本文關鍵詞： 原發(fā)性青光眼 視野 青光眼進展分析　出處：《昆明醫(yī)科大學》2012年碩士論文　論文類型：學位論文

【摘要】：目的通過比較傳統(tǒng)臨床方法和Humphrey視野計的青光眼進展分析(Glaucoma Progression Analysis, GPA)對青光眼視野進展的判別,研究GPA判斷原發(fā)性青光眼視野進展的作用,幫助臨床上對病情變化的判斷,做出合理治療方案。 方法回顧性研究原發(fā)性青光眼患者24例(39只眼),以Humphrey視野計進行視野檢查,每只眼2年以內(nèi)都有至少5次可靠的隨訪視野結(jié)果。利用Humphrey視野計的單視野檢測結(jié)果的總體偏差概率圖和模式偏差概率圖,參照臨床判斷標準,進行臨床判斷視野有無改變；利用Humphrey視野計自帶的青光眼進展分析軟件(GPA)進行分析,判斷視野有無改變。兩種方法將視野結(jié)果分為“進展”和“無進展”；臨床判斷和GPA方法判斷為“視野進展”,都至少需要兩次連續(xù)隨訪視野結(jié)果與基線視野結(jié)果對比均顯示出進展。使用卡方檢驗分析兩種方法對青光眼視野進展判斷結(jié)果的差異。GPA對患者序列視野結(jié)果視野指數(shù)(Visual Field Index, VFI)進行回歸分析計算出青光眼進展率。把臨床方法作為參考標準,計算GPA的篩查診斷指標,評估GPA的作用。 結(jié)果24例患者39只眼中,臨床方法判斷為“進展”17只眼(43.6%),“無進展”22只眼(56.4%)；GPA判斷為“進展”4只眼(10.3%),“無進展”35只眼(89.7%)。21只眼(53.8%)兩種方法均判斷為“無進展”；3只眼(7.7%)兩種方法均判斷出“進展”�？ǚ綑z驗分析兩種方法判斷結(jié)果的差異性分析,兩種方法無統(tǒng)計學差異(P=0.181),判斷視野是否進展的效果一致。臨床方法分別使用2、3次連續(xù)隨訪視野結(jié)果進行青光眼進展判斷時存有差異(P=0.000)。GPA分別使用2、3次連續(xù)隨訪視野結(jié)果進展青光眼進展判斷時沒有差異(P=0.544)。臨床方法和GPA兩種方法分別使用2次連續(xù)隨訪視野進行青光眼進展判斷沒有差異(P=I.000)；同樣,兩種方法使用3次連續(xù)隨訪視野進行青光眼進展判斷也沒有差異(P=0.784)。臨床方法使用總體偏差概率圖和模式偏差概率圖進行青光眼進展判斷時存在差異(P=0.017)。把臨床方法作為標準,計算GPA法的篩查診斷效果指標,靈敏度35%,特異度40%,陽性預測值82.35%,陰性預測值4.55%,陽性似然比0.583,陰性似然比0.125,Youden指數(shù)—0.25。 結(jié)論GPA和客觀臨床方法在判斷青光眼進展上有明顯的相關性。兩種方法判斷青光眼的進展效果一致。GPA對判斷青光眼視野進展有較高的特異性、陽性率以及敏感性。
[Abstract]:Objective to study the role of GPA in judging the progression of primary glaucoma by comparing the traditional clinical methods with that of Humphrey Progression analysis. Make a reasonable treatment plan. Methods Twenty-four patients with primary glaucoma and 39 eyes with primary glaucoma were studied retrospectively. The visual field was examined with Humphrey visual field meter. There were at least 5 reliable visual field results in each eye within 2 years. The overall deviation probability diagram and the pattern deviation probability diagram of the single field test result of Humphrey visual field meter were used to judge whether the visual field had changed or not according to the clinical judgment standard. The glaucoma progression analysis software of Humphrey visual field meter was used to analyze the progress of glaucoma. Two methods classify the visual field results as "progress" and "no progress", and the clinical judgment and GPA method are "visual field progress", both need at least two consecutive follow-up visual field results and baseline visual field results. Using chi-square test to analyze the difference between the two methods in judging the progress of glaucoma visual field. GPA-regression analysis of visual Field index (visual Field index, VFI) of patients with sequential visual field results was used to calculate the rate of glaucoma progression. Clinical methods as a reference standard, The screening diagnostic index of GPA was calculated and the role of GPA was evaluated. Results 39 eyes of 24 patients, The clinical methods were "progress" in 17 eyes, "no progress" in 22 eyes and GPA as "progress" in 4 eyes, and "no progress" in 35 eyes. The difference analysis of the results of the two methods of square test analysis, There was no statistical difference between the two methods and there was no statistical difference between the two methods. There was no statistical difference between the two methods in judging the progression of glaucoma. There was no difference between the two methods in judging the progress of glaucoma by using the results of 2 consecutive visual fields followed up for 2 consecutive times. GPA was used for 2 or 3 consecutive follow-up visual fields. Results there was no difference in judging the progression of advanced glaucoma. There was no difference between clinical method and GPA method in judging the progression of glaucoma with two consecutive follow-up visual fields. There was no difference between the two methods in judging the progress of glaucoma by using three consecutive follow-up visual fields. There was a difference between the two methods in judging the progress of glaucoma by using the total deviation probability chart and the pattern deviation probability chart. The clinical method was regarded as the standard. The sensitivity was 35%, specificity was 40%, positive predictive value was 82.35, negative predictive value was 4.55, positive likelihood ratio was 0.583, negative likelihood ratio was 0.125 and Youden index was 0.25. Conclusion there is a significant correlation between GPA and objective clinical methods in judging the progression of glaucoma, and the two methods have the same effect in judging the progression of glaucoma. GPA-GPA has a high specificity, positive rate and sensitivity in judging the progression of glaucoma visual field.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R775

【共引文獻】

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