患者的变化最大。
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Clinical and functional eye condition changes in the dry form of age macular degeneration depending on the AREDS stage
Purpose: to assess the functional state of the eyes in age-related macular degeneration depending on the AREDS classification stage.Material and methods. A clinical study of 60 patients (120 eyes) with the dry AMD form, aged 55.1 ± 4.2 years, involved 30 patients (60 eyes) aged 52.7 ± 3.9 years with AREDS 2 category (initial AMD stage, group1) and 30 patients (60 eyes) aged 57.9 ± 7.8 years with AREDS 3 category (intermediate AMD stage, group 2). The complex research involved visual acuity measurement, including the assessment of near vision in various illumination conditions according to the authors’ methodology, fluorescein angiography, refractometry, tonometry, optical coherence tomography (OCT), ultrasound duplex scanning of the eye; and an immunological study aimed at determining interleukins and interferons in blood serum.Results. Visual acuity was found to depend on test illumination in healthy subjects and to substantially drop at all illumination levels in AMD, especially in the 3rd stage. With the development of AMD, the activity of the immune response was recorded.The patients of groups 1 and 2 showed an increase in the inflammatory response and a depression of the anti-inflammatory response. In group 1, an increase was recorded in IL-I by 23.5% (p < 0.05), in IL5 by 25.4% (p < 0.05), and in IL8 by 19.9% (p < 0.05). In group 2, the value of these parameters exceeded the norm by 32.1, 39.5 and 25.4% (p < 0.05), respectively. The parameters of anti-inflammatory immunity (IL10 and TGF l) were lower than the reference level by 18.3 and 24.6% (p < 0.05) of patients of group 1 and by 24.3 and 30.75 (p < 0.05) of group 2. It was established that the degree of imbalance of the immune system is associated with the stage of AREDS. In group 2 patients with AREDS 3, the content of pro-inflammatory interleukins exceeded those of group 1: IL-I by 12.5% (p < 0.05), IL5 by 11.9% (p < 0.05), IL8 by 11, 2% (p < 0.05). IL10 and TGF l in group 2 were lower than in group 1 by 10.2 and 11.8% (p < 0.05).Conclusion. Near visual acuity measurement depending on test illumination may be used as a sensitive diagnostic test in AMD in patients. At an early stage of AMD development, a disorder in the immune defense is observed, taking the form of activation of the pro-inflammatory spectrum and depression of the anti-inflammatory component, as well as microcirculatory changes Homeostatic changes of the eye appear at an early stage of the disease and are progressing as the clinical picture is deteriorating. The changes are the greatest at patients with stage 3 of AREDS.
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