中国高颅压患者视神经鞘直径的诊断价值  

Optimal Optic Nerve Sheath Diameter Threshold for the Identification of Elevated Opening Pressure on Lumbar Puncture in a Chinese Population

作　　者：王丽娟[1] 冯良枢 姚燕[2] 王玉芝[1] 陈盈[1] 冯加纯[1] 邢英琦[1] 

机构地区：[1]吉林大学第一医院神经内科和神经科学中心,长春130021 [2]吉林大学公共卫生学院流行病与卫生统计学教研室

出　　处：《中国卒中杂志》2016年第7期563-569,共7页Chinese Journal of Stroke

摘　　要：目的确定视神经鞘直径(optic nerve sheath diameter,ONSD)评估颅内压(intracranial pressure,ICP)增高的诊断标准并研究其相关影响因素。方法本研究为双盲横断面研究,收集2013年3月-12月可疑高ICP需要进行腰椎穿刺测量脑脊液压力的患者为研究对象,记录患者的个体相关信息及脑脊液压力值,分为ICP正常组及增高组,比较两组患者相关因素的差异。运用接受者操作特性曲线(receiver operating characteristic,ROC)确定高ICP的ONSD最佳诊断值。结果共收录了279例患者,其中包括101例高ICP患者。比较显示,ONSD是ICP的独立预测因素(P<0.001),不受性别、年龄、体质指数(body mass index,BMI)、头围、腰围、高血压和病因分型的影响。ONSD能够有效准确地评估高ICP。运用超声检测ONSD诊断高ICP的最佳临界值是4.1 mm(敏感度95%,特异度92%)。结论我国高ICP患者的ONSD的诊断值比白种人低,因此建议检测ONSD评估高ICP时应该注意种族差异。Ultrasonography of the optic nerve sheath diameter（ONSD） is a non-invasive and rapid method that might be helpful in the identification of increased intracranial pressure（ICP）. The use of an ONSD greater than 5 mm on ultrasound as an indicator of increased ICP in a Caucasian population has been studied. However, the cut-off point of this predictor in Chinese patients has not been established. Thus, we conducted this study to identify the ONSD criterion for the detection of elevated opening pressure on lumbar puncture（LP） in a Chinese population and to investigate the influencing factors. This study was a blind cross-sectional study. Patients who presented with suspected increased ICP were included. The opening pressure on LP of each participant was confirmed. We analyzed the clinical differences between the groups of patients with abnormal and normal opening pressures on LP. A receiver operating characteristic curve was constructed to determine the ONSD cut-off point for the identification of abnormal opening pressure on LP. In total, 279 patients were recruited, and 101 patients presented with elevated opening pressure on LP. ONSD was a significant independent predictor of elevated opening pressure on LP（P〈0.001）. However, no statistical significance was observed regarding the factors that might have affected this relationship including gender, age, body mass index, waistline, head circumference, hypertension and pathological subtype. The ONSD cut-off point for the identification of elevated opening pressure on LP was 4.1 mm; this cut-off yielded a sensitivity of 95% and a specificity of 92%. ONSD is a strong and accurate predictor of elevated opening pressure on LP. The cut-off point of this predictor in a Chinese population was remarkably lower than that found in a Caucasian population. Thus, ethnic differences should be noted when using the ONSD as an indicator of increased ICP.

关 键 词：高颅压 视神经鞘 超声 无创 

分 类 号：R445.1[医药卫生—影像医学与核医学] R741.04[医药卫生—诊断学]