超声测量视盘联合视神经鞘对重症高颅压患者的评估价值  

The evaluation value of ultrasound measurement of optic disc combined with optic nerve sheath in patients with severe high intracranial pressure

作　　者：于泽洋 宋晓南[1] 李聪[1] 范佳煜 王丽娟[1] YU Zeyang;SONG Xiaonan;LI Cong(Department of Neurology,The First Hospiatal of Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院神经内科,吉林长春130021 [2]湖北文理学院附属医院,襄阳市中心医院康复医学科,湖北襄阳441021

出　　处：《中风与神经疾病杂志》2021年第11期976-979,共4页Journal of Apoplexy and Nervous Diseases

基　　金：国家自然科学基金(81801707)。

摘　　要：目的探究超声测量视盘高度(Optic disc height,ODH)能否评估高颅压以及联合视神经鞘直径(Optic nerve sheath diameter,ONSD)对高颅压的诊断价值。方法纳入2019年7月至2020年11月之间吉林大学第一医院神经内科重症需进行腰椎穿刺术的患者。在腰穿之前运用超声测量ODH及ONSD。根据腰穿压力,将患者分为正常颅压组和高颅压组,进行单因素及多因素分析,分析颅内压(Intracranial pressure,ICP)与各超声数据之间的相关性。生成ROC曲线确定ODH、ONSD评估高颅压的最佳临界值,分析ONSD联合ODH评估高颅压的价值。结果共计78例患者,两组各39例,比较两组患者基线数据无统计学差异。(1)高颅压组ONSD[(5.04±0.34)mm]高于正常颅内压组[(4.17±0.38)mm](P<0.001);高颅压组ODH[0.81(0.59-1)mm]高于正常颅压组ODH[0.39(0-0.59)mm](P<0.001)。(2)相关性分析显示ICP与ONSD(r=0.779,P<0.001)和ODH均呈正相关(r=0.572,P<0.001)。(3)ODH诊断高ICP的临界值为0.54 mm,灵敏度和特异度分别为85%和72%;ONSD诊断高ICP的临界值为4.68 mm,灵敏度和特异度分别为87%和95%;ONSD联合ODH诊断高ICP的灵敏度和特异度分别为95%和95%。(4)比较三者诊断高ICP的价值,ONSD大于ODH(P=0.036),ONSD联合ODH大于ONSD(P=0.043)或ODH(P=0.001)单一诊断。结论超声测量ODH可用于评估高ICP,ONSD联合ODH可提高评估高ICP的灵敏度。Objective To explore whether ultrasound measurement of optic disc height can evaluate intracranial hypertension and the value of ultrasound measurement of optic nerve sheath diameter combined with optic disc height in the diagnosis of elevated intracranial hypertension.Methods Enrolled patients who needed lumbar puncture in the Department of Neurology of the First Hospital of Jilin University between July 2019 and November 2020.Complete ultrasound examination before lumbar puncture,measure ONSD and ODH.According to the lumbar puncture pressure,the patients were divided into normal intracranial pressure group and intracranial hypertension group.Single-factor and multi-factor analysis were performed to obtain the relationship between ICP and each ultrasound data.Analyze the correlation between ICP and ONSD and ODH.Generate ROC curve,evaluate and compare the value of ONSD,ODH and ONSD combined with ODH in diagnosing intracranial hypertension.Results A total of 78 patients,39 cases in each group.There was no statistical difference in baseline data between the two groups.(1)ONSD[(5.04±0.34)mm]in intracranial hypertension group is higher than normal intracranial pressure group[(4.17±0.38)mm](P<0.001);ODH[0.81(0.59-1)mm]in intracranial hypertension group is higher than normal intracranial pressure group[0.39(0-0.59)mm](P<0.001);(2)Correlation analysis showed that ICP was positively correlated with ONSD(r=0.779,P<0.001)and ODH(r=0.572,P<0.001);(3)The cutoff value of ODH for diagnosing elevated ICP is 0.54 mm,the sensitivity and specificity are 85%and 72%,respectively;the cutoff value of ONSD for diagnosing elevated ICP is 4.68 mm,the sensitivity and specificity are 87%and 95%,respectively;The sensitivity and specificity of ONSD combined with ODH in the diagnosis of elevated ICP are 95%and 95%,respectively;(4)Compare the value of the three in diagnosing elevated ICP,ONSD is greater than ODH(P=0.036),ONSD combined with ODH is greater than ONSD(P=0.043)or ODH(P=0.001)alone.Conclusion Ultrasound measurement of ODH can be u

关 键 词：超声 视神经鞘直径 视盘高度 高颅压 

分 类 号：R445.1[医药卫生—影像医学与核医学]