GPA在识别原发性青光眼视野进展中的临床应用研究

发布时间：2018-02-26 23:14

本文关键词： 原发性青光眼视野青光眼进展分析　出处：《昆明医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的通过比较传统临床方法和Humphrey视野计的青光眼进展分析(Glaucoma Progression Analysis, GPA)对青光眼视野进展的判别,研究GPA判断原发性青光眼视野进展的作用,帮助临床上对病情变化的判断,做出合理治疗方案。方法回顾性研究原发性青光眼患者24例(39只眼),以Humphrey视野计进行视野检查,每只眼2年以内都有至少5次可靠的随访视野结果。利用Humphrey视野计的单视野检测结果的总体偏差概率图和模式偏差概率图,参照临床判断标准,进行临床判断视野有无改变；利用Humphrey视野计自带的青光眼进展分析软件(GPA)进行分析,判断视野有无改变。两种方法将视野结果分为“进展”和“无进展”；临床判断和GPA方法判断为“视野进展”,都至少需要两次连续随访视野结果与基线视野结果对比均显示出进展。使用卡方检验分析两种方法对青光眼视野进展判断结果的差异。GPA对患者序列视野结果视野指数(Visual Field Index, VFI)进行回归分析计算出青光眼进展率。把临床方法作为参考标准,计算GPA的筛查诊断指标,评估GPA的作用。结果24例患者39只眼中,临床方法判断为“进展”17只眼(43.6%),“无进展”22只眼(56.4%)；GPA判断为“进展”4只眼(10.3%),“无进展”35只眼(89.7%)。21只眼(53.8%)两种方法均判断为“无进展”；3只眼(7.7%)两种方法均判断出“进展”。卡方检验分析两种方法判断结果的差异性分析,两种方法无统计学差异(P=0.181),判断视野是否进展的效果一致。临床方法分别使用2、3次连续随访视野结果进行青光眼进展判断时存有差异(P=0.000)。GPA分别使用2、3次连续随访视野结果进展青光眼进展判断时没有差异(P=0.544)。临床方法和GPA两种方法分别使用2次连续随访视野进行青光眼进展判断没有差异(P=I.000)；同样,两种方法使用3次连续随访视野进行青光眼进展判断也没有差异(P=0.784)。临床方法使用总体偏差概率图和模式偏差概率图进行青光眼进展判断时存在差异(P=0.017)。把临床方法作为标准,计算GPA法的筛查诊断效果指标,灵敏度35%,特异度40%,阳性预测值82.35%,阴性预测值4.55%,阳性似然比0.583,阴性似然比0.125,Youden指数—0.25。结论GPA和客观临床方法在判断青光眼进展上有明显的相关性。两种方法判断青光眼的进展效果一致。GPA对判断青光眼视野进展有较高的特异性、阳性率以及敏感性。
[Abstract]:Objective to study the role of GPA in judging the progression of primary glaucoma by comparing the traditional clinical methods with that of Humphrey Progression analysis. Make a reasonable treatment plan. Methods Twenty-four patients with primary glaucoma and 39 eyes with primary glaucoma were studied retrospectively. The visual field was examined with Humphrey visual field meter. There were at least 5 reliable visual field results in each eye within 2 years. The overall deviation probability diagram and the pattern deviation probability diagram of the single field test result of Humphrey visual field meter were used to judge whether the visual field had changed or not according to the clinical judgment standard. The glaucoma progression analysis software of Humphrey visual field meter was used to analyze the progress of glaucoma. Two methods classify the visual field results as "progress" and "no progress", and the clinical judgment and GPA method are "visual field progress", both need at least two consecutive follow-up visual field results and baseline visual field results. Using chi-square test to analyze the difference between the two methods in judging the progress of glaucoma visual field. GPA-regression analysis of visual Field index (visual Field index, VFI) of patients with sequential visual field results was used to calculate the rate of glaucoma progression. Clinical methods as a reference standard, The screening diagnostic index of GPA was calculated and the role of GPA was evaluated. Results 39 eyes of 24 patients, The clinical methods were "progress" in 17 eyes, "no progress" in 22 eyes and GPA as "progress" in 4 eyes, and "no progress" in 35 eyes. The difference analysis of the results of the two methods of square test analysis, There was no statistical difference between the two methods and there was no statistical difference between the two methods. There was no statistical difference between the two methods in judging the progression of glaucoma. There was no difference between the two methods in judging the progress of glaucoma by using the results of 2 consecutive visual fields followed up for 2 consecutive times. GPA was used for 2 or 3 consecutive follow-up visual fields. Results there was no difference in judging the progression of advanced glaucoma. There was no difference between clinical method and GPA method in judging the progression of glaucoma with two consecutive follow-up visual fields. There was no difference between the two methods in judging the progress of glaucoma by using three consecutive follow-up visual fields. There was a difference between the two methods in judging the progress of glaucoma by using the total deviation probability chart and the pattern deviation probability chart. The clinical method was regarded as the standard. The sensitivity was 35%, specificity was 40%, positive predictive value was 82.35, negative predictive value was 4.55, positive likelihood ratio was 0.583, negative likelihood ratio was 0.125 and Youden index was 0.25. Conclusion there is a significant correlation between GPA and objective clinical methods in judging the progression of glaucoma, and the two methods have the same effect in judging the progression of glaucoma. GPA-GPA has a high specificity, positive rate and sensitivity in judging the progression of glaucoma visual field.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R775

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