基于社区慢病档案筛查糖尿病视网膜病变结果的双向一致性分析  

The effectiveness of screening for diabetic retinopathy among diabetics： a community-based study in Nanchang

作　　者：肖国蓓 高扬[1] 黄国富[1] 金昱[1] 刘维锋[1] 赵雁之 石浔[1] 

机构地区：[1]南昌市眼科医院南昌大学第三附属医院眼科,330006

出　　处：《中华眼视光学与视觉科学杂志》2015年第10期590-593,共4页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：南昌市科技支撑计划（洪科发计字2013-203-1）

摘　　要：目的通过不同诊断者（初诊医师和盲诊医师）及不同诊断方式f免散瞳数码眼底彩色照相和眼底荧光素血管造影（FFA）1双向评估社区筛查糖尿病视网膜病变（DR）诊断结果的一致性，探讨和摸索社区筛查DR的最优方式。方法横断面研究。横向实验由2名眼底病专业医师分别对932张免散瞳眼底彩色照片（后文简称照片）进行视网膜病变程度诊断分级，评估初诊（筛查现场拍照后立即进行诊断分级）和盲诊（在完全不了解患者视敏度和眼部条件的情况下仅依据照片进行诊断分级）的诊断一致性；纵向实验由同一名眼底病专业医师分别对239张照片和239份FFA结果进行诊断分级．评估2种诊断方式的一致性。在诊断有或无DR的一致性方面，作为二分类数据，采用kappa检验进行评价；在DR不同分级诊断的一致性方面，作为多分类数据，采用Kendall检验进行评价。结果横向实验中，初诊和盲诊在诊断有或无DR方面的Kappa值均为0．473。两者的DR不同分级诊断Kendall值为0．530，具有中度一致性。无明显视网膜病变671眼（72．0％），有视网膜病变261眼（28．O％）。纵向实验中，照片和FFA在诊断有或无DR方面的kappa值均为0．694。两者的DR不同分级诊断Kendall值为0．721，具有显著一致性。无明显视网膜病变92眼（38．5％），有视网膜病变147眼（61．5％）。结论由2名眼底病专业医师分别采用初诊和盲诊的方法对免散瞳数码眼底彩色照片进行疾病程度诊断分级的筛查模式，可以作为社区糖尿病视网膜病变筛查的优化筛查诊断方式。Objective To explore the best screening model for diabetic retinopathy （DR） among diabetics in the community by bidirectional consistency analysis. Comparative analysis was carried out on the following parameters： diagnosis made by different diagnostician （on-site diagnosis maker versus clinical diagnosis maker）, as well as different diagnostic methods （nonmydriatic digital fundus photography （DFP） versus fundus fluorescein angiography （FFA）. Methods Cross-sectional study. Transverse trial consists of classification of DR with fundus photography by two ophthalmologists, one making an on-site diagnosis immediately after DFP and the other making an clinical diagnosis based only off the photograph at another given time. The level of consistency between them was evaluated statistically. While longitudinal trial was also performed to assess the consistency of classification of DR, but by different diagnostic mode （DFP versus FFA） with the one diagnostician. Kappa statistics was used to evaluate the consistency of the presence or absence of DR. And the consistency of the classification of DR was quantified using the Kendall con＇elation analysis for the disaggregated data. Results In the transverse trial, 932 photographs from 500 diabetics were included. The Kappavalue of the presence or absence of DR was 0.473, and the Kendall value of classification of DR was 0.530, with a moderate degree of consistency. Among the 932 eyes, 671 eyes were diagnosed with no clinically significant DR （72.0%）, while 26l eyes with DR （28.0%）. Tile longitudinal trial included 239 eyes form 122 diabetics. Analysis resuhed in a Kappa value was 0.694 and Kendall value was 0.721, with a high deg1~e of consistency. Among the 239 eyes, 92 eyes were diagnosed as be absent of DR （38.5%） and 147 eyes diagnosed as having DR （61.5%）. Conclusion The mode of classification of DR by DFP by two ophthalmologists, one making an on-site diagnosis while the other making a clinical diagnosis only using the fundus photo

关 键 词：糖尿病视网膜病变 社区卫生服务 免散瞳数码眼底彩色照相 荧光素血管造影术 

分 类 号：R587.2[医药卫生—内分泌]