Spectralis OCT检测早期原发性闭角型青光眼黄斑区mGcc及盘周RNFL厚度变化的研究

发布时间：2018-03-03 18:29

  本文选题：Spectralis　切入点：OCT　出处：《西安医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:运用频域光学相干断层扫描仪(Spectralis optical coherence tomography,Spectralis OCT)测量正常组及早期原发性闭角型青光眼组视乳头周围视网膜神经纤维层(circumpapillary retinal never fiber layer,cp RNFL)厚度、黄斑区全视网膜厚度(MR)、黄斑区神经节细胞复合体(macular ganglion cell complex,m GCC)厚度、黄斑区神经纤维层(macular retinal nerve fiber layer,m RNFL)厚度、黄斑区神经节细胞层(macular ganglion cell layer,m GCL)厚度、黄斑区内丛状层(macular inner plexiform layer,ml PL)厚度、黄斑区神经节细胞层+内丛状层(即m GCL+IPL)厚度和神经节细胞复合体的厚度与全视网膜厚度的比值(ganglion cell complex thickness to total retinal thickness ratio,G/T),对比两组间cp RNFL、MR、m GCC、m RNFL、m GCL、ml PL、m GCL+IPL厚度及G/T比值差异,进而分析cp RNFL厚度与黄斑区各个参数在早期原发性闭角型青光眼中所具有的诊断意义。方法:临床横断面研究。经过汇总2016年07月到2016年12月期间来我院眼科就诊的患者、体检人员和本院所属职工相关病史资料,并严格按照筛选标准,最终确定受试研究对象29例(50眼),将其分为2组:正常组20例(39眼),早期原发性闭角型青光眼组9例(11眼);所有受试研究对象统一接受全面的眼科检查,具体包括视力或最佳矫正视力(best corrected visual acuity,BCVA)、电脑验光、眼压测量、裂隙灯检查、超声生物显微镜检查房角、眼前节三维分析测量角膜厚度、自动视野检查以及Spectralis OCT等检查。Spectralis OCT检查所有研究对象时,选择青光眼(Glaucoma)模式下的视乳头周围视网膜视神经纤维(RNFL)扫描和黄斑部多层扫描。运用统计学方法对比两组间每项参数的差异;同时利用受试者工作特征曲线下面积(area under the receiver operating characteristic,AROC)分析以上每项参数在早期原发性闭角型青光眼中的诊断价值。结果:两组间一般情况比较:正常组20例(39眼),其中男9例(18眼),女11例(21眼),年龄23~52(38.7±10.9)岁;早期原发性闭角型青光眼组9例(11眼),其中男3例(5眼),女6例(6眼),年龄41~76(55.8±10.2)岁;在性别和年龄构成比上两组间的差异并无统计学意义(P0.05);而MD对比差异则具有统计学意义(P0.05)。对比两组间的cp RNFL厚度变化,结果显示:鼻下cp RNFL厚度差异具有统计学意义(P0.05);而颞侧、颞上、颞下、鼻侧、鼻上的cp RNFL厚度比较差异均无统计学意义(P0.05);对比两组间的MR厚度变化,结果显示:外环颞侧MR厚度在这两组间比较差异有统计学意义(P0.05),而其余各象限的MR厚度在这两组间对比差异均无统计学意义(P:0.759、0.787、0.864、0.435、0.774、0.679、0.550均0.05);对比两组间m RNFL厚度变化,结果显示:内环上方m RNFL厚度在两组间的差异有统计学意义(P0.05);而其余各象限如:内环颞侧、颞下、鼻侧及外环颞侧、颞下、鼻侧、鼻上的m RNFL厚度在两组之间差异均无统计学意义(P0.05);对比两组间m GCL厚度变化,结果显示:内环鼻侧、及外环颞侧、鼻侧的m GCL厚度在两组间差异均有统计学意义(P0.05);而内环颞侧、下方及外环上方、下方m GCL厚度在两组之间的差异均无统计学意义(P0.05);对比两组间m IPL厚度变化,结果显示:内环鼻侧、上方及外环下方的m IPL厚度在两组之间差异均有统计学意义(P0.05);而内环颞侧、下方及外环颞侧上方、鼻部侧面的m IPL厚度在两组之间的差异无统计学意义(P0.05);对比两组间m GCC厚度变化,结果发现:内环鼻侧、颞侧m GCC厚度在两组间的差异有统计学意义(P≤0.05);而其余各象限:内环上方、下方及外环上方、颞侧、下方、鼻侧m GCC厚度在两组之间差异均无统计学(P0.05);对比两组间m GCL+IPL厚度变化,结果发现:内环上方、鼻侧及外环下方m GCL+IPL厚度在两组之间的差异有统计学意义(P0.05);而内环颞侧、鼻侧及外环上方、颞侧、鼻侧m GCL+IPL厚度在两组之间的差异均无统计学意义(P0.05);对比两组间G/T比值的差异,结果显示:正常人的G/T比值在内环上方、颞侧、下方、鼻侧及外环上方、颞侧、下方、鼻侧分别为34.2±1.9%、32.6±1.2%、36.4±3.3%、34.0±1.5%、35.4±2.1%、31.6±1.2%、36.4±2.1%、38.4±1.9%;内环上方、颞侧、鼻侧及外环颞侧G/T比值在两组间的差异有统计学意义(P0.05);内环下方及外环上方、下方、鼻侧在两组间的差异均无统计学意义(P0.05);区别两组间的AROC:除了颞侧cp RNFL厚度的AROC值(0.815)差异有统计学意义外(P=0.0020.05),其余各象限cp RNFL的AROC值均无统计学意义(P0.05);除了内环上方MR厚度的AROC值(0.731)差异有统计学意义外(P=0.0200.05),其余各象限MR的AROC值均无统计学意义(P0.05);内环颞侧、下方及鼻侧m RNFL厚度的AROC值在区别正常组与早期闭角型青光眼组差异无统计学意义外(P0.05),其余各象限差异均有统计学意义(P0.05);除了内环上方m GCL厚度的AROC值(0.803)差异有统计学意义外(P0.05),其余各象限均无统计学意义(P0.05);除了内环上方m IPL厚度的AROC值(0.765)差异有统计学意义外(P=0.0080.05),其余各象限m IPL的AROC值均无统计学意义(P0.05);内环上方m GCL+IPL厚度AROC值(0.797)差异有统计学意义(P=0.0030.05),其余各象限m GCL+IPL厚度AROC值均无统计学意义(P0.05);内环上方以及外环鼻侧m GCC厚度的AROC值分别为0.854、0.741,在区别正常组与早期闭角型青光眼组间差异有统计学意义(P0.05),其余各象限m GCC厚度AROC值均无统计学意义(P0.05);内环上方、颞侧及外环上方、下方、鼻侧G/T值的AROC值分别为0.869、0.744、0.726、0.734、0.732,在区别正常组与早期闭角型青光眼组间差异有统计学意义(P0.05),其余各象限G/T值的AROC值均无统计学意义(P0.05);且内环上方的G/T值的AROC值最高,为0.869,其次为内环上方及外环上方、颞侧的m RNFL厚度、内环上方的m GCC厚度、颞侧cp RNFL厚度,即就是内环上方G/T值的AROC值内环上方及外环上方、颞侧的m RNFL厚度的AROC值内环上方的m GCC厚度AROC值颞侧cp RNFL厚度的AROC值。结论:1.cp RNFL、MR、m RNFL、m GCL、m IPL、m GCL+IPL、m GCC厚度在青光眼患者中均出现局部变薄,G/T比值局部变小;2.G/T值AROC值明显高于cp RNFL及m GCC厚度,尤其是内环上方G/T值。
[Abstract]:Objective: using frequency domain optical coherence tomography (Spectralis optical coherence tomography, Spectralis OCT) measurement of the normal group and early primary angle closure glaucoma group of peripapillary retinal nerve fiber layer (circumpapillary retinal never fiber layer, CP RNFL) thickness, retinal macular thickness (MR), macular ganglion cell complex (macular ganglion cell complex, m GCC) thickness and macular retinal nerve fiber layer (macular retinal nerve fiber layer, m RNFL) thickness and macular ganglion cell layer (macular ganglion cell layer, m GCL) macular thickness, inner plexiform layer (macular inner plexiform layer, ML PL) thickness and macular ganglion cell layer and inner plexiform layer (m GCL+IPL) and the ratio of the thickness of the ganglion cell complex and the thickness of retinal thickness (ganglion cell complex thickness to total retinal thic Kness ratio, G/T, CP) were compared between two groups of RNFL, MR, m GCC, m RNFL, m GCL, ML PL, m GCL+IPL and G/T thickness ratio difference, and analysis of diagnostic value of CP RNFL thickness and macular parameters are in the early stage of primary angle closure glaucoma. Methods: the study the clinical cross section. After 07 months to December 2016 2016 during the summary to our hospital for treatment of patients, the medical personnel and staff related history data in our hospital, and in strict accordance with the selection criteria, and ultimately determine the subjects of the study of 29 cases (50 eyes), which can be divided into 2 groups: normal group of 20 cases (39 eye), early primary angle closure glaucoma group 9 cases (11 eyes); all subjects studied the unified acceptance of a comprehensive eye examination including visual acuity and best corrected visual acuity (best corrected visual acuity, BCVA), computer optometry, intraocular pressure, slit lamp examination, examination of ultrasound biomicroscopy angle. Anterior segment Three dimensional analysis of corneal thickness measurement, automatic perimetry, Spectralis OCT.Spectralis OCT check to check all the research object, choice of glaucoma (Glaucoma) under the mode of peripapillary retinal nerve fiber (RNFL) scanning and macular multi scanning. Using the statistical methods of each parameter differences between the two groups; at the same time use the area under the receiver operating characteristic curve (area under the receiver operating characteristic, AROC) analysis of the value of each parameter in the early diagnosis of primary angle closure glaucoma. Results: general comparison between the two groups: the normal group of 20 cases (39 eyes), including male 9 cases (18 eyes). 11 female patients (21 eyes), aged 23~52 (38.7 + 10.9) years; early primary angle closure glaucoma group 9 cases (11 eyes), including male 3 cases (5 eyes), female 6 cases (6 eyes), aged 41~76 (55.8 + 10.2) years; in gender and age composition the difference between the two groups than on There was no statistically significant difference (P0.05); while the MD difference was statistically significant (P0.05). CP RNFL thickness changes, comparison between the two groups showed that there was significant difference of CP RNFL thickness under the nose (P0.05); and the temporal, superior, temporal, nasal, nasal CP RNFL thickness the difference was not statistically significant (P0.05); MR thickness changes, comparison between the two groups showed that the outer ring of temporal MR thickness in the comparison between the two groups was statistically significant (P0.05), while the MR thickness of each quadrant of the contrast in the rest of this difference between the two groups were not statistically significant (P:0.759,0.787,0.864,0.435,0.774,0.679,0.550; 0.05) between the two groups m RNFL thickness, the results indicated that there were statistically significant differences in the thickness of RNFL above the inner m between the two groups (P0.05); and the rest of the quadrant such as inner temporal, temporal, nasal and temporal side of outer ring, temporal, nasal, nasal m RNFL in thickness 涓ょ粍涔嬮棿宸�寮傚潎鏃犵粺璁″�︽剰涔，

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