单张及多张眼底像检测糖尿病视网膜病变及其分级的价值  

Comparison of value of single-field and multiple-field fundus photography for grading diabetic retinopathy

作　　者：马英楠[1] 徐捷[1] 毛羽[1] 肖媛媛[1] 王爽[1] 李毅斌[1] 徐亮[1] 李建军[1] 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科研究所眼科学与视觉科学北京市重点实验室,100005

出　　处：《眼科》2016年第3期181-185,共5页Ophthalmology in China

基　　金：国家科技支撑计划课题(2013BAH19F04);北京市眼科研究所重点学科引领计划资助项目(201504)

摘　　要：目的探讨单张眼底像及多张眼底像判定糖尿病视网膜病变(DR)评级与荧光素眼底血管造影(FFA)的一致性。设计诊断试验。研究对象北京同仁医院眼科门诊18岁以上的糖尿病患者85例(162眼)。方法所有受试者进行FFA检查。择日进行非散瞳单张、散瞳两张、九张眼底照相。由两名医师按双盲原则采用DR国际分类法阅片判定有无DR并进行分级。两名医师的结果一致性以及FFA分级结果及不同视野眼底像分级的一致性均采用Kappa检验。主要指标Kappa值、敏感度、特异度。结果两位医师对单张、两张、九张眼底像DR分级比较判读结果的Kappa值分别为0.58、0.79、0.79。单张、两张、九张眼底像检测有无DR的敏感度分别为95.7%、98.6、100%,特异度均为100%。单张、两张、九张眼底像检测有无重度非增生性DR(NPDR)以上的DR灵敏度分别为57.9%、60.5%、71.1%,特异度均为100%。结论单张眼底像检测有无DR的敏感度高达95%以上,单张眼底像对近2/3的重度NPDR以上的DR可进行准确分级。Objective To compare the sensitivity and specificity of single-field fundus photography and multiple-field fundus photography with FFA in grading diabetic retinopathy. Design Diagnostic test. Participants Eighty-five cases（162 eyes） with diabetes over 18 years old in Department of Ophthalmology of Beijing Tongren Hospital were selected. Methods Nonmydriatic single-field digital fundus photography, mydriatic two-field fundus photography, nine-field fundus photography and FFA were performed in all subjects.Grading of diabetic retinopathy was carried out by two ophthalmologists according to diabetic retinopathy international clinical classifi-cation. Main Outcome Measures Kappa value, sensitivity, specificity. Results The Kappa value of two ophthalmologists on single-field, two-field, nine-field fundus photography was 0.58, 0.79, 0.79 respectively. The sensitivity of single-field, two- field, nine-field fundus photography for detecting the presence of diabetic retinopathy was 95.7%, 98.6, 100% respectively,and the specificity was 100%. The sensitivity of single-field, two-field, nine-field fundus photography for detecting the presence of severe non-proljferative diabetic retinopathy（NPDR） or more serious was 57.9%, 60.5%, 71.1% respectively, and the specificity was 100%. Conclusion The sensitivity of single-field fundus photography for the presence of diabetic retinopathy is more than 95%, and nearly 2/3 of NPDR or more se-rious can be accurately graded.

关 键 词：糖尿病视网膜病变/诊断 眼底照相 一致性 

分 类 号：R587.2[医药卫生—内分泌] R774.1[医药卫生—内科学]