频域光学相干断层成像在原发性开角型青光眼诊断中的应用  

Application of the frequency-domain optical coherence tomography database of normal humans in the diagnosis of primary open-angle glaucoma

作　　者：郑亚洁[1] 潘英姿[1] 

机构地区：[1]北京大学第一医院眼科,100034

出　　处：《中华眼视光学与视觉科学杂志》2015年第9期538-544,共7页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的 利用频域光学相干断层成像（FD-OCT）的种族特异性正常人数据库,建立简便实用的原发性开角型青光眼（POAG）的诊断模型.方法 横断面研究.对133例（133眼）正常人,99例（99眼）早期POAG患者行RTVue-100 FD-OCT的视神经乳头（ONH）、视网膜神经纤维层3.45 （RNFL3.45）、节细胞复合体（GCC）三项扫描.用扫描参数建立＂诊断模型＂.受检者操作特征曲线（ROC）及曲线下面积（AROC）用来反映FD-OCT的各项参数得分鉴别早期POAG和正常眼的能力.运用logistic回归模型进行参数的联合,建立早期POAG的诊断模型.结果 ①正常人和早期POAG患者2组间的所有ONH、RNFL3.45和GCC扫描单参数的分级评分差异均有统计学意义（P＜0.05）.②最佳单一参数为ONH扫描的神经纤维层总体平均厚度（R-A） （AROC=0.912）.③＂诊断模型＂的AROC大于最佳单一参数,差异有统计学意义.③经验证,ONH＂诊断模型＂的AROC为0.987,RNFL3.45＂诊断模型＂的AROC为0.959.结论 运用FD-OCT的种族特异性正常人数据库可建立评分系统和＂诊断模型＂,与单参数比较,多参数模型提高了早期POAG的诊断效能,且较简便,便于临床应用。Objective To build a practical and convenient diagnostic model of primary open-angle glaucoma （POAG） using the frequency-domain optical coherence tomography （FD-OCT） ethnic-specific database of normal humans for clinical application.Methods In a cross-sectional observational study, 133 eyes from 133 healthy subjects and 99 eyes from 99 early POAG patients were included in the study.MM 6/Radial slicer, optic nerve head （ONH）, retinal nerve fiber layer3.45 （RNFL 3.45） and ganglion cell complex （GCC） scans were measured in each subject with an RTVue-100 FD-OCT.Then, these parameters were used to establish the ＂diagnostic models＂.Receiver operating characteristic （ROC） curves and the area under the receiver operating characteristic curve （AROC） were used to reflect the capability of scores for each parameter of the FD-OCT in order to distinguish eyes in early-stage POAG from normal eyes.A combination of parameters was used with logistic regression to establish ＂diagnostic models＂ for early POAG.Results ①Significant differences were observed for all grading scores of ONH, RNFL3.45 and GCC scanning parameters between normal and early POAG groups （P〈0.05）.②The best single parameter for ONH scanning was the RNFL average （R-A） （AROC, 0.912）.③The AROCs of the ＂diagnosis model＂ were greater than the best single parameter.Their AROCs had significant differences.④We validated these models.The AROC of the ＂ diagnosis model＂ in ONH scanning was 0.987 and was 0.959 for RNFL3.45 scanning.Conclusion A multi-parameter ＂diagnosis model＂ using FD-OCT parameters and grading based on an ethnic-specific database of normal humans can improve the ability to diagnose early POAG.It may be convenient for clinical application.

关 键 词：体层摄影术 光学相干 种族特异性正常人数据库 青光眼 开角型 诊断模型 

分 类 号：R775[医药卫生—眼科]