联合多种检查方法客观评定视野缺损的法医学研究

发布时间：2018-05-27 12:16

本文选题：法医学 + 自动视野仪　；参考：《中国政法大学》2017年硕士论文

【摘要】：目的:本研究围绕着视野的客观评估,结合司法鉴定标准,展开了对于自动视野仪、模式翻转视觉诱发电位(PR-VEP)和视网膜神经纤维层(RNFL)厚度三种技术的分别研究,以探索视野客观评估的方法学路径。对象与方法:本研究采集60眼别,配合良好的青年受试者,进行2次自动视野仪的正常及模拟缺损检查,对2次测试结果进行配对T检验及ICC检验,并对判别为不可信的案例进行统计;PR-VEP采集常规位点的正常组、模拟1/4视野缺损组、模拟1/2视野缺损组的数据,进行配对T检验,后采集左右旁开2cm位点的数据,进行配对T检验,并对MD与振幅进行秩相关、回归分析。采集52眼别某医院明确诊断的外伤视神经病变所致视野缺损病历,进行RNFL与视野缺损指标的相关性及回归分析研究。结果:(1)自动视野仪PSD的ICC为98.9%,MD的ICC为95.5%,其他指标的ICC都小于60%,重复测试后,仅假阴性率的多次检测结果间的差异具有统计学意义,其自带的可信性评估系统,不能完全识别出伪装。(2)PR-VEP进行检测,正常人组的振幅1/4视野缺损组的振幅1/2视野缺损组的振幅,视野缺损达到1/4即可出现波形的异常,视野缺损达到1/2时,振幅明显低平,波形可以呈现反向波、w型波等。同时采集左右旁开处VEP数据:两处波形明显不同,差异具有统计学意义,左旁开的振幅右旁开的振幅,60’PR-VEP测得的N75-P100振幅与自动视野仪平均偏差的相关性为R=0.471(P=0.000)。(3)平均RNFL厚度(X)与视野有效值(Y)呈显著正相关R=0.543(P=0.000),相关回归方程为Y=-93.795+5.208X-0.037X2(R=0.691,P=0.000),与MD呈中度负相关R=-0.450(P=0.001),与LV呈中度负相关R=-0.440(P=0.001),与MS呈中度正相关R=0.400(P=0.003)。按照《人体损伤程度鉴定标准》规定,对平均RNFL厚度进行分组,通过方差分析,重伤组与轻伤组有极显著差异性,重伤组与轻微伤组有极显著差异性,轻伤组与轻微伤组有显著差异。结论:自动视野仪可以作为主观的功能性手段,结合视觉通路的特点,辅助鉴别伪装,而视觉电生理作为客观的定性手段,一定程度上也可以实现视野缺损的半定量和定位,RNFL厚度可以作为形态学手段,在司法鉴定中,定位并半定量地判别视野缺损的程度。多种手段联合使用,具有客观评估视野缺损程度的功能,可应用于《人体损伤程度鉴定标准》相关条款中。
[Abstract]:Objective: this study focused on the objective evaluation of visual field, combined with the standard of forensic identification, and carried out a study of the thickness of automatic visual field instrument, pattern reversal visual evoked potential (PR-VEP) and retinal nerve fiber layer (RNFL), respectively. In order to explore the perspective of objective assessment of the methodological path. Objects and methods: in this study, 60 eyes were collected and matched with good young subjects. The normal and simulated defects were examined twice by automatic visual field meter. The results of two tests were matched T test and ICC test. The normal group of normal loci were collected by PR-VEP, the data of 1 / 4 visual field defect group and 1 / 2 visual field defect group were simulated, then matched T test was performed, and the data of left and right 2cm sites were collected. Matched T test was performed, and rank correlation and regression analysis of MD and amplitude were carried out. Cases of visual field defect caused by traumatic optic neuropathy were collected in 52 eyes of a hospital. The correlation between RNFL and visual field defect index and regression analysis were studied. Results the ICC of PSD was 98.9 and the ICC of other indexes was 95.50.After repeated tests, the difference between the results of multiple tests with only false negative rate was statistically significant. The amplitude of the 1 / 4 visual field defect group in the normal group was 1 / 2 of the amplitude of the visual field defect group, and the abnormal waveform could be seen when the visual field defect reached 1 / 4. When the visual field defect reached 1 / 2, the amplitude was obviously low. The waveforms can be reversed waves and so on. At the same time, the VEP data were collected at the left and right side: the two waveforms were obviously different, and the difference was statistically significant. The correlation between the mean deviation of N75-P100 amplitude and the mean deviation of automatic visual field instrument is R = 0.471g / r 0.0000.000) the correlation between the mean RNFL thickness (X) and the effective value of visual field (Y) is significant positive correlation, and the correlation equation is: Y-93.795 5.20X-0.037X _ 2 ~ (0.691N) P _ (0.000), and the correlation equation is: Y-93.795 5.20X-0.037X _ 2 ~ (0.691N) P _ (0.000N), and the correlation equation is: r ~ (0.43) P ~ (0.000) (r _ 0. 795 ~ 5.20X-0.037X _ 2 ~ + _ 0. There was a negative correlation between RV and LV, a moderate negative correlation with LV, and a moderate positive correlation with MS, and a moderate positive correlation with MS. According to the Standard for the Identification of Human injury degree, the average thickness of RNFL was divided into two groups. By ANOVA, there were significant differences between severe injury group and mild injury group, and significant difference between severe injury group and mild injury group. There was significant difference between mild injury group and slight injury group. Conclusion: the automatic visual field instrument can be used as a subjective functional means, combined with the characteristics of the visual pathway to assist the identification of camouflage, and visual electrophysiology as an objective qualitative means. The thickness of RNFL can also be used as a morphological means to determine the degree of visual field defect in judicial identification. It has the function of objectively evaluating the degree of visual field defect and can be used in the relevant articles of the Standard for the Identification of Human injury degree.
【学位授予单位】：中国政法大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：D919

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