光学相干断层成像法测量脉络膜厚度在早期Vogt-小柳原田综合征诊断中的研究

发布时间：2018-05-02 20:37

  本文选题：Vogt-小柳-原田综合征 + 光学相干断层成像　； 参考：《大连医科大学》2017年硕士论文

【摘要】：目的:Vogt-小柳-原田综合征(Vogt-Koyanagi-Harada syndrome,简称 VKH)在临床上常以造影检查结果作为诊断的金标准,一经诊断则早期应用激素治疗,且应足疗程。目前临床有部分患者因造影剂过敏或肾功能不全等全身状态因素,无法完成造影检查,故不能及时诊断、尽早开展激素治疗。本研究应用光学相干断层成像法(optical coherence temography,OCT)定量测量黄斑区脉络膜厚度,研究其在VKH诊断中的准确度、敏感度及特异度,明确该方法用于临床诊断VKH的准确性,以期有助于临床早期诊断及治疗。方法:选取眼底荧光血管造影(fundus fluorescence angiography,FFA)及引哚菁绿血管造影(indocyanine green angiography,ICGA)结果为VKH诊断的金标准,应用OCT定量测量黄斑区脉络膜厚度,根据预设临床预期的敏感度及特异度,依样本量计算公式计算出所需病例组及对照组的病例数。收集沈阳市第四人民医院2015年1月1日至2016年12月31日就诊的VKH患者及其他眼病患者的眼底荧光血管造影检查结果、脉络膜造影检查结果、黄斑区脉络膜厚度结果等,邀请3位副高级以上从事眼底病专业临床医师盲法判读荧光血管造影结果、吲哚菁绿血管造影结果,诊断VKH或排除VKH,根据结果取平均数(按四舍五入法)作为最终计算病例数计入研究结果。OCT测量黄斑区中心凹处脉络膜厚度,根据受试者工作特性曲线确定检查结果临界值,最终根据诊断实验研究的标准四格表法来计算敏感度及特异度等结果。结果:1、OCT测量脉络膜厚度大于等于500 μm时,诊断VKH的准确度为88.10%。2、OCT测量脉络膜厚度大于等于500 μ m时,诊断VKH的敏感度为86.52%。3、OCT测量脉络膜厚度小于300 μ m时,排除VKH的特异度为89.23%。4、OCT测量脉络膜厚度小于300 μ m的患者,有85.31%的把握该病人未患VKH。5、OCT测量脉络膜厚度得到阴性结果的患者,有90.16%的把握病人未患VKH。结论:1、本诊断试验研究所确立的OCT测量脉络膜厚度界限在临床VKH的诊断中诊断准确度较高,且具有较好的诊断效率。2、OCT测量脉络膜厚度大于等于500 μ m临床诊断VKH的敏感性较高。阳性似然比较大,临床应用指标诊断VKH的把握度较大,不易漏诊。3、OCT测量脉络膜厚度小于300 μm时排除VKH的特异度较高,阴性似然比较小。临床应用此指标排除VKH的把握度较大,不易误诊。4、OCT测量脉络膜厚度介于300 μm-500μm之间时,需结合病史、查体、其他辅助检查结果做出准确诊断。
[Abstract]:Objective: Vogt-Koyanagi-Harada syndromeVogt-Koyanagi-Harada syndrome (VKHH) is often used as the gold standard for diagnosis. At present, some patients can not complete the examination because of contrast agent allergy or renal insufficiency, so they can not diagnose in time and start hormone therapy as soon as possible. In this study, optical coherence tomography (Oct) was used to quantitatively measure the choroidal thickness in macular area, to study its accuracy, sensitivity and specificity in the diagnosis of VKH, and to determine the accuracy of this method in clinical diagnosis of VKH. In order to help clinical early diagnosis and treatment. Methods: fundus fluorescence angiographygraphy (FFAA) and indyanine green angiographyography (ICGA) were selected as the gold criteria for the diagnosis of VKH. The choroidal thickness of macular area was quantitatively measured by OCT, and the sensitivity and specificity of the preset clinical expectation were calculated according to the preset clinical expected sensitivity and specificity. The number of cases in the needed case group and control group was calculated according to the formula of sample size. The results of fundus fluorescein angiography, choroidal angiography and choroidal thickness of VKH patients and other ophthalmopathy patients in Shenyang fourth people's Hospital from January 1, 2015 to December 31, 2016 were collected. Invited three senior and senior clinical doctors engaged in fundus disease to interpret the results of fluorescein angiography and indocyanine green angiography by blind method. Diagnosis of VKH or exclusion of VKH, taking the average of the results (rounding method) as the final calculated case count. Oct measured the choroidal thickness at the fovea of the macular area, and determined the critical value of the examination results according to the operating characteristic curve of the subjects. Finally, the sensitivity and specificity are calculated according to the standard four-grid table method. Results when the thickness of choroid was greater than 500 渭 m by Oct, the diagnostic accuracy of VKH was 88.10 when the thickness of choroid was greater than 500 渭 m, and the sensitivity of diagnostic VKH was 86.52. 3 when the thickness of choroid was less than 300 渭 m, the diagnostic accuracy of Oct was 88.10 渭 m. The specificity of excluding VKH was 89.23.4Oct in the patients whose choroidal thickness was less than 300 渭 m. 85.31% of the patients were sure that the patients had no VKH.5OCT negative results, and 90.16% of the patients had no VKHs. ConclusionThe diagnostic accuracy of OCT for measuring choroidal thickness in clinical VKH is higher, and the sensitivity of VKH is higher than 500 渭 m by using Oct to measure choroidal thickness more than 500 渭 m. The positive likelihood was large, the certainty of clinical application index in the diagnosis of VKH was high, the specificity of excluding VKH was higher when the thickness of choroid was less than 300 渭 m, and the negative likelihood was small. Clinical application of this index to exclude VKH has a greater degree of certainty, and it is difficult to misdiagnose. 4. When measuring choroidal thickness between 300 渭 m and 500 渭 m, it is necessary to make an accurate diagnosis with the results of medical history, physical examination and other auxiliary examinations.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R773.9
，

本文编号：1835399