HRT在青光眼早期诊断中的作用.ppt

HRT在青光眼早期诊断中的作用 前言前言+青光眼防止的关键在于在其诊断+青光眼的诊断标准眼压、视野 和视神经分析+视神经分析的重要性前言前言+视神经分析的目的 早期诊断 视神经监测 疗效的评价 HRT 简介 吴春之视野正常材料与方法（一）材料与方法（一）正常人102例132只眼，其中30例行双眼检测 青光眼117例128只眼青光眼分期：早期：MD5dB,中期：5dB10dB材料和方法（二）采用SPSS 10.0统计软件包，行t检验、方差分析、相关和回归分析 材料和方法（三）统计学方法 结 果一一、正常人视盘参数和影响因素正常人视盘参数和影响因素正常人视盘参数和影响因素正常人视盘参数和影响因素 1、正常人视盘参数 A.正常人左右眼间视盘各参数差异无 显著性意义（p0.05）B.男女间视盘各参数差异无显著性意义 （p0.05）Table 1 Morphometric optic disc variables measured by HRT Average and 95%confidece Standard Deviation Range bandsdisc area 2.2 0.30 1.573.43 1.612.79cup area 0.550.12 0.131.22 0.310.79rim area 1.670.21 1.162.22 1.242.06cup/disc area 0.240.07 0.070.42 0.100.38rim/disc area 0.760.07 0.580.93 0.620.90cup volume 0.120.08 0.010.64 0.010.28 rim volume 0.510.12 0.230.79 0.270.75mean cup depth 0.270.07 0.100.56 0.130.41max cup depth 0.690.16 0.351.2 0.381.00 cup shap measure -0.190.06 -0.310.05 -0.25-0.13 RNFL thickness 0.310.06 0.180.44 0.190.43RNFL area 1.620.34 0.922.24 0.952.29Horizontal C/D 0.500.12 0.020.73 0.260.74Vertical C/D 0.350.16 0.000.63 0.040.612.年龄对视盘参数的影响：年龄与RNFL厚度呈负相关 （r=-0.234,p=0.04）年龄与RNFL横截面积呈负相关 （r=-0.235,p=0.04)其余各参数与年龄无关 年龄年龄视网膜神经纤维层面积视网膜神经纤维层厚度3视盘大小对视盘参数的影响 r p r 2 Equation of the Regression linecup area 0.730 0.000 0.592 Y=0.529X-0.623rim area 0.689 0.000 0.475 Y=0.472X+0.623cup volume 0.525 0.000 0.276 Y=0.165X-0.248rim volume 0.199 0.089mean cup depth 0.355 0.002 0.126 Y=0.107Xmaximum cup depth 0.191 0.104cup shap measure 0.310 0.007 0.096 Y=0.061X-0.326mean RNFL thickness -0.254 0.025 0.084 Y=-0.162X+0.761RNFL cross section area 0.281 0.015 0.079 Y=0.323X+0.898horizontal C/D 0.360 0.002 0.949 Y=0.224X vertical C/D 0.360 0.002 0.847 Y=0.159X X=disc area盘沿面积视杯面积Y=0.472X+0.623 r2=0.475 Y=0.529-0.623 r2=0.592平均杯深视网膜神经纤维层面积Y=0.323X+0.761 r2=0.079Y=0.107X r2=0.126视杯容积垂直C/D水平C/D视杯形态Y=0.165X-0.248 r2=0.267 Y=195X r2=0.847 Y=0.244X r2=0.949Y=0.061X-0.326 r2=0.096Y=视网膜神经纤维层厚度Y=-0.162X+0.761 r2=0.0844.不同部位视网膜神经纤维层厚度和面积比较 RNFL厚度 RNFL面积 颞侧 0.10550.028 0.1340.036 鼻侧 0.35640.089 0.4520.118下方 0.74380.090 0.49040.061上方 0.75610.080 0.51080.058 上方,下方鼻侧颞侧二、正常人组与青光眼组HRT视盘参数比较早期青光眼组视杯面积、容积和C/D明显增大（p=0.000）盘沿面积、容积、视网膜神经纤维层厚度和横 截面积明显减少（p=0.000）视杯加深及视杯形态的不同二者具有显著性差异（p=0.000）normal early glaucoma t p disc area 2.280.33 2.330.38 1.418 0.158 cup area 0.530.23 1.190.61 8.635 0.000 rim area 1.660.21 1.380.38 10.827 0.000 cup/disc area ratio 0.230.08 0.480.13 12.040 0.000 rim/disc area 0.770.08 0.520.13 12.040 0.000 cup volume 0.110.09 0.310.18 7.177 0.000 rim volume 0.510.12 0.300.19 11.158 0.000 mean cup depth 0.230.07 0.350.10 7.381 0.000 maximum cup depth 0.670.17 0.770.26 3.720 0.000 cup shap measure -0.200.06 -0.080.07 9.875 0.000 mean RNFL thickness 0.310.06 0.210.04 5.557 0.000 RNFL cross section area 1.610.34 1.220.41 5.510 0.000 Horizontal C/D 0.490.13 0.670.21 8.522 0.000 Vertical C/D 0.340.17 0.630.22 10.454 0.000 Early stage Advanced stage Late stage F pdisc area 2.330.38 2.430.43 2.430.52 1.83 0.124cup area 1.190.61 1.310.52 1.580.51 37.31 0.000rim area 1.380.38 1.110.55 0.850.39 37.24 0.000C/D area ratio 0.480.13 0.550.15 0.660.15 69.50 0.000rim/disc area 0.520.13 0.450.15 0.340.15 69.50 0.000cup volume 0.310.18 0.410.31 0.510.34 18.44 0.000 rim volume 0.300.19 0.270.13 0.170.10 48.08 0.000mean cup depth 0.350.10 0.360.10 0.360.14 17.52 0.000max cup depth 0.770.26 0.770.23 0.830.22 6.06 0.000cup shape -0.080.07 -0.060.07 -0.0410.06 38.23 0.000RNFL thickness 0.210.04 0.190.03 0.120.03 24.20 0.000RNFL cross area 1.220.41 0.970.38 0.660.24 37.94 0.000 Horizontal C/D 0.670.21 0.770.13 0.810.14 37.94 0.000Vertical C/D 0.630.22 0.730.14 0.820.12 62.77 0.000 三、视野平均缺损与视盘参数的相关关系 r p r2 Equation of the Regssion line cup area 0.283 0.008*0.078 Y=3.236X+4.01 rim area -0.263 0.013*-0.270 Y=-3.914X+12.532cup volume 0.108 0.315 rim volume -0.428 0.000*0.183 Y=-20.078X+10.284cup shape 0.136 0.206 RNFL thickness -0.494 0.001*0.224 Y=-31.429X+11.562 RNFL area -0.339 0.001*0.112 Y=-3.422X+11.565Horizontal C/D 0.289 0.006*0.645 Y=11.263X Vertical C/D 0.438 0.000*0.192 Y=19.768 视野平均缺损视野平均缺损视野平均缺损盘沿体积盘沿面积视杯面积Y=-20.078X+10.284 r2=0.183Y=-3.914X+12.532 r2=0.270视野平均缺损Y=-3.422X+11.565 r2=0.112视网膜神经纤维层厚度视野平均缺损Y=-31.429X+11.562 r2=0.224视网膜神经纤维层厚度视野平均缺损Y=-31.429X+11.562 r2=0.224RNFL面积视网膜神经纤维层面积垂直C/D水平C/D视野平均缺损视野平均缺损Y=11.263X r2=0.645Y=19.768X r2=0.192视杯面积Y=3.24X+4.01通过逐步判别分析，筛选出盘沿体积和杯形态2个变量对鉴别早青贡献最大，结果如下：102只正常眼中判断正常的有95只眼,判断异常的有7只眼；特异性为94.2%；假阳性率为6.8%67只青光眼中判断异常的有56只眼 判断正常的有11只眼；敏感性为83.6%；假阴性率为16.4%四、早期青光眼HRT视盘参数判别分析结果 Table 7 Sensitivity and specificity of HRT shape characteristics inROC（receiver operating characteristics）analysis Sensitivity specificity ROC area Disc area 54.3 54.4 0.554 Cup area 57.6 91.2 0.850 Cup/disc area ratio 78.1 94.1 0.890 Rim area 78.8 89.7 0.863 Cup volume 57.6 94.1 0.775 Rim volume 81.8 85.3 0.889 Mean cup depth 63.6 80.9 0.775 Maximum cup depth 61.2 82.6 0.747 Cup shape measure 81.8 82.4 0.889 RNFL thickness 63.6 80.9 0.774 RNFL area 63.6 66.2 0.741 Horizontal C/D 72.7 77.9 0.800 Vertical C/D 81.8 80.9 0.860 视杯形态 ROC=0.889盘沿体积ROC=0.887C/D面积ROC=0.890ROC=0.860垂直C/D 讨 论(一)一、正常人视盘HRT参数的变异及其影响因素 正常人视盘大小有很大的变异 年龄对视盘参数的影响 屈光对视盘参数的影响 视盘大小对视盘参数的影响*眼别对视盘参数的影响 讨 论(二)二、HRT视盘参数检测用于青光眼诊断的敏感性和特异性 POAG患者与正常人视盘参数有显著性差异 POAG 患者早期、进展期和晚期视盘参数有 显著性差异 早期POAG的敏感性和特异性 A.本组资料:盘沿体积和视杯形态:敏感性83.6%，特 异性94.2%B.Bathija(无视野缺损)敏感性62%,特异性96%Mikelberg 敏感性87%，特异性88%wollstein(早)敏感性84%，特异性93%Uchida 盘沿面积敏感性84.3%，特异性96.3%C.ROC曲线 Iester 视杯形态：0.81 盘沿面积：0.81 C/D面积：0.80 盘沿容积：0.77本组资料：视杯形态：0.889 盘沿面积：0.863 C/D面积：0.89 盘沿容积：0.887 垂直C/D：0.86 讨 论(三)三、视盘参数与视野 MD与盘沿容积、RNFL厚度、垂直C/D相关较好 Toie（1998）：MD与盘沿容积、视杯形态和RNFL厚 度及RNFL横截面积相关显著 Lester（1998）：视野指数与视盘参数相关好的部位在上下方，相关性最好的在上下极盘沿丢失与视野缺损的一致性（图）视野损害较轻或无损害，视神经损害严重（图）赵刚 一致性苏淑珍视野早视神经晚吴春之视野正常