眼底彩照检测糖尿病黄斑水肿的敏感度和特异度分析  

Sensitivity and specificity of fundus photograph in detecting diabetic macular edema

作　　者：熊勇群 何宇深 谢培雯 郑逸 林建伟[1] 李远存 张贵华[1] XIONG Yongqun;HE Yushen;XIE Peiwen;ZHENG Yi;LIN Jianwei;LI Yuancun;ZHANG Guihua(Joint Shantou International Eye Center of Shantou University and The Chinese University of Hongkong,Shantou,Guangdong,515041;Ophthalmic Center,Foshan Second People′s Hospital of Guangdong Province,Foshan,Guangdong,528000)

机构地区：[1]汕头大学·香港中文大学联合汕头国际眼科中心,广东汕头515041 [2]广东省佛山市第二人民医院眼科中心,广东佛山528000

出　　处：《实用临床医药杂志》2023年第18期44-48,共5页Journal of Clinical Medicine in Practice

基　　金：广东省汕头市科技计划医疗卫生类别项目(190716155262406);2021广东省科技专项资金项目(210719096902710)。

摘　　要：目的 评估眼底彩照在糖尿病视网膜病变(DR)筛查中检测糖尿病黄斑水肿(DME)的敏感度和特异度。方法 收集1 438例DR患者的资料,所有患者均接受未矫正视力、最佳矫正视力、彩色眼底照相和频域光学相干断层扫描(SD-OCT)。以SD-OCT作为诊断DME的金标准,评估眼底彩照检测DME的敏感度、特异度及受试者工作特征(ROC)曲线的曲线下面积(AUC)。结果 本研究共纳入1 438例患者共2 326只眼,平均年龄(57.7±11.0)岁;背景期DR(R1组)1 412眼,增殖前期DR(R2组)710眼,增殖期DR(R3组)204眼。眼底彩照检测DME的敏感度为78.8%(95%CI:76.1%~81.2%),特异度为56.7%(95%CI:54.0%~59.3%),AUC为0.677(95%CI:0.659~0.696)。在R1组中,眼底彩照检测DME的敏感度、特异度和AUC分别为68.6%(95%CI:64.2%~72.7%)、58.8%(95%CI:69.4%~75.4%)、0.637(95%CI:0.611~0.664);在R2组中,其敏感度、特异度和AUC分别为86.3%(95%CI:82.3%~89.4%)、52.0%(95%CI:46.8%~57.2%)、0.691(95%CI:0.660~0.723);在R3组中,其敏感度、特异度和AUC分别为89.3%(95%CI:83.8%~93.2%)、42.9%(95%CI:28.0%~59.1%)、0.661(95%CI:0.575~0.747)。结论 眼底彩照在DR筛查中检测DME的敏感度较高,但特异度较低,单纯使用眼底彩照筛查DME将导致近半数患者进行转诊。Objective To evaluate the sensitivity and specificity of fundus photograph in detecting diabetic macular edema(DME)in screening for diabetic retinopathy(DR).Methods Data of 1438 patients with DR were collected.All patients received uncorrected visual acuity,best corrected visual acuity,color fundus photography,and spectral domain optical coherence tomography(SD-OCT).Using SD-OCT as the gold standard for the diagnosis of DME,the sensitivity,specificity and area under receiver operator characteristic(ROC)curve(AUC)of fundus color photography were evaluated.Results A total of 1438 patients with an average age of(57.7±11.0)years were enrolled in this study,with a total of 2326 eyes.There were 1412 eyes of background DR(group R1),710 eyes of pre-proliferative DR(group R2)and 204 eyes of proliferative DR(group R3).The sensitivity of DME detected by fundus photograph was 78.8%(95%CI,76.1%to 81.2%),the specificity was 56.6%(95%CI,54.0%to 59.3%),and the AUC was 0.677(95%CI,0.659 to 0.696).In group R1,the sensitivity,specificity and AUC of DME detected by fundus photograph were 68.6%(95%CI,64.2%to 72.7%),58.8%(95%CI,69.4%to 75.4%)and 0.637(95%CI,0.611 to 0.664),respectively;in the R2 group,the sensitivity,specificity and AUC were 86.3%(95%CI,82.3%to 89.4%),52.0%(95%CI,[JP3]46.8%to 57.2%)and 0.691(95%CI,0.660 to 0.723),respectively;in R3 group,the sensitivity,specificity and AUC were 89.3%(95%CI,83.8%to 93.2%),42.9%(95%CI,28.0%to 59.1%)and 0.661(95%CI,0.575 to 0.747),respectively.Conclusion The sensitivity of fundus photograph to detect DME in DR screening is high,but the specificity is low,and the use of fundus color imaging alone to screen DME will lead to transfer treatments of nearly half of the patients.

关 键 词：眼底彩照 糖尿病 黄斑水肿 敏感性 特异性 频域光学相干断层扫描 

分 类 号：R774.1[医药卫生—眼科] R445[医药卫生—临床医学]