视网膜神经节细胞估算值在青光眼进展分析中的应用研究
发布时间：2018-07-31 14:21
【摘要】：[目的]通过对青光眼结构性和功能性检查结果进行整合得到视网膜神经节细胞(Retinal Ganglion Cells,RGCs)估算值(Estimated Retinal Ganglion Cell Counts,eRGC),计算eRGC丢失率进而评估eRGC在青光眼进展中的应用价值。[方法]观察性队列研究。共纳入不同时期青光眼患者38人共69眼。所有患眼均至少接受5次连续的标准自动视野计(Standard Automated Perimetry,SAP)检测和光学相干断层扫描(Optical Coherence Tomography,OCT)检测,两种检测需在同一天完成,且第一次和最后一次检测的时间跨度至少为两年。将SAP检测所得视野(visualfield,VF)中特定位点敏感度、OCT检测所得视网膜神经纤维层(retinal nerve fiber layer,RNFL)的平均厚度以及患者年龄等参数,代入经验性公式计算出SAP对应RGC数目和OCT对应RGC数目,计算两者相关性。最后通过计算加权平均值得到各患眼最终的eRGC。用线性回归分析各患眼每次随访的eRGC随时间的变化,若得出的回归方程斜率为负值且斜率即eRGC丢失率高于年龄相关RGCs丢失量(7205细胞/年)且回归系数显著(P0.05)则认为有进展。把各受试者的eRGC所得进展情况与视野指数(visual field index,VFI)所得进展情况、平均RNFL厚度所得进展情况三者进行比较分析,评估eRGC对青光眼进展的估算价值。[结果]入组患者的基线eRGC为466949±311614。在这69眼中,9只眼(13.0%)的eRGC丢失率高于年龄相关RGCs丢失量(P0.05),即认为存在进展。这些患眼的eRGC丢失率均值为-67022细胞/年。用eRGC计算认为无进展的患眼中,eRGC丢失率均值为-16791细胞/年(7205细胞/年)。SAP对应eRGC与 OCT 对应 eRGC 之间的相关系数(correlation coefficient)为r=0.861,P0.01。依据eRGC认为青光眼存在进展的患眼比例大于单独用OCT平均RNFL厚度检测出存在进展的患眼比例(10.1%),也大于单独用SAP中VFI检测出存在进展的患眼比例(11.6%)。有2只患眼用三种方法均测出存在进展,有2只患眼只用eRGC测得进展,而用VFI和平均RNFL厚度均未测出进展。不存在同时用VFI和平均RNFL厚度测出进展而用eRGC测不出进展的患眼。[结论]用eRGC丢失率所得青光眼进展例数多于单独用VFI或单独用平均RNFL厚度所得青光眼进展例数。SAP对应RGC数目与OCT对应RGC数目之间呈现强相关性。eRGC测得无进展的青光眼患眼eRGC丢失率仍高于正常人。利用对青光眼结构和功能参数进行整合得到的eRGC是一种值得被进一步研究并应用于临床的新的检测青光眼进展的工具。
[Abstract]:[objective] to obtain the estimated value of (Retinal Ganglion cells of retinal ganglion cells (Retinal Ganglion cells) by integrating the results of structural and functional examination of glaucoma, and to calculate the eRGC loss rate and evaluate the application value of eRGC in the progression of glaucoma. [methods] observational cohort study. A total of 69 eyes of 38 patients with glaucoma at different stages were included. All eyes were examined with at least five consecutive standard automatic field of vision (Standard Automated) and optical coherence tomography (Oct). The first and last tests were performed on the same day, and the time span of the first and last tests was at least two years. The mean thickness and patient age of the retinal nerve fiber layer (retinal nerve fiber layerus) measured by Oct in the visual field (VF) were calculated by using the empirical formula to calculate the number of SAP corresponding to RGC and the number of OCT corresponding to RGC. Calculate the correlation between the two. Finally, the final eRGC of the affected eyes was obtained by calculating the weighted average. The linear regression analysis showed that the slope of the regression equation was negative and the slope of eRGC loss was higher than that of age-related RGCs (7205 cells / year) and the regression coefficient was significant (P0.05), if the slope of the regression equation was negative and the slope was higher than that of age-related RGCs (7205 cells / year), the regression coefficient was significant (P0.05). The progress of eRGC and visual field index (visual field index VFI) and the average RNFL thickness of each subject were compared and analyzed to evaluate the value of eRGC in estimating the progress of glaucoma. [results] the baseline eRGC of the patients was 466949 卤311614. The loss rate of eRGC in 9 eyes (13.0%) was higher than that in age-related RGCs (P0.05). The average eRGC loss rate in these eyes was-67022 cells per year. The average loss rate of eRGCs was -16791 cells / year (7205 cells / year). The correlation coefficient (correlation coefficient) between eRGC and OCT corresponding to eRGC was 0.861g / year (P 0.01). According to eRGC, the proportion of glaucoma patients with progression was greater than that with OCT average RNFL thickness (10.1%), and with SAP alone (11.6%). Progress was detected by three methods in 2 eyes and only by eRGC in 2 eyes, but no progress was detected with VFI and average RNFL thickness. There were no patients with VFI and average RNFL thickness, but not with eRGC. [conclusion] the number of glaucoma progression cases with eRGC loss rate is more than that with VFI alone or with average RNFL thickness. There is a strong correlation between the number of RGC corresponding to RGC and the number of RGC corresponding to OCT. The loss rate of eRGC in glaucoma eyes is still higher than that in normal eyes. The eRGC obtained by integrating the structure and functional parameters of glaucoma is a new tool for detecting the progress of glaucoma, which is worthy of further study and clinical application.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R775
本文编号：2155861
[Abstract]:[objective] to obtain the estimated value of (Retinal Ganglion cells of retinal ganglion cells (Retinal Ganglion cells) by integrating the results of structural and functional examination of glaucoma, and to calculate the eRGC loss rate and evaluate the application value of eRGC in the progression of glaucoma. [methods] observational cohort study. A total of 69 eyes of 38 patients with glaucoma at different stages were included. All eyes were examined with at least five consecutive standard automatic field of vision (Standard Automated) and optical coherence tomography (Oct). The first and last tests were performed on the same day, and the time span of the first and last tests was at least two years. The mean thickness and patient age of the retinal nerve fiber layer (retinal nerve fiber layerus) measured by Oct in the visual field (VF) were calculated by using the empirical formula to calculate the number of SAP corresponding to RGC and the number of OCT corresponding to RGC. Calculate the correlation between the two. Finally, the final eRGC of the affected eyes was obtained by calculating the weighted average. The linear regression analysis showed that the slope of the regression equation was negative and the slope of eRGC loss was higher than that of age-related RGCs (7205 cells / year) and the regression coefficient was significant (P0.05), if the slope of the regression equation was negative and the slope was higher than that of age-related RGCs (7205 cells / year), the regression coefficient was significant (P0.05). The progress of eRGC and visual field index (visual field index VFI) and the average RNFL thickness of each subject were compared and analyzed to evaluate the value of eRGC in estimating the progress of glaucoma. [results] the baseline eRGC of the patients was 466949 卤311614. The loss rate of eRGC in 9 eyes (13.0%) was higher than that in age-related RGCs (P0.05). The average eRGC loss rate in these eyes was-67022 cells per year. The average loss rate of eRGCs was -16791 cells / year (7205 cells / year). The correlation coefficient (correlation coefficient) between eRGC and OCT corresponding to eRGC was 0.861g / year (P 0.01). According to eRGC, the proportion of glaucoma patients with progression was greater than that with OCT average RNFL thickness (10.1%), and with SAP alone (11.6%). Progress was detected by three methods in 2 eyes and only by eRGC in 2 eyes, but no progress was detected with VFI and average RNFL thickness. There were no patients with VFI and average RNFL thickness, but not with eRGC. [conclusion] the number of glaucoma progression cases with eRGC loss rate is more than that with VFI alone or with average RNFL thickness. There is a strong correlation between the number of RGC corresponding to RGC and the number of RGC corresponding to OCT. The loss rate of eRGC in glaucoma eyes is still higher than that in normal eyes. The eRGC obtained by integrating the structure and functional parameters of glaucoma is a new tool for detecting the progress of glaucoma, which is worthy of further study and clinical application.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R775
【参考文献】
相关期刊论文 前3条
1 吕帆;邓如芝;;视觉功能与眼部相关疾病诊疗——深入探究的必要性[J];中华实验眼科杂志;2015年06期
2 Barkana Y.;Gerber Y.;Mora R.;R.Ritch;王海燕;;检测眼顺序对瑞典交互式阈值运算标准24-2程序检测自动视野的影响[J];世界核心医学期刊文摘.眼科学分册;2006年11期
3 Quigley H.;Broman A.T.;王文军;;2010—2020年世界范围内青光眼患者数量的评估研究[J];世界核心医学期刊文摘.眼科学分册;2006年Z1期
相关硕士学位论文 前1条
1 吴娅莉;视网膜神经节细胞估算值在青光眼评估中的应用研究[D];昆明医科大学;2016年
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