超声测量视神经鞘直径筛查子痫前期患者颅内压增高的研究  

Ultrasonic measurement of optic nerve sheath diameter for screening intracranial hype rtension in pre-eclampsia patients

作　　者：过勇杰 童武华[2] 张青贵[2] 朱康元 许仁美 李银峰[2] 卢中秋[1] GUO Yongjie;TONG Wuhua;ZHANG Qinggui(Graduate School of Wenzhou Medical University,Wenzhou 325035,China)

机构地区：[1]温州医科大学研究生院,325035 [2]嘉兴市妇幼保健院重症医学科

出　　处：《浙江医学》2019年第20期2168-2172,共5页Zhejiang Medical Journal

摘　　要：目的 探讨采用超声经眼眶测量视神经鞘直径(ONSD)筛查子痫前期患者颅内压(ICP)增高的价值.方法 随机选取65例子痫前期孕妇,根据ICP增高诊断标准分为ICP正常组及ICP增高组,同期纳入22例无合并症的单胎孕妇作为对照组.比较各组间ONSD、24h尿蛋白定量、大脑中动脉搏动指数(PI)、平均动脉压(MAP)的差异;采用受试者工作特征曲线(ROC)分析ONSD筛查子痫前期孕妇ICP增高的效能,得出最佳临界值;采用Bland-alterman检验ONSD(超声)与ONSD(CT)的一致性关系.结果65例子痫前期孕妇中可疑颅高压孕妇34例(52.31%),最终判定为ICP增高孕妇22例(33.84%).ICP增高组ONSD(超声)大于ICP正常组及对照组(P<0.05),ICP正常组与对照组ONSD(超声)无统计学差异(P>0.05).ICP增高组的24h尿蛋白定量、PI和MAP高于ICP正常组及对照组(均P<0.05),ICP正常组高于对照组(P<0.05).左、右眼ONSD(超声)筛查子痫前期孕妇ICP增高的ROC曲线下面积分别为0.81和0.72(P<0.05),95%可信区间分别为0.69~0.93和0.59~0.84.左、右眼ONSD(超声)筛查子痫前期孕妇ICP增高的最佳临界值分别为5.03mm和4.93mm,此时筛查灵敏度分别为0.68和0.77,特异度分别为0.85和0.61,阳性预测值分别为60.00%和40.48%,阴性预测值分别为88.70%和88.89%,准确度分别为80.46%和65.52%,约登指数分布为0.53和0.39.左、右眼ONSD(超声)与ONSD(CT)差值的平均偏倚分别为0.11mm和0.11mm,95%一致性界限为(-0.25^+0.46)和(-0.29^+0.52),各有2.94%样本超出95%的一致性界限.结论 超过30%的子痫前期孕妇会继发颅内高压,ONSD(超声)与ONSD(CT)一致性良好,超声测量ONSD在筛查子痫前期孕妇ICP增高时具有较好的灵敏度和特异度,临床应用价值较高,可为防治子痫前期孕妇颅内压增高及并发症提供有效评估手段.Objective To assess the application of transorbital measurement of optic nerve sheath diameter(ONSD)in screening for increased intracranial pressure(ICP)in patients with preeclampsia.Methods Sixty-five pregnant women with preeclampsia were divided into normal group and high ICP group according to the diagnostic criteria of high ICP.Twenty-two normal pregnant women were enrolled as control group.The ONSD,24-h urinary protein,middle cerebral artery pulsatility index(PI)and mean arterial pressure(MAP)were compared among the three groups.The optimal threshold for screening ICP elevation in patients with preeclampsia by ONSD was analyzed using ROC curve.The consistency between ONSD measured by ultrasound and ONSD measured by CT was tested by Bland-alterman method.Results Among 65 cases of preeclampsia,34 cases(52.31%)were suspected of intracranial hypertension,and 22 cases(33.84%)were finally diagnosed as intracranial hypertension.The ONSD(ultrasound)in ICP-elevated group was higher than that in ICP-normal group and control group(P<0.05);while there was no significant difference between ICP-normal group and control group(P>0.05).The 24-h urine protein,middle cerebral artery PI and MAP in the ICP-elevated group were higher than those in the ICP-normal group and the control group(P<0.05),and those in the ICP-normal group were higher than those in the control group(P<0.05).The area under the ROC curve(AUC)of ONSD(ultrasound)for ICP elevation in the left and right eyes was 0.81 and 0.72(P<0.05),95%confidence interval was 0.69~0.93 and 0.59~0.84,respectively.The optimal thresholds of ONSD for ICP elevation were 5.03 mm and 4.93mm in left and right eyes,respectively.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 0.6800 and 0.7727,0.8500 and 0.6154,60.00%and 40.48%,88.70%and 88.89%,80.46%and 65.52%,respectively.The average bias of the difference between ONSD(ultrasound)and ONSD(CT)was 0.11 mm for both left and right eyes;the 95%consistent limits were(-0.25^+0.46)and(-0.29^+0

关 键 词：子痫前期 超声 视神经鞘直径 颅内压 

分 类 号：R71[医药卫生—妇产科学]