超声测量视神经鞘直径与视盘高度对颅内静脉窦血栓患者颅内压增高的诊断价值  

Value of optic nerve sheath diameter and optical disk elevation measured by ultrasound in the diagnosis of intracranial hypertension in patients with cerebral venous sinus thrombosis

作　　者：田兵 段建钢[2] 陈虹秀 刘然[1] 陈松伟 潘希娟 邢英琦[1] Tian Bing;Duan Jiangang;Chen Hongxiu;Liu Ran;Chen Songwei;Pan Xijuan;Xing Yingqi(Department of Vascular Ultrasonography,Xuan Wu Hospital,Capital Medical University,Beijing 100053,China;Department of Emergency,Xuan Wu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院血管超声诊断科,北京100053 [2]首都医科大学宣武医院急诊科,北京100053

出　　处：《中华超声影像学杂志》2023年第9期790-795,共6页Chinese Journal of Ultrasonography

摘　　要：目的探讨超声测量视神经鞘直径(ONSD)与视盘高度(ODE)对颅内静脉窦血栓(CVST)患者颅内压增高的诊断价值。方法连续回顾性纳入2021年1-12月在首都医科大学宣武医院神经内科及急诊科患有CVST需行腰椎穿刺术并行ONSD检查的患者50例。腰椎穿刺术后,记录患者的颅内压初压。颅内压80~200 mmH_(2)O为颅内压正常,颅内压>200 mmH_(2)O定义为颅内压增高。将50例CVST患者分为颅内压正常组(14例)和颅内压增高组(36例)。比较两组之间的基线资料、ONSD、ODE的差异,并生成ROC曲线,分析曲线下面积(AUC)以及ONSD的诊断界值。采用Spearman相关分析法分析ONSD、ODE、CVST累及范围评分与颅内压之间是否存在相关性。结果①颅内压正常组与颅内压增高组之间性别、年龄、体质指数差异无统计学意义(均P>0.05)。②颅内压增高组ONSD、ODE大于颅内压正常组,差异有统计学意义[(4.83±0.33)mm比(4.21±0.21)mm、(0.67±0.44)mm比(0.24±0.29)mm,均P<0.001];Spearman相关分析显示,ONSD、ODE与患者颅内压呈正相关(rs=0.74、0.51,均P<0.001)。③颅内压增高组CVST累及范围评分高于颅内压正常组,差异有统计学意义[5.0(3.0,7.5)分比2.5(2.0,5.0)分,P=0.015];Spearman相关分析显示,CVST累及范围评分与患者颅内压呈正相关(rs=0.43,P<0.001)。④颅内静脉窦血栓患者诊断颅内压增高时,ONSD的AUC为0.935,ONSD最佳诊断界值为4.5 mm,敏感性0.81,特异性0.93。结论超声测量ONSD与ODE是识别CVST患者颅内压增高的可靠影像方法。Objective To investigate the diagnostic value of ultrasonic measurement of optic nerve sheath diameter(ONSD)and optical disk elevation(ODE)for intracranial hypertension in patients with cerebral venous sinus thrombosis(CVST).Methods A total of 50 patients with CVST who underwent lumbar puncture and ONSD examination in the Department of Neurology and Emergency Department of Xuanwu Hospital,Capital Medical University from January 2021 to December 2021 were retrospectively enrolled.After lumbar puncture,the patient′s initial intracranial pressure was recorded.Normal ICP was defined as ICP between 80 and 200 mmH_(2)O,and increased ICP was defined as ICP>200 mmH_(2)O.Fifty patients with CVST were divided into normal ICP group(14 cases)and increased ICP group(36 cases).The differences of baseline data,ONSD and ODE between the two groups were compared,and the receiver operating characteristic(ROC)curve was generated.The area under the curve(AUC)and the diagnostic cut-off value of ONSD were analyzed.Spearman correlation analysis was used to analyze the correlation between ONSD,ODE,CVST involvement range scores and intracranial pressure.Results①There were no significant differences in gender,age and body mass index between the normal ICP group and the increased ICP group(all P>0.05).②The ONSD and ODE in the increased ICP group were higher than those in the normal ICP group,and the differences were statistically significant[(4.83±0.33)mm vs(4.21±0.21)mm,(0.67±0.44)mm vs(0.24±0.29)mm,all P<0.001].Spearman correlation analysis showed that ONSD and ODE were positively correlated with intracranial pressure(rs=0.74,0.51,all P<0.001).③The extent of CVST involvement in the intracranial hypertension group was higher than that in the normal intracranial pressure group,and the difference was statistically significant[5.0(3.0,7.5)vs 2.5(2.0,5.0),P=0.015].Spearman correlation analysis showed that CVST involvement score was positively correlated with intracranial pressure(rs=0.43,P<0.001).④In the diagnosis of intracranial

关 键 词：超声检查 颅内静脉窦血栓 视神经鞘直径 高颅压 

分 类 号：R743[医药卫生—神经病学与精神病学] R445.1[医药卫生—临床医学]