甲状腺功能障碍性视神经病变的视觉功能改变及早期诊断指标的ROC曲线分析  

Visual function changes of dysthyroid optic neuropathy and ROC curve analysis for early diagnostic indicators

作　　者：王沙[1,2,3] 王津伟 陈露 谭佳[1,2,3] WANG Sha;WANG Jinwei;CHEN Lu;TAN Jia(Eye Center,Xiangya Hospital,Central South University,Changsha 410008;Hunan Key Laboratory of Ophthalmology,Changsha 410008;National Clinical Research Center for Geriatric Disorders,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院眼科中心,长沙410008 [2]湖南省眼科学重点实验室,长沙410008 [3]国家老年疾病临床医学研究中心,长沙410008

出　　处：《中南大学学报（医学版）》2023年第8期1197-1202,共6页Journal of Central South University ：Medical Science

基　　金：湖南省自然科学基金(2022JJ30964,2022JJ30959)。

摘　　要：目的:甲状腺功能障碍性视神经病变(dysthyroid optic neuropathy,DON)严重危害甲状腺相关眼病患者视力。本研究观察DON患者的视觉功能改变,并评价DON检测指标的诊断价值。方法:回顾性分析2017年1月至2019年12月在中南大学湘雅医院就诊的49例DON患者(98眼)的临床资料。所有患者均行最佳矫正视力(best corrected visual acuity,BCVA)、Humphrey视野、视觉诱发电位(visual evoked potential,VEP)和对比敏感度检测。将98眼分为DON组(45眼)和非DON组(53眼)。采用t检验比较2组患者上述各项检测的相关指标,受试者操作特征(receiver operating characteristic,ROC)曲线分析各指标的敏感度和特异度。结果:DON组的BCVA和视野指数(visual field index,VFI)均显著低于非DON组(均P<0.05),平均缺损(mean deviation,MD)和模式标准偏差(pattern standard deviation,PSD)均显著高于非DON组(均P<0.05)。DON组的低频对比敏感度(low frequency contrast sensitivity,CSL)、中频对比敏感度(medium frequency contrast sensitivity,CSM)、高频对比敏感度(high frequency contrast sensitivity,CSH)均明显低于非DON组(均P<0.05),CSH尤为明显。在15°、30°和60°空间频率时,与非DON组比较,DON组的N135波幅显著降低,N75波、P100波、N135波的潜伏期显著延长(均P<0.05);在15°和30°空间频率时,DON组较非DON组P100波幅明显降低(均P<0.05)。ROC曲线分析结果显示:VFI、CSL、CSM、CSH和15°P100波幅诊断DON的曲线下面积(area under the curve,AUC)分别为0.812、0.841、0.880、0.784和0.791,以CSM的敏感度和特异度最高。结论:DON患者的视觉功能均存在不同程度的受损。VFI、CSL、CSM、CSH和15°P100波幅可能成为早期诊断DON的有效指标。Objective:Dysthyroid optic neuropathy(DON)is a class of diseases that makes seriously endanger to the vision of patients with thyroid-associated ophthalmopathy.This study aims to observe the visual function changes in patients with DON,and to evaluate the diagnostic value of indicators diagnosing DON.Methods:A retrospective study was conducted on 98 eyes of 49 patients with dysthyroid optic neuropathy(DON)who were treated in Xiangya Hospital of Central South University from January 2017 to December 2019.All patients were received the examination of best corrected visual acuity(BCVA),Humphrey visual field,visual evoked potential(VEP),and contrast sensitivity.Ninety-eight eyes were divided into a DON group(45 eyes)and a non-DON group(53 eyes).T-test was used to compare the related indicators between the 2 groups.The sensitivity and specificity of each indicator were analyzed by receiver operating characteristic(ROC)curve.Results:The BCVA and visual field index(VFI)of the DON group were significantly lower than those of the non-DON group(all P<0.05).The mean deviation(MD)and pattern standard deviation(PSD)of the DON group were significantly higher than those of the non-DON group(all P<0.05).The low frequency contrast sensitivity(CSL),medium frequency contrast sensitivity(CSM),and high frequency contrast sensitivity(CSH)of the DON group were significantly lower than those of the non-DON group(all P<0.05),with CSH being particularly prominent.Compared with the non-DON group,at spatial frequencies of 15°,30°,and 60°,the amplitude of N135 wave was significantly reduced,and the latency of N75 wave,P100 wave,and N135 wave was significantly prolonged in the DON group(all P<0.05);at spatial frequencies of 15°and 30°,the amplitude of P100 wave was significantly reduced in the DON group(P<0.05).The ROC curve analysis results showed that the area under the curve(AUC)of VFI,CSL,CSM,CSH and 15°P100 amplitude diagnosing DON were 0.812,0.841,0.880,0.784,and 0.791,respectively,with CSM possessing the highest sensitivity and s

关 键 词：甲状腺功能障碍性视神经病变 甲状腺相关眼病 视觉诱发电位 受试者操作特征曲线 

分 类 号：R581[医药卫生—内分泌] R774.6[医药卫生—内科学]