超声测量视盘联合视神经鞘在评估肺癌软脑膜转移高颅压中的作用  

The role of ultrasound measurement of optic disc combined with optic nerve sheath in the assessment of high intracranial pressure due to leptomeningeal metastasis of lung cancer

作　　者：林永娟[1] 蒋澄 卞征[1] 李会颖 黄明敏[1] 尹震宇[1] 郭爱斌[1] LIN Yongjuan;JIANG Chen;BIAN Zheng;LI Huiying;HUANG Mingmin;YIN Zhenyu;GUO Aibin(Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院,南京210008

出　　处：《中国中医眼科杂志》2023年第2期116-122,共7页China Journal of Chinese Ophthalmology

基　　金：江苏省干部保健科研课题(BJ18006、BJ21002);南京市卫生局重点项目(ZKX16031);南京市科学技术委员会医疗卫生项目(201715020);南京市医学重点科技发展项目(ZKX18014);希思科-豪森肿瘤研究基金(Y-HS2019-5)。

摘　　要：目的研究超声测量视神经鞘直径(ONSD)和视盘高度(ODH)与肺癌眼内和软脑膜转移(LM)患者颅内压(ICP)的相关性,探讨ONSD联合ODH预测LM患者高颅压的诊断价值。方法收集2020年6月—2022年1月于南京大学医学院附属鼓楼医院就诊的肺癌伴LM患者90例(LM组),其中3例为眼内转移,并根据腰椎穿刺压力界值(200 mm H_(2)O)分为正常颅压组(LM1组48例)和高颅压组(LM2组42例),并收集同期45例肺癌非LM患者作为对照组。对比3组间ONSD、ODH差异,并在鞘内注射化疗(鞘注化疗)前后动态监测,分析ONSD、ODH与ICP之间的相关性,运用受试者工作特征(ROC)曲线分析两指标诊断LM高颅压的最佳阈值,评估ONSD联合ODH预测ICP升高的可行性。结果(1)基线资料及视神经超声测量值:3组患者年龄、头围、血压等基线数据差异无统计学意义(P>0.05)。(2)ONSD:LM2组ONSD为(6.06±0.48)mm高于LM1组(5.37±0.48)mm和对照组(4.53±0.30)mm,均有统计学意义(t_(LM1)=6.852,t_(对照)=17.995,均P=0.000)。(3)ODH:LM2组ODH为0.80(0.60,1.20)mm高于LM1组和对照组[均为0.00(0.00,0.00)mm],均有统计学意义(H_(LM1)=32.207,H_(对照)=56.964,均P=0.000)。(4)Pearson相关性分析:ONSD(r=0.675,P=0.000)和ODH(r=0.583,P=0.000)与ICP均呈正相关。(5)ROC曲线分析:ONSD和ODH诊断高颅压的临界值分别为5.6 mm、0.52 mm,曲线下面积分别为0.851(95%CI:0.773~0.929,P=0.000)和0.844(95%CI:0.758~0.930,P=0.000)。2项指标联合曲线下面积为0.938(95%CI:0.884~0.991,P=0.000),灵敏度和特异度分别为90.48%和89.58%。(6)鞘内注射前后ONSD值动态变化:对7例LM患者鞘注化疗前后行视神经动态监测,发现ONSD和ODH值在鞘注化疗2 h后先升高再逐步下降,差异均无统计学意义(P>0.05)。结论床旁超声测量ONSD联合ODH是简便、有效的无创ICP的监测方法,灵敏度高、特异性强,为临床早期发现肺癌LM患者的ICP升高并及时干预提供重要依据,值得推广应用。OBJECTIVE To investigate the correlation between optic nerve sheath diameter(ONSD),optic disc height(ODH)measured by ultrasound and intracranial pressure(ICP)in patients with lung cancer with intraocular and leptomeningealmetastasis(LM),and to explore the diagnostic value of ONSD combined with ODH in predicting intracranial hypertension in LM patients.METHODS A total of 90 patients with lung cancer with leptomeningeal metastasis(LM group)who were treated at Drum Tower Hospital affiliated to Nanjing University Medical College from Jun 2020 to Jan 2022 were collected,including three cases with intraocular metastasis.Those patients were divided into normal ICP group(LM1 group,n=48)and high ICP group(LM2 group,n=42)according to the lumbar puncture pressure value(200 mm H_(2)O),and 45 lung cancer patients without LM during the same period were enrolled as control group.We compared the differences of ONSD and ODH among three groups,dynamically monitored them before and after intrathecal chemotherapy,analyzed the correlation between ONSD,ODH and ICP,used ROC curve to explore the optimal threshold of the two indicators to diagnose LM patients complicated with elevated ICP,and evaluated the feasibility of ONSD combined ODH to predict ICP elevation.RESULTS(1)Baseline data and ultrasonic measurement of optic nerve:There was no significant difference in the baseline data of age,head circumference,blood pressure,etc.of the three groups(P>0.05).(2)ONSD:The ONSD of LM2 group was[(6.06±0.48)mm],higher than that of LM1 group[(5.37±0.48)mm],and control group[(4.53±0.30)mm],with significant significance(t_(LM1)=6.852,t_(control)=17.995,both P=0.000).(3)ODH:The ODH of LM2 group was[0.80(0.60,1.20)mm]higher than that of LM1 group and control group[both 0.00(0.00,0.00)mm],with statistical significance(H_(LM1)=32.207,H_(Control)=56.964,both P=0.000).(4)Pearson correlation analysis:ONSD(r=0.675,P=0.000)and ODH(r=0.583,P=0.000)were positively correlated with ICP.(5)ROC curve analysis:The best threshold value of ONSD and ODH were 5.6 m

关 键 词：眼内转移 软脑膜转移 高颅压 视神经鞘直径 视盘高度 超声检查 

分 类 号：R770.43[医药卫生—眼科]