应用海德堡相干光断层扫描仪检测正常国人视网膜神经纤维层厚度

发布时间：2018-05-02 22:49

本文选题：相干光断层扫描仪 + 视网膜神经纤维层厚度　；参考：《河北医科大学》2011年硕士论文

【摘要】：目的:相关光断层扫描仪(Optical Coherence Tomography,OCT)是一种高分辨率,非接触性的生物组织成像技术,依据光学相干原理设计而成,可以起到类似活体组织病理观察的作用,并定量地测量各结构参数和变化。自问世以来已获得广泛的临床应用,其中视网膜神经纤维层(Retinal Nerve Fiber Layer,RNFL)厚度的检测在青光眼早期诊断和随访中具有重要的作用。但是目前国内尚未建立中国人RNFL正常值范围,目前使用的OCT所提供的正常人RNFL厚度的参考值与国人是否有差异还存在争议。此外,对众多影响因素如年龄、性别、眼别、视盘大小等对RNFL厚度的影响还不明确。本研究旨在通过测量正常人RNFL厚度值并与国外相关参考值对照,建立中国人RNFL厚度正常值的参考范围同时探讨可能影响正常人RNFL厚度的因素及其变化规律,以期为青光眼早期诊断的临床工作提供参考。方法: 1研究对象:选择2009年6月至2011年3月在河北医科大学第二医院眼科门诊检查为符合纳入和排除标准的自愿受试者,共172例331眼,8~73岁(平均年龄41.81±1.21岁)正常中国人,其中女性84例(164只眼),男性88例(167只眼)。 2检查方法:所有研究对象均接受病史询问,视力、屈光度、裂隙灯、眼底、眼压及视野检查,符合纳入标准者行OCT检测。 2.1应用海德堡Spectralis OCT,选择RNFL厚度(3.4mm)扫描模式对受试者视网膜进行以视盘为中心3.4mm为直径的环形扫描,利用计算机自带的分析软件图像分析系统分析RNFL厚度值并记录结果,包括9个参数:N,I,T,S,NI,TI,TS,NS,G分别指鼻侧,下方,颞侧,上方,鼻下,颞下,鼻上,颞上象限及全周平均厚度值。 2.2选择光栅线性扫描模式横向及纵向扫描视盘,对视盘横径及竖径进行测量,记录结果包括:视盘横径,视盘竖径。 3统计学方法:采用SPSS13.0统计软件进行分析,各项均数以x±s表示;与国外参考值、不同年龄组、不同性别和眼别间比较采用单样本t检验、方差分析、独立样本t检验等比较方法;年龄、视盘横径和竖径与RNFL厚度的相关性分析采用线性相关与回归分析进行统计学比较。以P0.05为差异具有统计学意义,P0.01为差异具有显著统计学意义。结果: 1正常人RNFL厚度值和视盘横径、竖径分别为:鼻侧75.46±15.20μm,下方139.33±19.02μm,鼻下121.74±24.90μm,颞下157.48±20.76μm,颞侧80.54±12.81μm,颞上146.74±18.81μm,鼻上121.71±23.68μm,上方133.93±17.35μm,全周107.62±10.60μm;视盘横径为1.56±0.17mm,竖径为1.74±0.17mm。 2与国外参考值间的比较:中国人各象限及全周RNFL厚度值均显著高于国外参考值(P0.01)。 3不同年龄间的比较:各年龄组间除N、T、NS三个象限,其余象限I、NI、TI、TS、S五个象限及全周G平均RNFL厚度值均有差别(P0.05)。在这五个象限和全周平均RNFL厚度值中,6个年龄组的曲线图除NI象限外,其余均呈以21~30岁组和41~50岁组为高点≤20岁组、31~40岁组和61~73岁组值为低点的“M”形,其中又以≤20岁组和61~73组值较低。 4不同性别间的比较:颞侧T平均RNFL厚度值女性高于男性(P0.05),其余象限和全周平均RNFL厚度值均无差别(P0.05)。 5不同眼别间的比较:鼻上NS和上方S平均RNFL厚度值左眼高于右眼(P0.05),其余象限和全周平均RNFL厚度值均无差别(P0.05)。 6年龄与RNFL厚度的相关性分析:颞上TS和颞下TI象限平均RNFL厚度与年龄成负相关(r=0.137,P=0.012和r=0.145,P=0.008),其余象限和全周平均RNFL厚度值与年龄未发现线性相关。 7 RNFL厚度与视盘横径和竖径的相关性分析:鼻侧N、下方I、颞侧T、上方S四个象限与视盘横径均呈正相关(P0.05),相关系数分别为0.215,0.158,0.252,0.189。除鼻侧N象限外(P0.05),下方I、颞侧T、上方S三个象限与视盘竖径均呈正相关(P0.05),相关系数分别为0.214,0.117,0.240。结论: 1正常人视网膜神经纤维层扫描曲线呈双峰形,以鼻侧N和颞侧T较薄,上方S和下方I较厚,其中以颞上TS和颞下TI最厚。正常国人各象限及全周RNFL平均厚度参考值见表1。 2正常人RNFL厚度主要受种族、年龄、及视盘横径和竖径的影响,性别和眼别对RNFL厚度的影响很小。
[Abstract]:Objective: Optical Coherence Tomography (OCT) is a high resolution, non-contact biological tissue imaging technique designed according to the principle of optical coherence. It can play a role similar to the pathological observation of the living tissue and measure the parameters and changes of each structure. The detection of the thickness of the retinal nerve fiber layer (Retinal Nerve Fiber Layer (RNFL)) plays an important role in the early diagnosis and follow-up of glaucoma. However, the normal range of the normal value of the Chinese people's RNFL has not been established at home. There is a dispute between the reference value of the normal human RNFL thickness provided by the current OCT and whether there is a difference between the people of RNFL and the people. In addition, the influence of many factors such as age, sex, eye and disc size on the thickness of RNFL is not clear. This study aims to establish the reference range of the normal value of the Chinese people's RNFL thickness by measuring the RNFL thickness of normal people and comparing with the relevant reference values abroad. In order to provide reference for the early diagnosis of glaucoma.
Method:
1 subjects: selected volunteers in the ophthalmology outpatient department of the second hospital of Hebei Medical University from June 2009 to March 2011, 172 cases, 331 eyes, and 8~73 years (average age 41.81 + 1.21 years) were normal Chinese, including 84 women (164 eyes) and 88 men (167 eyes).
2 method of examination: all the subjects were examined by medical history, visual acuity, diopter, slit lamp, fundus, intraocular pressure and visual field examination. The patients met the inclusion criteria were tested by OCT.
2.1 Spectralis OCT in Heidelberg was used to select the RNFL thickness (3.4mm) scan mode for the retina of the subjects to scan the diameter of the retina with the center of the disc as the center, and to analyze the RNFL thickness value and record the results by the computer analysis software image analysis system, including the 9 parameters: N, I, T, S, NI, TI, temporal side, respectively. Above, under nasal, temporal, nasal, upper temporal quadrant and whole week mean thickness.
2.2 choose grating linear scanning mode to scan horizontally and vertically, and measure the transverse diameter and vertical diameter of the optic disc. The results include: the transverse diameter of the optic disc and the vertical diameter of the optic disc.
3 statistical method: using SPSS13.0 statistical software to analyze, each of them was represented by X + s; compared with foreign reference values, different age groups, different sex and eyes, comparison of single sample t test, variance analysis, independent sample t test and so on; age, the correlation analysis of the transverse diameter and vertical diameter of the optic disc and the thickness of RNFL is linear correlation and Regression analysis was used for statistical comparison. The difference between P0.05 and P0.01 was statistically significant.
Result:
1 the thickness of RNFL and the transverse diameter of the optic disc were 75.46 + 15.20 mu m in the nasal side, 139.33 + 19.02 m below the nose, 121.74 + 24.90 in the nose, 80.54 + and 12.81 m in the temporalateral, 146.74 + 19.02 m on the temporal side, 15.20 of the temporomandibular 15.20 mu m. 74 + 0.17mm.
2 comparison with foreign reference values: Chinese quadrant and full week RNFL thickness values are significantly higher than foreign reference values (P0.01).
3 the comparison between different age groups: except N, T, NS three quadrants, the rest quadrant I, NI, TI, TS, S, five quadrants and all week G average RNFL thickness values are different (P0.05). In these five quadrants and all Zhou Pingjun RNFL thickness values, the 6 age groups, except for the age group and the age group, are higher than 20 years old. The 31~40 year old group and the 61~73 year old group were low value "M" shape, and the values of the group aged less than 20 years and the 61~73 group were lower.
4 Comparison between different sexes: the mean RNFL thickness of the temporal T was higher in females than in males (P0.05), but there was no difference in the other quadrants and the mean RNFL thickness of the whole week (P0.05).
5 Comparison of different eyes: the average RNFL thickness of the upper nasal NS and the upper S was higher in the left eye than in the right eye (P0.05), and there was no difference in the other quadrants and the mean RNFL thickness of the whole week (P0.05).
The correlation analysis of 6 age and RNFL thickness: the average RNFL thickness of the temporal TS and the infratemporal TI quadrant was negatively correlated with age (r=0.137, P=0.012 and r=0.145, P=0.008), and the rest quadrant and the total weekly mean RNFL thickness was not linearly correlated with age.
The correlation between 7 RNFL thickness and the transverse diameter and vertical diameter of the optic disc: the nasal N, the lower I, the temporal T, the S four quadrants above the disc transverse diameter were positively correlated (P0.05), the correlation coefficient was 0.215,0.158,0.252,0.189. except the nasal N quadrant (P0.05), the lower I, the temporal T, and the three quadrants above the optic disc were positively correlated with the optic disc vertical diameter. For 0.214,0.117,0.240.
Conclusion:
The retinal nerve fiber layer scanning curve of 1 normal people was Shuangfeng shaped, with the thinner T in the N and the temporal side of the nasal side, the thicker S and lower I above, and the thickest of TS and infratemporal TI. The reference values of the normal people's quadrants and the whole week RNFL mean thickness were shown in table 1..
2 the thickness of RNFL in normal subjects was mainly affected by race, age, transverse diameter and vertical diameter of optic disc, and gender and eye had little effect on RNFL thickness.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R775

【参考文献】