联合Pentacam及Corvis ST诊断顿挫期圆锥角膜的研究  

The study on combination of Pentacam and Corvis ST for the diagnosis of forme frusta keratoconus

作　　者：张慧 田磊 秦晓 郭莉莉 张迪 李林 张海霞 Zhang Hui;Tian Lei;Qin Xiao;Guo Lili;Zhang Di;Li Lin;Zhang Haixia(School of Biomedical Engineering,Capital Medical University,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application,Beijing 100069,China;Beijing Tongren Eye Center,Beijing Institute of Ophthalmology,Beijing Tongren Hospital,Capital Medical University,Beijing Key Laboratory of Ophthalmology and Visual Sciences,Beijing 100730,China;Beijing Advanced Innovation Center for Big Data-Based Precision Medicine,Beihang University&Capital Medical University,Beijing Tongren Hospital,Beijing 100730,China)

机构地区：[1]首都医科大学生物医学工程学院临床生物力学应用基础研究北京市重点实验室,100069 [2]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,100730 [3]北京航空航天大学-首都医科大学北京大数据精准医疗高精尖创新中心同仁分中心,100730

出　　处：《眼科》2022年第1期51-56,共6页Ophthalmology in China

基　　金：国家自然科学基金资助项目(32171304、82171101);北京市科技新星计划(Z181100006218099);北航-首医大数据精准医疗高精尖创新中心同仁分中心开放基金项目(BHTR-KFJJ-202001)。

摘　　要：目的探索联合角膜形态学与生物力学特性诊断顿挫期圆锥角膜的其他组合方式,以发掘更多的潜在敏感参数。设计诊断试验。研究对象顿挫期圆锥角膜患者50例(50眼),同期欲行角膜屈光手术术前患者50例(50眼)。方法绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析各纳入参数对顿挫期圆锥角膜的诊断效率并进行Delong检验。将ROC曲线下面积(the area under the ROC curve,AUC)>0.70的参数作为自变量,用前向逐步法建立Logistic回归模型对顿挫期圆锥角膜的诊断进行多因素分析。主要指标角膜最薄点厚度(TP)、角膜断层摄影和生物力学指数(TBI)及在体角膜弹性模量(E)。结果除Km F、Astig F、Kmax F、A1V、A2T、A2V、HCT、PD、bIOP外,其余参数的组间比较均存在统计学差异。在所纳入参数中,TP对顿挫期圆锥角膜的诊断效率最高(AUC=0.810)。对AUC>0.7的参数进行Logistic回归,结果显示TP和弹性模量E是顿挫期圆锥角膜确诊的独立危险因素:CP=e^(β)/(1+e^(β))(β=-0.063×TP-42.158×E+45.919)。ROC曲线分析显示,该模型预测值的AUC为0.916,可显著提高对于顿挫期圆锥角膜的诊断能力(CP与TP比较,Z=2.796,P=0.0052)。结论角膜最薄点厚度对顿挫期圆锥角膜的诊断效率与TBI无统计学差异;在圆锥角膜发病早期,虽然角膜中央3 mm区域内总平均曲率几乎无改变,但其下上方曲率差值呈现增大趋势;角膜弹性模量在顿挫期圆锥角膜诊断中的作用值得被关注,可作为补充参数用于疾病评估。Objective To explore more combinations of corneal morphology and biomechanics for diagnosisof formefruste keratoconus,so as to explore more potential sensitive parameters.Design Diagnostic test.Participants Fifty patients(50 eyes)with forme frusta keratoconus and 50 patients(50 eyes)with pre-operative corneal refractive surgery were included.Methods Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficiency of formefrustekeratoconus and Delong test was performed.The parameters of area under the ROC curve(AUC)greater than 0.70 were taken as independent variables,and Logistic regression model was established by the forward stepwise method to perform multivariate analysis on the diagnosis of forme fruste keratoconus.Main Outcome Measures Thinnest pachymetry(TP),tomographic and biomechanical index(TBI)and elastic modulus(E).Results Except for Km F,Astig F,Kmax F,A1V,A2T,A2V,HCT,PD,bIOP,there were statistical differences among the other parameters.TP had the highest diagnostic efficiency and AUC was 0.810.The forward stepwise Logistic regression was performed on the parameters with AUC exceeding 0.7,and the resulting model was as follows:CP=e^(β)/(1+e^(β))(β=-0.063×TP-42.158×E+45.919).The above analysis revealed that TP and E were the independent risk factors for the diagnosis of forme frusta keratoconus.ROC curve analysis showed that the AUC of this model was 0.916,which could significantly improve the diagnostic ability of forme frusta keratoconus(CP vs.TP:Z=2.796,P=0.0052;Delong test).Conclusion There is no significant difference between the diagnostic efficiency of corneal thinnest point thickness and TBI.In the early stage of keratoconus,the total mean curvature in the central 3 mm area of the cornea almost do not change but the difference between the inferior and superior curvature show an increasing trend.The role of corneal elastic modulus in the diagnosis of forme frusta keratoconus is worthy of attention and may be used as a supplementary parameter for disease assessment

关 键 词：顿挫期圆锥角膜/诊断 形态学 生物力学 

分 类 号：R779.6[医药卫生—眼科]