COVID-19是视神经和视网膜急性血管疾病发展的新风险因素

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新冠状病毒感染（COVID-19）是一种病毒性呼吸道疾病，伴有系统性"内皮炎"。COVID-19患者常常表现出与高凝状态、纤维蛋白溶解度低、血管内血小板聚集增加有关的变化，以及血管壁的抗血栓能力下降和血管舒缩功能受损，这显著增加了血栓栓塞并发症的风险。目前正在积极研究COVID-19与视神经和视网膜的血管性和炎症性病变相关的致病因素。诱发眼部血管血流受损的原因之一可能是在感染过程的急性期观察到的灌注压下降。这既是由于其临床过程的特殊性，也是由于所采取的抢救措施的特殊性。作为感染后血管壁损伤的机制，其继发性自身免疫性炎症被认为是一个重要的因素。本出版物是第一个冠状病毒相关的缺血性神经炎的例子，它研究了这些疾病之间可能的致病关系。

作者简介

Vadim Turgel

Academican I.P. Pavlov First St. Petersburg State Medical University

Email: zanoza194@gmail.com
ORCID iD: 0000-0003-3049-1974

postgraduate student

俄罗斯联邦, 6-8 L’va Tolstogo str., Saint Petersburg, 197089

Vladimir A. Antonov

Academican I.P. Pavlov First St. Petersburg State Medical University

Email: antonov@alborada.fi
ORCID iD: 0000-0002-5823-8367

postgraduate student

俄罗斯联邦, 6-8 L’va Tolstogo str., Saint Petersburg, 197089

Svetlana N. Tultseva

Academican I.P. Pavlov First St. Petersburg State Medical University

Email: tultceva@yandex.ru
ORCID iD: 0000-0002-9423-6772
SPIN 代码: 3911-0704

MD, Dr. Sci. (Med.)

俄罗斯联邦, 6-8 L’va Tolstogo str., Saint Petersburg, 197089

Fedor E. Shadrichev

St. Petersburg Territorial Diabetology Center

Email: shadrichev_dr@mail.ru
ORCID iD: 0000-0002-7790-9242
SPIN 代码: 4465-8381

MD, Cand. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

Niurguyana N. Grigorieva

St. Petersburg Territorial Diabetology Center

编辑信件的主要联系方式.
Email: grinur@mail.ru
SPIN 代码: 7299-4748

MD, Cand. Sci. (Med.), ophthalmologist

俄罗斯联邦, Saint Petersburg

参考

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补充文件

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2. 图.1.一位患者在发病后第5天，双眼视盘的光学相干断层扫描数据。右眼视乳头旁视网膜神经纤维周围的厚度明显增加，视神经组织渗透到玻璃体中。左眼视盘的形态参数在年龄标准范围内 Fig. 1. OCT of both optic nerve heads, 5 days after first symptoms.There is a significant increase of the retinal nerve fiber layer’s thickness in the peripapillar area of the right eye, protruding of the optic nerve tissue into the vitreous. Morphometric indices of the optic nerve head of the left eye - within the expected range for age

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3. 图.2.患者发病后第5天的眼底照片。患者的右眼（a）和左眼（b）的眼底。两只眼睛都显示出非增殖性糖尿病视网膜病变：视网膜内出血，单个棉絮斑和固体渗出物。右眼的视盘水肿和苍白，并伴有出血。在左眼，沿鼻上方血管弓有一个被固体渗出物包围的大动脉瘤 Fig. 2. Fundus photo, 5 days after first symptoms. Right (а) and left (b) eye fundi status. In both eyes, there are signs of non-proliferative diabetic retinopathy: intraretinal hemorrhages, single cotton-wool spots and hard exudates. On the right eye, optic disc edema and paleness with a hemorrhage are present. On the left eye, along the upper nasal vascular arcade, there is a single macroaneurysm surrounded by hard exudates

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4. 图.3.双眼视盘的光学相干断层扫描数据，6个月后的检查。右眼视乳头旁视网膜神经纤维层明显变薄，陷凹直径与视盘直径之比增加到0.7。左眼视盘的形态参数符合年龄标准，与第一次检查相比没有动态变化 Fig. 3. OCT of both optic nerve heads, 6 months after the first examination. The neuroretinal rim thickness and that of the retinal nerve fiber layer in the parapapillar area of the right eye are significantly thinned, cup-to-disc ratio is increased up to 0.7. Morphometric indices of the optic nerve head of the left eye - within the expected range for age, without any dynamic changes when compared to the first examination

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5. 图.4.第一次检查后6个月患者的眼底照片。患者的右 眼（a）和左眼（b）的眼底状态。右眼的视网膜变化和视盘萎缩变化部分消退。二阶和三阶动脉血管上有明显的血管硬化和铜丝状。在左眼，大动脉瘤消退，后极部和从下方沿周围视网膜出血增加 Fig. 4. Fundus photo, 6 months after the first examination. Right (а) and left (b) eye fundi status. On the right eye, a partial regression of retinal changes, atrophic optic nerve head changes may be noted. Significant angiosclerosis, “copper wire” sign on the 2nd and 3rd range arterioles are present. On the left eye, there is a macroaneurism regression, more retinal hemorrhages in the posterior pole and in the lower periphery

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6. 图.5.第一次检查后6个月患者视盘的光学相干断层扫描血管成像数据。右眼（a）和左眼（b）的视盘灌注值。平均灌注密度分别为32.9％和40.5％ Fig. 5. AngioOCT of the optic nerve head, 6 months after the first examination. Optic nerve head perfusion indices of the right (а) and left (b) eye. Mean values of perfusion density are 32.9 and 40.5 %, respectively

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7. 图.6.第一次检查后6个月患者的光学相干断层扫描血管成像数据。右眼（a）和左眼（b）黄斑区浅层血管丛的血管密度值（mm/mm2），右眼（c）和左眼（d）视乳头旁丛的血管密度值。患侧所有测量区域的血管密度都有下降 Fig. 6. AngioOCT of the patient, 6 months after the first examination. Vascular density indices (mm/mm2) of the superficial vascular plexus in the macular area of the right (а) and the left (b) eye, and vascular density indices of the parapapillary plexus of the right (c) and the left (d) eye. A decrease in vascular density in all measurement areas on the involved side is noted

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版权所有 © Turgel V., Antonov V., Tultseva S., Shadrichev F., Grigorieva N., 2021

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