全景激光扫描眼底照相在糖尿病视网膜病变筛查中的作用

发布时间：2018-01-04 20:20

  本文关键词：全景激光扫描眼底照相在糖尿病视网膜病变筛查中的作用　出处：《安徽医科大学》2014年硕士论文　论文类型：学位论文

  更多相关文章： 糖尿病视网膜病变筛查 全景激光扫描眼底照相

【摘要】：目的：探讨全景激光扫描眼底照相(Optomap)作为筛查糖尿病视网膜病变(diabetic retinopathy,DR)方法的可行性。 方法：前瞻性临床病例研究,研究对象为经我院糖尿病中心确诊的1型和2型糖尿病并参加视网膜病变筛查的患者,共75例患者,141只眼。所有的病例均进行全景激光扫描免散瞳眼底照相和七方位散瞳眼底照相,观察各种糖尿病视网膜病变眼底阳性表现敏感性,特异性。以糖尿病视网膜病变国际分期及国内分期为标准比较全景激光扫描眼底照相筛查糖尿病视网膜病变的敏感性,特异性,以及与七方位眼底照相检查的一致性。以黄斑出血和渗出性病变为指标评价全景激光扫描眼底照相筛查糖尿病性黄斑病变的敏感性和特异性。 结果：各种糖尿病视网膜病变眼底阳性表现敏感性,特异性以及与七方位散瞳眼底照相一致性如下：微血管瘤的敏感性为51.2%,特异性为48.3%,一致性为k=0.536,视网膜出血的敏感性为91.8%,特异性为95.6%,一致性为k=0.901,硬性渗出的敏感性为85.3%,特异性为87.9%,一致性为k=0.864,棉绒斑的敏感性为85.7%,特异性为87.5%,一致性为k=0.852,新生血管的敏感性为72.1%,特异性为76.9%,一致性为k=0.745,玻璃体积血的敏感性为64.2%,特异性为70.0%,一致性为k=0.658,微血管异常的敏感性为43.0%,特异性为46.5%,一致性为k=0.456,静脉串珠的敏感性为47.7%,特异性为49.8%,一致性为k=0.485。以国际糖尿病视网膜病变分期为标准,以轻度非增殖性糖尿病视网膜病变为阈值时,全景激光扫描眼底照相诊断的敏感性为73.45%,特异性为75.01%,阳性预测值为0.772,阴性预测值为0.738,一致性为0.625。以中度非增殖性糖尿病视网膜病变为阈值,全景激光扫描眼底照相的敏感性为94.85%,特异性为98.82%,阳性预测值为0.865,阴性预测值为0.905,一致性为0.912。以重度非增殖性糖尿病视网膜病变为阈值,全景激光扫描眼底照相的敏感性为70.65%,特异性为79.78%,阳性预测值为0.714,阴性预测值为0.730,一致性为0.772。以糖尿病视网膜病变国内分期为标准时,全景激光扫描眼底照相诊断Ⅰ期糖尿病视网膜病变的敏感性为51.2%,特异性为48.3%,一致性为k=0.536；Ⅱ期病变的敏感性为91.8%,特异性为95.6%,一致性为k=0.901,Ⅲ期及以上病变的敏感性为69.5%,特异性为72.8%,一致性为71.5%。全景激光扫描眼底照相筛查黄斑区出血和黄斑渗出性病变的敏感性和特异性分别为0.782,0.875和0.754,0.862。 结论：全景激光扫描眼底照相对中度NPDR以上的糖尿病视网膜病变及黄斑病变具有良好的敏感性和特异性,可作为一种门诊免散瞳眼底照相筛查糖尿病视网膜病变的可靠方法。
[Abstract]:Objective: to investigate the feasibility of panoramic laser scanning fundus photography (Optomapa) as a screening method for diabetic retinopathy (DM). Methods: a prospective clinical study of 75 patients with type 1 and type 2 diabetes mellitus and retinopathy screening was carried out in our hospital. 141 eyes. All the patients underwent panoramic laser scanning without pupil radiography and seven directions pupil fundus radiography to observe the sensitivity of all kinds of diabetic retinopathy fundus positive. To compare the sensitivity and specificity of panoramic laser scanning fundus photography in screening diabetic retinopathy according to the international and domestic stages of diabetic retinopathy. The sensitivity and specificity of panoramic laser scanning fundus photography for the screening of diabetic macular lesions were evaluated with macular hemorrhage and exudative lesions. Results: the sensitivity, specificity and consistency with the radiography of the eye fundus of all kinds of diabetic retinopathy were as follows: the sensitivity of microangioma was 51.2 and the specificity was 48.3%. The consistency was 0.536, the sensitivity of retinal hemorrhage was 91.8, the specificity was 95.60.901, the sensitivity of rigid exudation was 85.3%. The specificity was 87.9, the consistency was 0.864, the sensitivity was 85.7, the specificity was 87.5, and the consistency was 0.852. The sensitivity of neovascularization was 72.1%, the specificity was 76.9, the consistency was 0.745, the sensitivity of vitreous volume blood was 64.2 and the specificity was 70.0%. The consistency was 0.658, the sensitivity of microvascular abnormality was 43.0, the specificity was 46.5, the consistency was 0.456, the sensitivity of intravenous beads was 47.7%. The specificity was 49.8 and the consistency was 0.485.When the international stage of diabetic retinopathy was taken as the standard and the threshold value was mild nonproliferative diabetic retinopathy. The sensitivity, specificity, positive predictive value and negative predictive value of panoramic laser scanning fundus photography were 73.45, 75.01, 0.772 and 0.738, respectively. The consistency was 0.625.The sensitivity of panoramic laser scanning was 94.85 and the specificity was 98.82% with moderate nonproliferative diabetic retinopathy as the threshold. The positive predictive value was 0.865, the negative predictive value was 0.905, the consistency was 0.912. The threshold value was severe non-proliferative diabetic retinopathy. The sensitivity, specificity, positive predictive value and negative predictive value of panoramic laser scanning fundus photography were 70.65, 79.78, 0.714 and 0.730, respectively. The consistency was 0.772.The sensitivity of panoramic laser scanning fundus photography for the diagnosis of stage I diabetic retinopathy was 51.2% when the domestic stage of diabetic retinopathy was taken as the standard. The specificity was 48.3 and the consistency was 0.536; The sensitivity of stage 鈪，

本文编号：1379947